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Tumor length as a prognostic factor in esophageal cancer management

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

To determine whether tumor length provides additional prognostic information beyond traditional TNM staging alone.

Methods

A retrospective review was conducted of 356 patients with stage I–III esophageal cancer treated with curative intent at the University of Washington between 1995 and 2010. All patients had esophagoduodenoscopy prior to treatment. Multivariate Cox models were performed to evaluate the impact of tumor length on mortality as both a continuous and binary variable (≤3 and >3 cm), controlling for stage, histology, treatment, gender, and age.

Results

Among all patients, each increasing centimeter of tumor involvement was associated with a 13 % increased risk of mortality (hazard ratio (HR) = 1.13, p < 0.001). The hazard ratio for death was 1.22 (p = 0.009) for stage I patients, 1.12 (p = 0.146) for stage II patients, and 1.08 (p = 0.095) for stage III patients. When dichotomizing tumor length among all patients, tumors >3.0 cm were not associated with poorer survival compared with tumors ≤3.0 cm (HR = 1.16, p = 0.466). Among the stage I population, the adjusted relative risk of mortality for patients with tumors >3 cm is 2.63 with a trend towards significance (p = 0.089). No increased risk of mortality was observed among the stage II and III populations.

Conclusion

The increased risk of mortality associated with longer tumors, with the effect largely influenced by the stage I patients, helps generate a hypothesis that tumor length may have greater prognostic significance in stage I patients than in stage II/III patients. Our findings suggest that it may be helpful to include tumor length in esophageal cancer staging guidelines.

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Conflict of interest

Camille Berriochoa, Daniel Hibbard, Mary Morcos, Aasthaa Bansal, Bryan Comstock, Brant Oelschlager, Carlos Pellegrini, Veena Shankaran, Jing Zeng, and Shilpen Patel declare that they have no conflict of interest. Additionally, we would like to emphasize that there were neither financial grants nor funding sources that contributed to this research. Authors do not have industrial links or affiliations.

Ethical standard statement

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Author information

Authors and Affiliations

  1. School of Medicine, University of Washington, Seattle, WA, USA

    Camille Asher Berriochoa, Daniel Hibbard & Mary Morcos

  2. Center for Biomedical Statistics, University of Washington, Seattle, WA, USA

    Aasthaa Bansal & Bryan Comstock

  3. Department of Surgery, University of Washington, Seattle, WA, USA

    Brant Oelschlager & Carlos Pellegrini

  4. Department of Hematology and Oncology, University of Washington, Seattle, WA, USA

    Veena Shankaran

  5. Department of Radiation Oncology, University of Washington, Seattle, WA, USA

    Jing Zeng & Shilpen Patel

  6. University of Washington Medical Center, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195-6043, USA

    Shilpen Patel

Authors
  1. Camille Asher Berriochoa
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  2. Daniel Hibbard
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  3. Mary Morcos
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  4. Aasthaa Bansal
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  5. Bryan Comstock
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  6. Brant Oelschlager
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  7. Carlos Pellegrini
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  8. Veena Shankaran
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  9. Jing Zeng
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  10. Shilpen Patel
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Corresponding author

Correspondence to Shilpen Patel.

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Berriochoa, C.A., Hibbard, D., Morcos, M. et al. Tumor length as a prognostic factor in esophageal cancer management. J Radiat Oncol 4, 71–77 (2015). https://doi.org/10.1007/s13566-014-0179-y

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  • DOI: https://doi.org/10.1007/s13566-014-0179-y

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