OA01.6. Reshaping Esophageal Cancer N Staging With a Target-Ring Burden Framework: A Multicenter Retrospective Study

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ID: 325977
2026
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Ranked #106 of 453 articles by views in diseases of the esophagus : official journal of the international society for diseases of the esophagus

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Abstract
Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Given the limited integration of nodal count and spatial distribution in current esophageal cancer N staging, we sought to develop and validate a newN staging system that incorporates both dimensions. Methods We used prospectively maintained, retrospective databases from three centers (2008–2022). The primary endpoint was overall survival (OS). We constructed a Target–Ring Burden framework by computing Spearman correlations from station-involvement proportions across primary-tumor locations, mapping stations via multidimensional scaling to a 0–5 radial distance, then discretizing this distance into rings 0–3 and flagging cross-compartment spread (cervical, thoracic, abdominal). At the patient level, nodal burden, maximal ring distance, and cross-compartment indicators were aggregated; a Cox model generated a risk score, and survival-driven cut points were applied to classify N+ cases into newN (N1–N3; N0 defined as no nodal metastasis). Discrimination was evaluated using Kaplan–Meier with log-rank, Cox, and time-dependent ROC at 12/36/60 months. Results We analyzed 5,261 consecutive patients. Overall distribution was N0 2,976 (56.6%); by AJCC, N1 1,418 (27.0%), N2 688 (13.1%), N3 179 (3.4%); by newN, N1 1,338 (25.4%), N2 596 (11.3%), N3 351 (6.7%). Regarding risk gradients (multivariable Cox, vs N0), hazard ratios for AJCC N1/N2/N3 were 1.52/2.05/1.90, whereas for newN they were 1.50/1.93/2.25 (all P <0.05), showing a more orderly stepwise pattern with a more pronounced highest-risk group. In multivariable Cox models restricted to N+ patients, time-dependent AUC at 12/36/60 months were 0.642/0.681/0.698 for AJCC and 0.652/0.690/0.708 for newN. Conclusion In this multicenter cohort, the newN staging that integrates nodal count and spatial spread outperformed the current N staging, with clearer survival gradients and higher time-dependent AUC at 12/36/60 months. It also identified poorer-prognosis subgroups within current N1–N2, supporting incorporation of both nodal burden and anatomic/cross-compartment information into clinical stratification and postoperative decision-making.
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Authors Ruichen Cui, Xiang Li, Shenglu Lian, Yushang Yang, L. Chen
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.011
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.011/70760219/doag077.011.pdf
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