ArticleBMC cancer2026
Spatial nodal pattern refines disease-free survival stratification beyond pathological N stage in resected esophageal squamous cell carcinoma.
Article in BMC cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLymph node metastasis is a major determinant of recurrence in esophageal squamous cell carcinoma (ESCC), but conventional pathological N staging is based mainly on positive-node counts and may not capture the anatomical heterogeneity of nodal spread. We developed and evaluated a station-level Spatial-N classification for postoperative 3-year disease-free survival (DFS) stratification in resected ESCC.
methodsWe retrospectively analyzed 1,276 patients with pathologically confirmed ESCC who underwent upfront curative-intent esophagectomy between January 2019 and December 2024. Spatial-N pattern was assigned hierarchically using station-level pathological nodal mapping: Pattern 0, N0; Pattern 1, single-region metastasis; Pattern 2, recurrent laryngeal nerve (RLN)-chain high-risk station involvement, defined as 106recR and/or 106recL positivity without cross-region metastasis; and Pattern 3, cross-region metastasis. DFS was analyzed within a prespecified 36-month framework using Kaplan-Meier analysis and Cox regression. Predictive performance was compared among the 8th AJCC pathological N stage model, the Spatial-N model, and an integrated Spatial-N model incorporating Spatial-N pattern, pathological T stage, lymphovascular invasion, and adjuvant therapy.
resultsAmong 1,276 patients, 745 (58.4%), 250 (19.6%), 180 (14.1%), and 101 (7.9%) were classified as Patterns 0, 1, 2, and 3, respectively. Spatial-N pattern significantly stratified 3-year DFS in the overall cohort and within the pN1 subgroup. In multivariable analysis, Spatial-N pattern remained independently associated with DFS, with adjusted hazard ratios of 3.14, 7.15, and 10.25 for Patterns 1, 2, and 3 versus Pattern 0, respectively. Compared with 8th AJCC pN staging, the Spatial-N model improved discrimination (C-index, 0.731 vs 0.699; 3-year AUC, 0.775 vs 0.742). The integrated model achieved the highest discrimination (C-index, 0.747; 3-year AUC, 0.794). Adding positive lymph node count, lymph node ratio, or positive nodal station count did not materially improve performance.
conclusionsSpatial-N pattern provides anatomically organized prognostic information beyond count-based nodal staging and refines postoperative 3-year DFS stratification in resected ESCC. This station-level framework may complement 8th AJCC pathological N staging and support individualized postoperative risk assessment, pending external validation.
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