Abstract
Background
The 7th edition of the Union for International Cancer Control (UICC) TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. In the 8th edition of UICC-TNM staging system, there is no information available for treatment modality (surgery alone or neoadjuvant therapy [NAC] followed by surgery [NAC-S]), although clinical stage, neoadjuvant pathologic stage, and pathologic stage were analyzed and identified. The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal squamous cell cancer (ESCC) patients treated by NAC-S.
Methods
Database of 140 consecutive ESCC patients in our hospital was retrospectively restaged in 7th and 8th UICC-TNM system. The prognostic impacts of pathologic stage after NAC according to the both staging systems were compared.
Results
The median follow-up period was 4.8 years (range 0.2–9.7), with 49 patients dead at the time of analysis. In 7th edition, the 3-year overall survival rates (3y-OS) of ypStages 0, I, II, III, and IV were 100%, 93.5%, 93.5%, 43.9%, and 0.0%, respectively. In 8th edition, the 3y-OS of ypStages 0, I, II, III, and IV were 100%, 96.5%, 90.2%, 51.7%, and 29.6%, respectively. There were no marked differences between 7th and 8th edition in the prognoses. The both editions poorly distinguish the prognoses of ypStages 0, I, and II. For pathological prognostic group in 7th edition, the 3y-OS of Groups 0, I, II, III, and IV were 100%, 97.0%, 90.6%, 43.9%, and 0.0%, respectively. For pathological prognostic group in 8th edition, the 3y-OS of Groups 0, I, II, III, and IV were 100%, 96.7%, 89.8%, 51.7%, and 29.6%, respectively. For patients with ypStages 0-II, pretreatment higher CEA was poor prognostic factor (HR 7.1, 95% confidence interval 1.9–25.9).
Conclusion
Our study indicates the problem that the ypStage in the 8th TNM staging system poorly distinguish the prognoses of ypStages 0, I, and II in patients undergoing NAC-S. Additional study is needed to evaluate the role of ypStage 0-II incorporation of new prognostic factors.
Disclosure
All authors have declared no conflicts of interest.
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