Cancer of the esophagus and esophagogastric junction

Abstract

request of the AJCC, worldwide data from 3 continents were assembled to develop data-driven, harmonized esophageal staging for the seventh edition of the AJCC/UICC cancer staging manuals. METHODS: All-cause mortality among 4627 patients with esophageal and esophagogastric junction cancer who underwent surgery alone (no preoperative or postoperative adjuvant therapy) was analyzed by using novel random forest methodology to produce stage groups for which survival was monotonically decreasing, distinctive, and homogeneous. RESULTS: For lymph node-negative pN0M0 cancers, risk-adjusted 5-year survival was dominated by pathologic tumor classification (pT) but was modulated by histopathologic cell type, histologic grade, and location. For lymph node-positive, pNþM0 cancers, the number of cancer-positive lymph nodes (a new pN classification) dominated survival. Resulting stage groupings departed from a simple, logical arrangement of TNM. Stage groupings for stage I and II adenocarcinoma were based on pT, pN, and histologic grade; and groupings for squamous cell carcinoma were based on pT, pN, histologic grade, and location. Stage III was similar for histopathologic cell types and was based only on pT and pN. Stage 0 and stage IV, by definition, were categorized as tumor in situ (Tis) (high-grade dysplasia) and pM1, respectively. CONCLUSIONS: The prognosis for patients with esophageal and esophagogastric junction cancer depends on the complex interplay of TNM classifications as well as nonanatomic factors, including histopathologic cell type, histologic grade, and cancer location. These features were incorporated into a data-driven staging of these cancers for the seventh edition of the AJCC/UICC cancer staging manuals.

Gastric Cancer Staging with Radiologic Imaging Modalities and UICC Staging System

“…Therefore, small cardia cancer within 5 cm but apart from the EGJ is classified as gastric cancer, but it can be staged according to esophageal cancer after it grows enough to reach to the EGJ. This esophageal cancer staging came from an assembled worldwide database from three continents to overcome the previous esophageal cancer staging system which had problems of empiric stage grouping and lack of harmonization with stomach cancer [38,39,40]. …”

“…The extremely different incidence of esophageal adenocarcinoma, EGJ cancer, and gastric cancer in Western and Eastern countries has limited the well-designed comparative research. The reference data for esophageal cancer staging were collected through the Worldwide Esophageal Cancer Collaboration in which there were only two Eastern hospitals among the 48 participating institutions and about 65% of the data used for the analysis was collected before 2000 [38,39,40]. Moreover, the Japanese population that represents the Eastern population usually has a much shorter length of the lesser curvature (about 15-20 cm) than Americans, who represent the Western population [46].…”

EUS Staging of Luminal Cancers in the Upper GI Tract

“…In the latest revision of the AJCC Staging Manual, T4 tumors were divided into resectable tumors (T4a) and unresectable (T4b). Those tumors invading pleura, pericardium and diaphragm are considered resectable and those invading other structures such as the trachea and aorta are considered unresectable [1,26]. Image 3.…”

“…Decreased accuracy and understaging has been reported when a biliary stent is present. Intraductal ultrasound (IDUS) is yet another method of visualizing ampullary tumors by use of a high-frequency ultrasound probe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) inserted into the bile duct during ERCP. Various studies have shown superior T staging for IDUS compared to EUS [56,58,59], with overall accuracy for tumor staging ranging between 78-88% for IDUS.…”

Esophageal Cancer Staging

“…Finally, the principle of assuring homogeneity within groups guided both the amalgamation and segmentation of cancer characteristics between adjacent groups to arrive at the final stage groupings [3][4][5].…”