Proposed Modification of Nodal Status in AJCC Esophageal Cancer Staging System Wayne Hofstetter, MD, Arlene M. Correa, PhD, Neby Bekele, PhD, Jaffer A.

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Proposed Modification of Nodal Status in AJCC Esophageal Cancer Staging System Wayne Hofstetter, MD, Arlene M. Correa, PhD, Neby Bekele, PhD, Jaffer A. Ajani, MD, Alexandria Phan, MD, Ritsuko R. Komaki, MD, Zhongxing Liao, MD, Dipen Maru, MD, Tsung T. Wu, MD, Reza J. Mehran, MD, David C. Rice, MD, Jack A. Roth, MD, Ara A. Vaporciyan, MD, Garrett L. Walsh, MD, Ashleigh Francis, BS, Shanda Blackmon, MD, Stephen G. Swisher, MD The Annals of Thoracic Surgery Volume 84, Issue 2, Pages 365-375 (August 2007) DOI: 10.1016/j.athoracsur.2007.01.067 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 American Joint Commission on Cancer (AJCC) esophageal staging, nodal designation. Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer, New York (available at: www.springeronline.com).Regional Lymph Node Stations for Staging Esophageal Cancer, From Front (A) and Side (B)1 Supraclavicular nodesAbove suprasternal notch and clavicles2R Right upper paratracheal nodesBetween intersection of caudal margin of innominate artery with trachea and the apex of the lung2L Left upper paratracheal nodesBetween top of aortic arch and apex of the lung3P Posterior mediastinal nodesUpper paraesophageal nodes, above tracheal bifurcation4R Right lower paratracheal nodesBetween intersection of caudal margin of innominate artery with trachea and cephalic border of azygous vein4L Left lower paratracheal nodesBetween top of aortic arch and carina5 Aortopulmonary nodesSubaortic and para-aortic nodes lateral to the ligamentum arteriosum6 Anterior mediastinal nodesAnterior to ascending aorta or innominate artery7 Subcarinal nodesCaudal to the carina of the trachea8M Middle paraesophageal lymph nodesFrom the tracheal bifurcation to the caudal margin of the inferior pulmonary vein8L Lower paraesophageal lymph nodesFrom the caudal margin of the inferior pulmonary vein to the esophagogastric junction9 Pulmonary ligament nodesWithin the inferior pulmonary ligament10R Right tracheobronchial nodesFrom cephalic border of azygous vein to origin of RUL bronchus10L Left tracheobronchial nodesBetween carina and LUL bronchus15 Diaphragmatic nodesLying on the dome of the diaphragm, and adjacent to or behind the crura16 Paracardial nodesImmediately adjacent to the gastroesophageal junction17 Left gastric nodesAlong the course of the left gastric artery18 Common hepatic nodesAlong the course of the common hepatic artery19 Splenic nodesAlong the course of the splenic artery20 Celiac nodesAt the base of the celiac artery The Annals of Thoracic Surgery 2007 84, 365-375DOI: (10.1016/j.athoracsur.2007.01.067) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Kaplan-Meier survival, patients grouped by current American Joint Commission on Cancer (AJCC) nodal staging. The Annals of Thoracic Surgery 2007 84, 365-375DOI: (10.1016/j.athoracsur.2007.01.067) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier survival, patients grouped by number of involved lymph nodes. The Annals of Thoracic Surgery 2007 84, 365-375DOI: (10.1016/j.athoracsur.2007.01.067) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Kaplan-Meier survival, patients grouped by proposed modification to the American Joint Commission on Cancer nodal staging. (B) Analysis of surgery only subgroup. (C) Analysis of induction therapy subgroup. The Annals of Thoracic Surgery 2007 84, 365-375DOI: (10.1016/j.athoracsur.2007.01.067) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig A1 Distribution of differences under the null distribution. (Obs. Test Stat. = observed test statistic.) The Annals of Thoracic Surgery 2007 84, 365-375DOI: (10.1016/j.athoracsur.2007.01.067) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions