Worldwide Esophageal Cancer Collaboration: clinical staging data

Abstract

SUMMARY To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data—simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival—for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5–25 mg/kg2, 47%), little weight loss (2.4 ± 7.8 kg), 0–1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cNO (44%), cMO (95%), and cG2–G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cNO versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.

Worldwide Esophageal Cancer Collaboration: pathologic staging data

“…However, the role of pure pathologic staging for treatment decision and prognostication for these cancers is waning. 4,8 …”

“…4 Data were requested in completely deidentified form (Health Insurance Portability and Accountability Act research standards) for analysis, using a set of required variables with standard definitions. Local ethics-board approval of the databases and data-use agreements was executed with Cleveland Clinic.…”

Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals

“…3 Of these 22,123 had treatment, survival, and pT data available. Among the latter, 7,773 had pathologic staging after neoadjuvant therapy.…”

“…Median potential follow-up was 8.9 years 6 ; however, median actual follow-up for surviving patients was 2.5 years, with 25% followed more than 5.1 years and 10% more than 8.4 years. 3 …”

“…1 Post-7 th edition AJCC instructions and goals of the Worldwide Esophageal Cancer Collaboration (WECC) 2 were to develop, if indicated, separate neoadjuvant pathologic staging recommendations for cancer of the esophagus and esophagogastric junction for the 8 th edition AJCC Cancer Staging Manual. Data provided by WECC 3,4 served as substrate for a data-driven machine-learning analysis producing data-driven neoadjuvant pathologic stage groups . An additional machine-learning analysis produced data-driven anatomic neoadjuvant pathologic stage groups based only on ypT, ypN, and ypM categories.…”