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Prognostic significance of total disease length in esophageal cancer

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Abstract

Background

This study tested the hypothesis that endoluminal ultrasound (EUS) defined total length of disease (including both the primary tumor and the position and number of proximal and distal lymph nodes-ELoD) and the associated EUS lymph node metastasis count (ELNMC) are better predictors of outcome than endoscopic esophageal cancer (OC) length and radiological tumor node metastasis stage in patients who undergo potentially curative treatment with surgery or definitive chemoradiotherapy (dCRT).

Methods

A total of 645 consecutive patients diagnosed with OC and managed by a multidisciplinary team were staged by CT and EUS. The primary outcome measure was survival from date of diagnosis.

Results

A total of 323 patients received surgery (208 neoadjuvant chemotherapy), and 322 who were deemed unsuitable for surgery received dCRT. Univariable analysis revealed that survival was related to EUS T (p < 0.0001), N (p < 0.0001), EUS primary tumor length (p = 0.037), ELoD (p = 0.011), ELNMC (p < 0.0001), and treatment type (p = 0.001). Multivariable analysis revealed two factors: ELoD (hazard ratio (HR), 0.961; 95 % confidence interval (CI), 0.925–0.998; p = 0.041) and ELNMC (HR, 1.08; 95 % CI, 1.015–1.15; p = 0.016) were independently associated with survival.

Conclusions

ELoD and ELNMC should become part of routine OC radiological staging to optimize stage-directed therapeutic outcomes.

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Acknowledgments

This work has been published in part in abstract form: Br J Surg 2010;97(S2):60.

Disclosures

No financial support or commercial backing was received in relation to this work. L. Davies, J.D. Mason, S.A. Roberts, D. Chan, T.D. Reid, M. Robinson, S. Gwynne, T.D. Crosby, and W.G. Lewis have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. South East Wales Cancer Network, Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK

    L. Davies, J. D. Mason, D. Chan, T. D. Reid & W. G. Lewis

  2. South East Wales Cancer Network, Department of Radiology, University Hospital of Wales, Cardiff, UK

    S. A. Roberts

  3. Department of Radiology, Royal Gwent Hospital, Newport, UK

    M. Robinson

  4. Department of Oncology, Velindre Hospital, Cardiff, UK

    S. Gwynne & T. D. Crosby

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  1. L. Davies
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  2. J. D. Mason
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  3. S. A. Roberts
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  4. D. Chan
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  5. T. D. Reid
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  6. M. Robinson
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  7. S. Gwynne
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  8. T. D. Crosby
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  9. W. G. Lewis
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Correspondence to L. Davies.

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Davies, L., Mason, J.D., Roberts, S.A. et al. Prognostic significance of total disease length in esophageal cancer. Surg Endosc 26, 2810–2816 (2012). https://doi.org/10.1007/s00464-012-2250-3

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  • DOI: https://doi.org/10.1007/s00464-012-2250-3

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