Several reports have questioned the appropriateness of the 6th edition of the International Union Against Cancer tumor node metastases guidelines for staging esophageal cancer.
Additional pathologic characteristics, besides the 3 basic facets of anatomic spread, might also have prognostic value.
Dr Bas Wijnhoven and colleagues evaluated prognostic factors and tumor staging in patients after esophagectomy for cancer.
|Subdivision of early tumors showed 5-year survival differences|
|Annals of Surgery|
The team evaluated all patients who underwent resection of the esophagus for carcinoma between 1995 and 2003 were extracted from a prospective database.
Univariate and multivariate analysis was performed to identify prognostic factors for survival.
The goodness of fit and accuracy of 3 staging models predicting survival were assessed.
The staging models included the International Union Against Cancer tumor node metastases, Korst classification, and Rice classification.
The researchers reported that a total of 292 patients underwent esophagectomy.
The 5-year overall survival rate was 29%.
The team found that p tumor-, p node-, and p metastases-stage, and radicality of the resection were independent prognostic factors.
The research team found subdivision of tumors into mucosal and submucosal showed significant differences in 5-year survival between both groups.
Using this subdivision, the team observed the 5-year survival rate for those in the mucosal group was 90% vs 47% in the submucosal group.
Subdivision of p node-stage into 3 groups based on the number of positive nodes, or the lymph node ratio also refined staging.
The research team noted that the current subclassification of metastases 1 is not warranted.
The staging model of Rice was more accurate than the International Union Against Cancer tumor node metastases classification in predicting survival.
Dr Wijnhoven's team concluded, "This study supports the view that the current International Union Against Cancer tumor node metastases
staging model for esophageal cancer needs to be revised."