A Role for Tumor Volume Assessment in Resectable Esophageal Cancer.

Abstract

Esophageal cancer has a poor prognosis, and many patients undergoing surgery have a low chance of cure. Imaging studies suggest that tumor volume is prognostic. The study aimed to evaluate pathological tumor volume (PTV) as a prognostic variable in esophageal cancer. This single-center cohort study included 283 patients who underwent esophageal cancer resections between 2000 and 2012. PTVs were obtained from pathological measurements using a validated volume formula. The prognostic value of PTV was analyzed using multivariable regression models, adjusting for age, tumor grade, tumor(T) stage, nodal stage, lymphovascular invasion, resection margin, resection type, and chemotherapy response, which provided hazard ratios (HRs) with 95% confidence intervals (CIs). Primary outcomes were time to death and time to recurrence. Secondary outcomes were margin involvement and lymph node positivity. Correlation analysis was performed between imaging and PTVs. On unadjusted analysis, increasing PTV was associated with worse overall mortality (HR 2.30, 95% CI 1.41-3.73) and disease recurrence (HR 1.87, 95% CI 1.14-3.07). Adjusted analysis demonstrated worse overall mortality with increasing PTV but reached significance in only one subgroup (HR 1.70, 95% CI 1.09-2.38). PTV was an independent predictor of margin involvement (OR 2.28, 95% CI 1.02-5.13) and lymph node-positive status (OR 2.77, 95% CI 1.23-6.28). Correlation analyses demonstrated significant positive correlation between computed tomography (CT) software and formula tumor volumes (r=0.927, p<0.0001), CT and positron emission tomography tumor volumes (r=0.547, p<0.0001), and CT and PTVs (r=0.310, p<0.001). Tumor volume may predict survival, margin status, and lymph node positivity after surgery for esophageal cancer.