3446 - Development and Validation of a Predictive Nomogram for Abdominal Lymph Node Recurrence in Patients with Thoracic Esophageal Squamous Cell Carcinoma: Insights from a Multicenter Study

Purpose/Objective(s):

Esophageal squamous cell carcinoma (ESCC) is notably prevalent in East Asia and remains a significant cause of cancer-related mortality, with abdominal lymph node recurrence (ALNR) being a critical factor affecting patient outcomes. This study developed and validated a nomogram for predicting ALNR risk in patients with thoracic ESCC, enhancing decision-making for surgical and adjuvant therapies.

Materials/Methods:

We retrospectively analyzed 404 patients with thoracic ESCC across two centers, segmenting them into training and validation cohorts. Logistic regression was used to identify predictors of ALNR, and these variables informed the creation of a predictive nomogram. The receiver operating characteristic (ROC) curve was utilized to define thresholds for lymph node dissection.

Results:

The nomogram integrated three key predictors of ALNR: tumor location, adjuvant radiotherapy, and positive abdominal lymph node dissection (PALND). It demonstrated high predictive accuracy with an area under the curve (AUC) of 0.739 (95% CI, 0.671-0.807) in the training cohort and 0.788 (95% CI, 0.651-0.925) in the validation cohort. It suggests a minimum dissection of six abdominal lymph nodes in N+ ESCC patients and highlights a significant increase in ALNR risk with two or more positive lymph nodes.

Conclusion:

The nomogram provides a powerful tool for surgical planning and risk stratification in thoracic ESCC treatment, emphasizing the crucial role of comprehensive abdominal lymph node dissection. It is recommended that postoperative radiotherapy (PORT) clinical target volumes (CTV) include lymph node groups 1, 2, 3, and 7 for patients with lower thoracic ESCC, potentially refining therapeutic strategies and improving prognosis.