Endoscopic esophageal tumor length

Abstract

BACKGROUND: Pathologic esophageal tumor length (pL) is an independent predictor of long-term survival. However, whether patients with longer (high-risk) tumors can be identified by endoscopy before surgery has not been established. The objective of the current study was to determine the value of endoscopically measured tumor length (cL) in predicting overall survival in patients with esophageal adenocarcinoma. METHODS: All patients with esophageal adenocarcinoma who had undergone resection without neoadjuvant therapy and who had documented preoperative endoscopy findings were identified retrospectively by using prospectively collected databases at 2 institutions: The University of Texas M. D. Anderson Cancer Center (n ¼ 164; training set) and University of Rochester Medical Center (n ¼ 109; validation set). Esophageal tumors were assessed preoperatively by endoscopy for cL, depth (cT), and lymph node involvement (cN). Univariate and multivariate analyses of cL and other standard prognostic factors were performed. RESULTS: In the training set, cL was correlated directly with pL (Pearson correlation [r] ¼ 0.683; P < .001). Regression tree analyses suggested an optimum cutoff point of cL >2 cm to identify patients with decreased long-term survival (5-year survival rate: cL >2 cm, 29%; cL 2 cm, 78%; P < .001). Multivariate Cox regression analysis demonstrated that cL >2 cm was an independent risk factor for long-term survival (hazard ratio, 2.3; 95% confidence interval, 1.1-4.4; P ¼ .02) even after controlling for age, cT, and cN. Validation with the validation dataset confirmed that cL was correlated directly with pL (r ¼ 0.657; P < .001) and predicted long-term survival using a cL cutoff point of >2 cm (hazard ratio, 2.8; 95% confidence interval, 1.4-5.8; P ¼ .004; univariate analysis). CONCLUSIONS: Endoscopic esophageal tumor length was identified as an independent predictor of long-term survival and may help to identify high-risk patients before they receive cancer-directed therapy.

Analysis of the tumor length and other prognosis factors in pT1-2 node-negative esophageal squamous cell carcinoma in a Chinese population

“…As previous reports reported that 30 mm was a well separation [3-6], we used this length to evaluate survival time.…”

“…Recent publications have suggested that pathologic esophageal tumor length is directly correlated with long-term survival [3-6]; however, most of these data originated in western countries, and the cancer type was predominantly adenocarcinoma.…”

Survival predictors associated with signet ring cell carcinoma of the esophagus (SRCCE): A population-based retrospective cohort study

“…Francisco and Agoston et al [30, 31] declared that the relationship between the size of the oncologic entity with a worse prognosis in esophageal adenocarcinoma was not proven. In a retrospective study of 273 patients at the University of Texas MD Anderson Cancer Center and the University of Rochester Medical Center, Gaur et al [32] identified tumor size as an independent prognostic indicator and demonstrated that an endoscopically measured tumor length >2 cm predicted a decline in long-term survival.…”

Peer Review #1 of "The prognostic value of tumor length to resectable esophageal squamous cell carcinoma: a retrospective study (v0.1)"

“…This was found to be 3.1 cm ( Figure S1A) -based on the highest Youden index (sensitivity + specificity -1) (Heagerty et al 2000). Then, we used a regression tree survival analyses for pathologically measured tumor length (Gaur et al 2011) and found it to be 2.9 cm ( Figure S1B). The mean of these two results -3.0 cm -was used as the threshold value for optimal cut-off.…”

“…In the current American Joint Committee on Cancer (AJCC) staging system for esophageal tumors, stage depends on the depth of the tumor (T classification), lymph node involvement (N classification), and distant metastasis (M classification), without consideration on tumor length (Edge & Compton 2010). Studies have shown that pathologic tumor length had prognostic value to EAC (Bolton et al 2009;Gaur et al 2011;Yendamuri et al 2009). In China, a few studies were conducted to show the association between the overall survival (OS) rate and the tumor length, among the survival of ESCC patients (Feng et al 2013;Ma et al 2015;Wang et al 2011;Wang et al 2012).…”