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Purpose <p>Evidence on the prognostic and staging effects of lymphovascular invasion (LVI) after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) is limited. We aimed to determine the prognostic value of LVI and develop a modified post-neoadjuvant pathologic staging (ypStage) system integrating LVI and ypTNM stage to improve risk stratification.</p> Methods <p>This multi-institutional study included patients with ESCC receiving neoadjuvant chemoradiotherapy and R0 resection. Recursive partitioning analysis (RPA) was conducted to derive prognostic groupings. A modified ypStage system was developed, validated, and compared with ypTNM stage.</p> Results <p>A total of 931 patients were divided into training (n = 565) and external validation (n = 366) cohorts. LVI was present in 115 patients (12.4%). LVI was an independent predictor of survival and disease recurrence, with hazard ratios of 1.70 for overall survival and 1.74 for recurrence-free survival. By integrating LVI status and ypTNM stage, nonmetastatic ESCC were classified into three stages with distinct prognoses. The proposed RPA stage provided superior hazard consistency, hazard discrimination, sample size balance, and outcome prediction over ypTNM stage.</p> Conclusions <p>LVI was a strong prognostic factor, independent of the current ypTNM stage in ESCC. We developed an RPA-based ypStage system integrating LVI status and ypTNM stage that exhibited good prognostic performance.</p>

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Integrating lymphovascular invasion and ypTNM staging system for esophageal squamous cell carcinoma undergoing neoadjuvant chemoradiotherapy and surgery: a multi-institutional analysis

  • 期刊论文

  • 发表日期：

    2025年12月19日

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  • Shiliang Liu,
  • Yujin Xu,
  • Xufeng Guo,
  • Wencheng Zhang,
  • Geng Wang,
  • Gang Zhao,
  • Yihong Ling,
  • Ruiqi Wang,
  • Li Zhang,
  • Baoqing Chen,
  • Qiaoqiao Li,
  • Hong Yang,
  • Mian Xi

摘要

Purpose

Evidence on the prognostic and staging effects of lymphovascular invasion (LVI) after neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) is limited. We aimed to determine the prognostic value of LVI and develop a modified post-neoadjuvant pathologic staging (ypStage) system integrating LVI and ypTNM stage to improve risk stratification.

Methods

This multi-institutional study included patients with ESCC receiving neoadjuvant chemoradiotherapy and R0 resection. Recursive partitioning analysis (RPA) was conducted to derive prognostic groupings. A modified ypStage system was developed, validated, and compared with ypTNM stage.

Results

A total of 931 patients were divided into training (n = 565) and external validation (n = 366) cohorts. LVI was present in 115 patients (12.4%). LVI was an independent predictor of survival and disease recurrence, with hazard ratios of 1.70 for overall survival and 1.74 for recurrence-free survival. By integrating LVI status and ypTNM stage, nonmetastatic ESCC were classified into three stages with distinct prognoses. The proposed RPA stage provided superior hazard consistency, hazard discrimination, sample size balance, and outcome prediction over ypTNM stage.

Conclusions

LVI was a strong prognostic factor, independent of the current ypTNM stage in ESCC. We developed an RPA-based ypStage system integrating LVI status and ypTNM stage that exhibited good prognostic performance.