Validation of the Chinese version of the Malocclusion Impact Questionnaire (MIQ).

OBJECTIVE: To translate and cross-culturally adapt the Malocclusion Impact Questionnaire (MIQ) into Chinese and to assess the psychometric properties of the Chinese version of the MIQ (MIQ/C) for use among adolescents with malocclusion in China. MATERIALS AND METHOD: First, the MIQ/C was developed according to international guidelines. Then, the MIQ/C was filled out by 536 adolescents between 10 and 16 years of age. This study used exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, internal consistency, and test-retest reliability to evaluate the psychometric properties of the MIQ/C. RESULTS: Following EFA, three domains were extracted, accounting for 65.950% of the total variance. The CFA results showed that the fit indices of each factor in the three-factor model all reached the standard (chi-square/DF = 2.591, GFI = 0.919, TLI = 0.926, CFI = 0.928, RMSEA = 0.076). The scale evidenced a good relationship with the two global questions, indicating good convergent validity. The Cronbach alpha value and the intraclass correlation coefficients (ICC) value of the MIQ/C were 0.929 and 0.893, respectively. CONCLUSION: The MIQ/C demonstrated good reliability and validity and can be further studied and applied in Chinese adolescents with malocclusion. CLINICAL RELEVANCE: The MIQ/C can be applied to assess the psychosocial impact of malocclusion among Chinese adolescents.

Determining the minimal important difference of the Oral Health Impact Profile for Chronic Periodontitis.

AIM: Building on previous psychometric work, we aimed to further assess the minimally important difference (MID) of the Oral Health Impact Profile for Chronic Periodontitis (OHIP-CP). METHODS: In total, 240 consecutive patients with chronic periodontitis were recruited in the study. The OHIP-CP was completed at baseline and after six weeks. Methodology testing included the confirmatory factor analysis (CFA) and MID. Confirmatory factor analysis (CFA) was performed to assess the fit of the previously proposed three-factor model. The MID of this questionnaire was determined by applying anchor-based and distribution-based approaches. RESULTS: The CFA supported a three-factor model for the OHIP-CP with acceptable fit to the data. The fit indices were χ2 /df = 2.231, GFI = 0.935, TLI = 0.969 and CFI = 0.976, RMSEA = 0.076. The OHIP-CP scores showed significant improvements after treatment (p < .001). The anchor-based MIDs of OHIP-CP for "oral function restriction," "oral pain" and "psychological and social impact," and total score were 2, 1, 4 and 7 points, respectively. The effect sizes (ES) and standardized response mean (SRM) for the OHIP-CP were moderate to large. CONCLUSIONS: The MID of the OHIP-CP is recommended for interpreting clinically meaningful change in oral health-related quality of life (OHRQoL) over time.

OHRQoL changes among Chinese preschool children following dental treatment under general anesthesia.

OBJECTIVE: To assess dental treatment under dental general anesthesia (DGA) among Chinese preschool children by investigating changes in their oral health-related quality of life (OHRQoL), the incidence of postoperative complications, and parental satisfaction. METHOD: A single-center prospective cohort study was conducted. A total of 190 children who received treatment for early childhood caries (ECC) under DGA were included. The primary outcome was a change in the children's OHRQoL at 1 month after the operation compared to that at baseline, which was measured by the Early Childhood Oral Health Impact Scale (ECOHIS). The secondary outcomes were the incidence of complications within 1 day after treatment and parental satisfaction with the DGA treatment. RESULTS: In total, 180 participants were successfully reevaluated after the operation, yielding a 94.7% follow-up response rate. The total ECOHIS score decreased by 76.3% (P < 0.01) after treatment, demonstrating a large effect. Approximately 74.4% of the children complained of at least one complication, including sleepiness (43.3%), emergence agitation (38.9%), nausea/vomiting (13.9%), dizziness (10.6%), and fever (3.3%), on the first day. Approximately 85.5% of the parents were satisfied with the DGA treatment. CONCLUSION: DGA treatment has a positive effect on Chinese preschool children's OHRQoL and is evaluated highly by their parents. CLINICAL RELEVANCE: Dental treatment under general anesthesia improved the OHRQoL of Chinese preschool children.

Validation of a web-based version of the Craniofacial Pain and Disability Inventory.

OBJECTIVE: To translate and cross-culturally adapt the Craniofacial Pain and Disability Inventory (CF-PDI) into Chinese and, to evaluate measurement properties of the web-based version of the CF-PDI. METHODS: The Chinese version (CF-PDI/C) was first produced according the guidelines. Then, the web-based version of CF-PDI/C (eCF-PDI/C) was developed by our team and a third-party survey provider. The eCF-PDI/C was distributed to patients with painful temporomandibular disorders (TMD) with or without headache to evaluate its psychometric properties. The reliability of the eCF-PDI/C was detected by internal consistency and test-retest reliability. The validity of the measure was performed through construct validity and convergent validity. RESULTS: A total of 206 patients were recruited. The Cronbach's α value and the intraclass correlation coefficients (ICC) value of the eCF-PDI/C was .912 and .82, respectively. Following exploratory factor analysis (EFA), three factors were extracted, accounting for 77.153% of the total variation. With regard to the convergent validity, the measure evidenced a good relationship with the global health question. CONCLUSIONS: The eCF-PDI/C displays good reliability and validity through rigorous performance tests. This can be recommended for use among patients with painful TMD with or without headache.

FAM3B promotes progression of oesophageal carcinoma via regulating the AKT-MDM2-p53 signalling axis and the epithelial-mesenchymal transition.

FAM3B has been suggested to play important roles in the progression of many cancers, such as gastric, oral, colon and prostate cancer. However, little is known about the role of FAM3B in human esophageal squamous cell carcinoma (ESCC). In the present study, we found that FAM3B expression was higher in ESCC tissues than in adjacent normal tissues. Using quantitative real-time polymerase chain reaction, we found similar results in cell lines. FAM3B expression was significantly related to T/TNM stage. Importantly, Kaplan-Meier analysis revealed that a high expression level of FAM3B predicted a poor outcome for ESCC patients. Overexpression of FAM3B inhibits ESCC cell death, increases oesophageal tumour growth in xenografted nude mice, and promotes ESCC cell migration and invasion. Further studies confirmed that FAM3B regulates the AKT-MDM2-p53 pathway and two core epithelial-to-mesenchymal transition process markers, Snail and E-cadherin. Our results provide new insights into the role of FAM3B in the progression of ESCC and suggest that FAM3B may be a promising molecular target and diagnostic marker for ESCC.

The Role and Prognostic Significance of Aortopulmonary, Anterior Mediastinal, and Tracheobronchial Lymph Nodes in Esophageal Cancer: Update of the Eighth-Edition TNM Staging System (2018).

BACKGROUND: The eighth edition of TNM staging for esophageal cancer will be implemented at 2018. The stations 5, 6, and 10 lymph nodes (LNs) have been omitted from the regional lymph node map for the new TNM staging. However, the role and prognostic significance of these LN stations were not clear. The purpose of this study was to investigate whether the revised nodal staging is appropriate and to verify the role, prognostic significance, and therapeutic value of these LNs in esophageal cancer. METHODS: The records of patients who underwent esophagectomy for cancer in our department between 2007 and 2013 were retrospectively analyzed. The rate of metastases was calculated for stations 5, 6, and 10 LNs. LN metastasis and patient survival were analyzed. RESULTS: A total of 1637 patients were included. The calculated rate of metastasis to stations 5, 6, and 10 was 3.2%, 2.3%, and 4.9%, respectively. No difference was found in the N stage determined by the seventh and eighth edition N staging systems. The status of station 5, 6, or 10 was not associated with long-term survival according to Cox proportional hazards model analysis. CONCLUSIONS: Metastasis to stations 5, 6, or 10 LNs was infrequent. Omitting of stations 5, 6, and 10 LNs in the eighth edition TNM staging did not influence the accuracy and survival-predicting efficacy. The therapeutic value of lymphadenectomy of stations 5, 6, and 10 was limited. The status of stations 5, 6, and 10 LNs was not associated with long-term survival.

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer.

BACKGROUND: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. METHODS: "Side-insertion" technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. RESULTS: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50-400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. CONCLUSION: RAILE is safe and feasible. Our modified procedure highlighting the "side-insertion" method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

Reliability and validity of a Chinese version of the Oral Health Impact Profile for edentulous subjects.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of the Chinese version of the Oral Health Impact Profile for edentulous subjects (OHIP-EDENT-C). METHODS: After translation and cross-cultural adaptation following international guidelines, 162 complete denture wearers were recruited to complete the questionnaire. The reliability of the OHIP-EDENT-C was evaluated using internal consistency and test-retest methods. The validity of the OHIP-EDENT-C was analyzed by construct validity and convergent validity. Construct validity was determined based on factor analysis and convergent validity by analyzing the correlation between OHIP-EDENT-C subscale scores and the global question. RESULTS: Cronbach's alpha value (internal reliability) for the total OHIP-EDENT-C score was 0.972, and the intraclass correlation coefficient value (test-retest reliability) was 0.763 (similar to the original OHIP-EDENT). Construct validity was determined by factor analysis, extracting five factors, accounting for 74.31 % of the variance. All items had factor loadings above 0.40. In terms of convergent validity, the OHIP-EDENT-C subscale was significantly highly correlated to the global question. CONCLUSION: The results suggest that the OHIP-EDENT-C is a reliable and valid measure to evaluate OHRQoL for edentulous subjects in China.

Reliability and validity of the Chinese version of the short form of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15).

OBJECTIVES: The aim of this study was to validate the short form of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) in Chinese patients with dentine hypersensitivity (DH). METHODS: In total, 200 patients with DH were recruited to complete the questionnaire. The reliability of the DHEQ-15 was evaluated using internal consistency and test-retest methods. The exploratory factor analysis (EFA) was conducted to identify domains of the DHEQ-15. Convergent validity was determined by analyzing the correlation between DHEQ-15 subscale scores and the global rating of oral health question. RESULTS: Cronbach's alpha value (internal reliability) for the total DHEQ-15 score was 0.934 (higher to the original DHEQ-15' 0.924), and the intraclass correlation coefficient value (test-retest reliability) was 0.894 (lower to the original DHEQ-15' 0.939). The EFA identified three components with eigenvalues >1, explaining 53.0, 17.1, and 12.3% of the variance, respectively, accounting for a total of 82.4% of the variance. The three components named 'restrictions' (three items), 'changes in eating habits' (six items), and 'emotions and identity' (six items). In terms of convergent validity, the DHEQ-15 subscale was significant highly negatively correlated to the global oral health rating. CONCLUSIONS: The results provide initial evidence that the DHEQ-15 can be properly used for assessment of patients with DH in China.

Validation of the chinese version of the oral health impact profile for TMDs (OHIP- TMDs-C).

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of the the Chinese version of the Oral Health Impact Profile for TMDs (OHIP-TMDs-C). STUDY DESIGN: The OHIP-TMDs was initially translated and cross-culturally adapted to Chinese following international guidelines; then subsequently validated for the psychometric characteristics of reliability and validity. In total, 156 participants with temporomandibular disorders (TMDs) were recruited to complete the questionnaire. The reliability of the OHIP-TMDs-C was evaluated using internal consistency and test-retest methods. The validity of the OHIP-TMDs-C was analysed by construct validity and convergent validity. Construct validity was determined based on factor analysis, and convergent validity by analyzing the correlation between OHIP-TMDs-C subscale scores and the global rating of oral health question. RESULTS: Cronbach's alpha value (internal reliability) for the total OHIP-TMDs-C score was 0.917 and the intraclass correlation coefficient (ICC) value (test-retest reliability) was 0.899. Construct validity was determined by factor analysis, extracting five factors, accounting for 78.6% of the variance. All items had factor loadings above 0.40. In terms of convergent validity, the OHIP-TMDs-C subscale was significant correlated to the global oral health rating. CONCLUSIONS: The results suggest that the OHIP-TMDs-C has good reliability and validity and thus may be used as a valuable instrument for patients with TMDs in China.

Reliability and validity of the Chinese version of the chronic oral mucosal diseases questionnaire.

INTRODUCTION: The aim of this study was to evaluate the reliability and validity of the Chinese version of the Chronic Oral Mucosal Diseases Questionnaire (COMDQ). METHODS: A consecutive sample of 200 patients with chronic oral mucosal diseases was enrolled to complete the questionnaire after its translation and cross-cultural adaptation. The reliability of the Chinese version of COMDQ was determined through internal consistency and test-retest methods. The construct validity of COMDQ was analysed by exploratory factor analysis (EFA). RESULTS: Cronbach's alpha value for the total COMDQ score was 0.894, and the test-retest intraclass correlation coefficient value for the total COMDQ score was 0.83. The EFA extracted four factors, which accounted for 67.89% of the variance. All items showed adequate factor loadings, ranging from 0.487 to 0.947. CONCLUSION: The results suggest that the Chinese version of the COMDQ has satisfactory psychometric properties and is applicable to patients with chronic oral mucosal diseases in China.

Validation of the Chinese version of the Summated Xerostomia Inventory (SXI).

OBJECTIVES: The aim of this study was to validate the Chinese version of the Summated Xerostomia Inventory (SXI). METHODS: The English SXI was translated into Chinese, cross-cultural adaptation and pilot tested. The final Chinese version of SXI was tested in a consecutive sample of 212 patients with xerostomia. The reliability of the Chinese version of SXI was determined through internal consistency and test-retest methods. The construct validity of SXI was analysed by content validity, construct validity, and convergent validity. RESULTS: Cronbach's alpha value for the SXI score was 0.798, and the test-retest intraclass correlation coefficient value for the SXI score was 0.837. Construct validity was proved by the presence of one-factor structure that accounted for 57.68 % of the variance and fitted well into the model. The correlation between the total score of the SXI and the global oral health question was 0.75, indicating very good correlation (P < 0.01). CONCLUSION: This study provided preliminary evidence concerning validity and reliability of the Chinese version of the SXI. The results provide initial evidence that the SXI may be a useful tool for the mainland Chinese xerostomia patients for both clinical and epidemiologic researches.

Development of the Chinese version of the Dentine Hypersensitivity Experience Questionnaire.

The aim of this study was to evaluate the reliability and the validity of the Chinese version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ). After translation and cross-cultural adaptation following international guidelines, 110 patients with dentine hypersensitivity were recruited to complete the questionnaire. The reliability of the Chinese version of the DHEQ was evaluated using internal consistency and test-retest methods. Construct validity was determined based on factor analysis, discriminative validity (by comparing the subscale scores difference in the degree of sensitivity being investigated), and convergent validity (by analyzing the correlation between DHEQ subscale scores and the global rating of oral health question). Cronbach's alpha value (internal reliability) for the total DHEQ score was 0.95 and the intraclass correlation coefficient (ICC) value (test-retest reliability) was 0.85. Construct validity was determined by factor analysis, extracting eight factors, accounting for 74% of the variance. All items had factor loadings of >0.40. In addition, the Chinese version of the DHEQ was found to be valid for distinguishing patients with varying degrees of dentine hypersensitivity. In terms of convergent validity, the impact scale was significantly highly correlated to the global oral health rating. The results suggest that the Chinese version of the DHEQ has satisfactory psychometric properties and is applicable for patients with dentine hypersensitivity in China.

[Reliability and validity of the Dundee Ready Educational Environment Measure (DREEM) among Chinese dental students].

PURPOSE: To evaluate the reliability and validity of the Dundee Ready Educational Environment Measure (DREEM) among Chinese dental students. METHODS: Students' perceptions of the educational environment were evaluated using the Chinese version of the 50-item DREEM. When they accomplished the questionnaires, the collected data were analyzed to evaluate the reliability and validity of the scale. Reliability was analyzed by internal consistency and split half reliability, and validity was analyzed by exploratory factor analysis and convergent validity. The data were analyzed by reliability and validity test using SPSS 22.0 software package. RESULTS: A total of 260 dental students were enrolled in this study. All the DREEM questionnaires were completely filled out. The Cronbach's α, split-half reliability of the scale was 0.936, 0.816. By factor analysis of construct validity, the 50 items were classified into 5 domains, the cumulative proportion was 47.071%. The scale had certain logical relation between the items in the same domains. The Spearman's rank correlation coefficient of the scale was between 0.447 and 0.556. CONCLUSIONS: With satisfactory psychometric properties, DREEM is suitable for assessing educational environments among Chinese dental students.

Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma.

BACKGROUND: The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. AIM: To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC. METHODS: This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy. RESULTS: Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m2 and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m2 and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m2 and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m2 and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS (P < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors. CONCLUSION: PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.

[Measurement and analysis of dental education environment in College of Stomatology, Chongqing Medical University].

PURPOSE: To investigate the degree of satisfaction with educational environment among dental students in College of Stomatology, Chongqing Medical University. METHODS: In 2017, students' perceptions of the educational environment were evaluated using the 50-item DREEM. SPSS 24.0 software package was used for statistical analysis. RESULTS: A total of 260 valid questionnaires were recovered. The total Cronbach's α coefficient of DREEM was 0.915, and the total score of the DREEM was 164.99±19.53. CONCLUSIONS: The DREEM showed excellent internal consistency for the overall scores, and the education environment of dental education in our college is at a very good level.

Prognostic Evaluation of Nodal Skip Metastasis for Thoracic Esophageal Squamous Cell Carcinoma.

BACKGROUND: Nodal skip metastasis (NSM) is a prognostic factor in certain malignant tumors, but the clinical and prognostic implications of NSM in esophageal squamous cell carcinoma (ESCC) are still unclear. The study aimed to assess its risk factors and prognostic value in thoracic ESCC. METHODS: A retrospective study was conducted in patients with thoracic ESCC who underwent esophagectomy from March 2009 to March 2012 in the Department of Thoracic Surgery, West China Hospital, Sichuan University. The prognostic implications and risk factors of NSM were assessed in our study. RESULTS: The incidence of NSM in the entire cohort was 37.9%. Tumor location (P = .016), pT stage (P = .029), and pN stage (P < .001) were identified to be independent risk factors for NSM. The overall survival (OS) was similar between patients with and without NSM. The OS had no significant difference between pN1 patients with and without NSM, whereas the OS was significantly worse in pN2 patients with NSM than those without NSM (P = .001). The OS was similar between patients with NSM level 1 and NSM level 2, but the OS was significantly better in patients with NSM level 1 than NSM level 2 among patients with lower thoracic ESCC (P = .013). CONCLUSIONS: The effect of NSM on prognosis of thoracic ESCC may be mainly reflected in patients with pN2 stage. The prognostic value of NSM level for thoracic ESCC may be mainly reflected in patients with lower thoracic tumor.

Isobaric tags for relative and absolute quantitation-based quantitative proteomics analysis provides novel insights into the mechanism of cross-incompatibility between tree peony and herbaceous peony.

Interspecific hybridisation is the main method for improvement and breeding of tree peony (Paeonia ostii T.Hong & J.X.Zhang), but cross-incompatibility as the major factor restricting the rapid development of interspecific hybridisation. To better understand the molecular mechanisms involved in cross-incompatibility between tree peony (Paeonia ostii cv. Fengdanbai) and herbaceous peony (Paeonia lactiflora Pall. cv. Fenyunu), a quantitative proteomic analysis using isobaric tags for relative and absolute quantitation (iTRAQ) technology was performed on the stigma 24h after pollination. Of the 2900 proteins whose levels were quantitated, 685 proteins were differentially expressed in the stigma after hybrid pollination, in contrast to self-pollination. Functional annotation analysis showed that dysregulated proteins involved in RNA degradation, the Ca signalling pathway, the phosphatidylinositol signalling system and the mitogen-activated protein kinase (MAPK) signalling pathway may have made contributions to cross-incompatibility. The downregulated expression of enolase, DnaK (Heat Shock Proteins, HSP70), GroEL (Heat Shock Proteins, HSP60), calmodulin and glyoxalase I, and the upregulated expression of adenine nucleotide translocator indicated that the energy synthesis required by pollen tube growth, the signal pathway and the metabolic pathway related to the growth polarity of the pollen tube were blocked after hybrid pollination. Eight genes were selected to confirm their expression by quantitative real-time PCR. Compared with the STRING database, a protein-protein interaction network of the chosen proteins was constructed. These results provide fundamental and important information for research into the molecular mechanisms of cross-incompatibility in peony and should facilitate interspecific hybridisation in agricultural practice.

[Confirmatory factor analysis of the shortened dentine hypersensitivity experience questionnaire].

OBJECTIVE: This review aims to identify the dimensional structure of the shortened dentine hypersensitivity experience questionnaire (DHEQ-15) using confirmatory factor analysis (CFA). METHODS: The Chinese language version of DHEQ-15 was applied to 210 patients with dentine hypersensitivity aged 18-70 years old. The three-dimensional construct was confirmed by CFA. RESULTS: All the questionnaires were fully completed. The item "Because of the sensations, I take longer to finish a meal than others" was the most frequently reported by the parents. The modified three-factor model is suitable for the data. The chi-square fit statistics/degree of freedom was 2.213, the goodness-of-fit index was 0.905, the adjusted goodness-of-fit index was 0.872, the normed fit index was 0.845, the incremental fit index was 0.962, the Tucker-Lewis index was 0.969, the comparative fit index was 0.977, and the root mean square error of approximation was 0.068. CONCLUSIONS: Our findings generally support the three-dimensional construct of the DHEQ-15. Thus, DHEQ-15 can be used as a valid instrument in patients with dentine hypersensitivity in China.

Strategies of nodal staging of the TNM system for esophageal cancer.

The 8th edition of UICC/AJCC TNM staging for esophageal cancer will start in use since 2018. The nodal staging in this version of TNM system remains unchanged from the 7th edition that based on the number of lymph nodes (LN) involved, except the limited revision of the regional LN map. In this review, N staging revision was evaluated from its initially simple definition of negative (N0) and positive (N1) LN(s) to the current positive node number based proposal. Meanwhile the disadvantages of current N staging were discussed. The refined nodal staging system in view of the number of metastatic node stations was introduced; as well as the extent and station of metastatic node could better reflect the disease progression and prognosis. The controversy on N staging of esophagogastric junction cancer was also discussed. Other reported N staging associated elements including LN ratio and lymphatic vessel invasion were reviewed and evaluated.