Refining esophageal cancer staging after neoadjuvant therapy: importance of treatment response

Barbour, A.P., Jones, M., Gonen, M., Gotley, D.C., Thomas, J., Thomson, D.B., Burmeister, B. and Smithers, B.M. (2008) Refining esophageal cancer staging after neoadjuvant therapy: importance of treatment response. Annals of Surgical Oncology, 15 10: 2894-2902. doi:10.1245/s10434-008-0084-y


Author Barbour, A.P.
Jones, M.
Gonen, M.
Gotley, D.C.
Thomas, J.
Thomson, D.B.
Burmeister, B.
Smithers, B.M.
Title Refining esophageal cancer staging after neoadjuvant therapy: importance of treatment response
Journal name Annals of Surgical Oncology   Check publisher's open access policy
ISSN 1068-9265
1534-4681
Publication date 2008-10-01
Year available 2008
Sub-type Article (original research)
DOI 10.1245/s10434-008-0084-y
Open Access Status Not yet assessed
Volume 15
Issue 10
Start page 2894
End page 2902
Total pages 9
Place of publication U.S.A.
Publisher Springer
Language eng
Subject C1
920102 Cancer and Related Disorders
110323 Surgery
1112 Oncology and Carcinogenesis
Abstract Objective: Accurate staging is vital for esophageal cancer management. The utility of the American Joint Committee on Cancer (AJCC) staging system 6th edition for esophageal cancer has been questioned for resected patients who receive neoadjuvant chemoradiotherapy (CRT). This study was undertaken to assess the AJCC staging system for patients with esophageal cancer that have received neoadjuvant CRT and to identify clinicopathological variables that predict survival.
Formatted abstract
Objective  Accurate staging is vital for esophageal cancer management. The utility of the American Joint Committee on Cancer (AJCC) staging system 6th edition for esophageal cancer has been questioned for resected patients who receive neoadjuvant chemoradiotherapy (CRT). This study was undertaken to assess the AJCC staging system for patients with esophageal cancer that have received neoadjuvant CRT and to identify clinicopathological variables that predict survival.Methods  Review of a prospective esophageal cancer database was undertaken for patients that received neoadjuvant CRT and resection. Primary tumor response was defined as major (≤10% residual tumor cells) or minor (>10% residual tumor cells). Cox regression and concordance analyses were used to determine prognostic factors. Median follow-up was 61 months.Results  Of 131 patients with invasive cancer, there were 40/131 (31%) with squamous cell carcinoma (SCC) and 88/131 (65%) with adenocarcinoma. The procedure-related mortality rate was 3.8%. Median survival was 33 months. A major response was demonstrated by 79/131 (60%) patients. Survival analyses found that the AJCC 6th edition was unable to discriminate between stages 0, I, and IIa or stages IIb and III. Multivariate survival analyses found age, pretreatment tumor length >6 cm, positive lymph nodes, and a major tumor response were independent prognostic factors. These data were used to derive a new staging system that had improved discrimination of stage groups over the current AJCC system.Conclusion  The current AJCC staging system for esophageal cancer is inadequate for patients that receive neoadjuvant CRT. Refinement of the AJCC staging system should include primary tumor response for patients receiving neoadjuvant CRT. 
Keyword Chemoradiotherapy
Esophageal cancer
Prognostic factors
Staging
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Unknown

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 41 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 43 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Tue, 07 Apr 2009, 00:08:33 EST by Denise Wilson on behalf of Faculty Of Health Sciences