Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer

Hollis, Alexander Conor; Quinn, Lauren; Hodson, James; Evans, Emily; Plowright, James; Begum, Ruksana; Mitchell, Harriet; Hallissey, M. T.; Whiting, John; Griffiths, Ewen A.

doi:10.1002/jso.24789

Cited by 18 publications

(13 citation statements)

References 35 publications

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“…The view that tumor size has a negative effect on predicting survival is supported by many investigators; however, the relationship between the T stage and discriminatory value of tumor size is still underappreciated [20][21][22][23]. Our study identified tumor size as an independent prognostic factor in T1-2 stage esophageal cancer patients, which is in line with previous results [12,13].…”

Section: Discussionsupporting

confidence: 90%

Tumor Size as a Critical Prognostic Factor in T1-2 Stage Esophageal Cancer

2020

Gastroenterology Research and Practice

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Background. Tumor size has been measured in esophageal cancer for decades, but the role of tumor size in relation to T stage in the prediction of survival is still underappreciated. Thus, the present study is aimed at investigating the influence of T stage on the predictive value of tumor size in clinical stage I–IV esophageal cancer patients. Materials and Methods. Data were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) cancer registry program. Cox proportional hazards regression was utilized to identify the independent prognostic ability of the factor. Kaplan-Meier analysis was used to estimate the distribution of survival outcome. Harrell’s concordance index (c-index) was used to quantify the predictive ability of the prognostic model and prognostic factor. Results. According to the T stage, subgroup analysis showed that tumor size was not an independent risk factor in T3 and T4 stage esophageal cancer patients. Furthermore, the predictive power of tumor size was negatively impacted by the increase in T stage. Furthermore, the discriminative ability of the Cox model based on the tumor-node-metastasis (TNM) system with tumor size outperformed the model based on the TNM system only. Conclusion. The current study identified tumor size as a critical clinical prognostic signature for esophageal cancer with considerable discriminatory ability and prognostic value. Therefore, tumor size should be included in the American Joint Committee on Cancer (AJCC) TNM staging of T1-2 esophagus cancer patients.

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Section: Discussionsupporting

confidence: 90%

Tumor Size as a Critical Prognostic Factor in T1-2 Stage Esophageal Cancer

2020

Gastroenterology Research and Practice

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“…Patients with inoperable disease undergoing ‘open and close’ procedures, with no resection, were excluded. The data set included demographic, treatment and pathology details along with complications. The study was approved by the Queen Elizabeth Hospital clinical audit department.…”

Section: Methodsmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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Background: Recent evidence suggests that complications after oesophagectomy may decrease shortand long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67⋅9 per cent) developed postoperative complications, with 128 (39⋅8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0⋅071) or nodal (N) status (P = 0⋅882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0⋅032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0⋅97, P = 0⋅915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1⋅64 (P = 0⋅007) and 1⋅74 (P = 0⋅013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.Funding information Queen Elizabeth Hospital Birmingham Charity (Upper Gastrointestinal Fund) Upper G.I. Blues of the consensus reporting guidelines on oesophageal complications 11 , a lack of standardization of complication reporting made understanding the relationship between complications and long-term survival difficult.

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“…As the three most important predictors, T (primary tumor), N (lymph node), and M (metastasis) are the cornerstones of the current stage classification in esophageal squamous cell carcinoma (ESCC) (2). In addition, several other characteristics have also been reported as independent predictors, including tumor location, histology, differentiation, and circumferential resection margin (9)(10)(11)(12). Whether lymphovascular invasion (LVI) in ESCC should be recognized as an independent prognostic factor for survival is a controversial issue in clinical research (13).…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of lymphovascular invasion in patients with esophageal squamous cell carcinoma

Yang

et al. 2019

Ann. Transl. Med

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Background: Whether lymphovascular invasion (LVI) in esophageal squamous cell carcinoma (ESCC) should be considered an independent prognostic factor for survival is controversial. The aim of this report was to investigate the prognostic value of LVI for patients with ESCC. Methods: Between October 2010 and July 2011, 152 ESCC patients were retrospectively reviewed. All of the patients underwent curative resection as their primary treatment. Clinicopathological features and overall survival (OS) rate were investigated. Kaplan-Meier curves were used to calculate the OS rate, and the prognostic factors were identified by Cox regression model. Results: Positive LVI was found in 49 (32.2%) patients. Patients with negative LVI had a significantly better 5-year OS rate than those with positive LVI (52.9% vs. 28.8%; P=0.000). The age, T stage, N stage, tumor differentiation, and LVI were demonstrated to be significant prognostic factors for OS through univariate analyses. LVI was confirmed as an independent prognostic factor for OS through multivariate survival analyses. Subgroup analyses revealed that LVI was associated with a decreased OS in node-negative patients, and no significant difference was observed in node-positive cases. Conclusions: Our study highlighted that LVI is an independent prognostic factor in patients with resectable ESCC. LVI may facilitate the stratification of patients with poor survival.

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Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer

Abstract: Tumor lengths on pathology were found to be the most predictive of patient outcome. However, after accounting for other tumor-related factors, tumor length only resulted in a marginal improvement in predictive accuracy.

Cited by 18 publications

References 35 publications

Tumor Size as a Critical Prognostic Factor in T1-2 Stage Esophageal Cancer

Tumor Size as a Critical Prognostic Factor in T1-2 Stage Esophageal Cancer

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Prognostic value of lymphovascular invasion in patients with esophageal squamous cell carcinoma

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