Evaluation of the 7th edition of the UICC-AJCC tumor, node, metastasis classification for esophageal cancer in a Chinese cohort

Abstract

Background: To assess and evaluate the prognostic value of the 7 th edition of the Union for InternationalCancer Control-American Joint Committee on Cancer (UICC-AJCC) tumor, node, metastasis (TNM) staging system for Chinese patients with esophageal cancer in comparison with the 6 th edition. Methods: A retrospective review was performed on 766 consecutive esophageal cancer patients treated with esophagectomy between 2008 and 2012. Patients were staged according to the 6 th and 7 th editions for esophageal cancer respectively. Survival was calculated by the Kaplan-Meier method, and multivariate analysis was performed using Cox regression model. Results: Overall 3-year survival rate was 59.5%. There were significant differences in 3-year survival rates among T stages both according to the 6 th edition and the 7 th edition (P<0.001). According to the 7 th edition, the 3-year survival rates of N0 (75.4%), N1 (65.2%), N2 (39.7%) and N3 (27.3%) patients were significant differences (P<0.001). Kaplan-Meier curve revealed a good discriminatory ability from stage I to IV, except for stage IB, IIA and IIB in the 7 th edition staging system. Based on the 7 th edition, the degree of differentiation, tumor length and tumor location were not independent prognostic factors on multivariate analysis. The multivariate analyses suggested that pT-, pN-, pTNM-category were all the independent prognostic factors based on the 6 th and 7 th edition staging system. Conclusions: The 7 th edition of AJCC TNM staging system of esophageal cancer should discriminate pT2-3N0M0 (stage IB, IIA and IIB) better when considering the esophageal squamous cell cancer patients.Therefore, to improve and optimize the AJCC TNM classification for Chinese patients with esophageal cancer, more considerations about the value of tumor grade and tumor location in pT2-3N0M0 esophageal squamous cell cancer should be taken in the next new TNM staging system.

Texture analysis of CT imaging for assessment of esophageal squamous cancer aggressiveness

“…The important indexes reflecting the aggressiveness of esophageal cancer include TNM stage and its differentiation degree (2,3), which might be evaluated by endoscopic ultrasonography (EUS), computed tomography (CT) or endoscopic biopsy preoperatively. EUS performed well in T staging but poorly in N staging with a low sensitivity and specificity (4).…”

The ratio of negative lymph nodes count inside the thoracic cavity to the positive lymph count is a prognostic factor in esophageal squamous cell carcinoma

“…The status of LNM in ESCC is essential for evaluating the tumor stage and selection of post-operative treatment (15,16). The classi cation on tumor stage of AJCC (7th edition) is primarily based on the number of PLN rather than the number of NLN, since the majority of previous studies have demonstrated that the number of PLN is an independent prognostic factor in ESCC and an indicator for the extent of lymphadenectomy (17).…”

Comparison of the prognostic difference between ypTNM and equivalent pTNM stages in esophageal squamous cell carcinoma based on the 8th edition of AJCC classification

“…In 2013, Chen et al have analyzed data with the 7th edition of AJCC staging system and reported that the 5-year survival rates in p0, pIa, pIb, pIIa, pIIb, pIIIa, pIIIb, pIIIc and pIV stages are 100%, 84.8%, 78.6%, 66.5%, 53.4%, 33.6%, 22.4%, 15.0% and 0%, respectively [24]. In 2016, Huang et al have retrospectively analyzed the clinicopathologic data of 766 ESCC patients according to the 7th edition of AJCC staging system and suggested that the 3-year survival rates in pIa, pIb, pIIa, pIIb, pIIIa, pIIIb and pIIIc stages are 85.7%, 71.1%, 82.1%, 76.8%, 53.5%, 32.5% and 29.5%, respectively [11]. Considering the rearrangement and renaming of the 8th edition of AJCC staging system [16,18], we conducted further survival analysis in our patients with different pTNM stages using the new system.…”

“…With the widespread use of neoadjuvant therapy, it clearly creates an extra demand on prognostic evaluation. The 7th edition of American Joint Committee on Cancer (AJCC) staging system is widely used for prognosis stratification throughout the world in EC patients with surgery alone [9][10][11]. Some studies believe that the ypTNM classification describing the presence and anatomical extent of vital tumor cells is also an essential prognostic factor in EC patients with neoadjuvant therapy [12,13].…”