Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

Abstract

Objective To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer (EC).Methods A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound (EUS),esophagoscopy,thoracic CT scans,and contrast esophagography and had detailed information on postoperative pathological stages.The predictive value of preoperative clinical T/N stage based on EUS + CT for postoperative pathological stage was analyzed.The diseasefree survival (DFS) and overall survival (OS) were analyzed according to the UICC TNM classification (2002/ 2009) and the clinical stage based on imaging findings.Results The median follow-up was 47 months.A total of 305 (85.2％) of all patients were analyzed by clinical stage based on EUS + CT.Among them,the predictive value of clinical T stage for pathological T stage was 0-88.6％,highest (88.6％) for T1 stage and lowest for T4 stage.The predictive value of clinical N stage (N0/N1) was 62.5-100％.The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted (P =0.000 and 0.000).There were significant differences in OS between stage groups,except the comparison between two stage Ⅳ patients and other groups,according to 2002 UICC TNM classification.There were usually insignificant differences in OS between stage groups,according to 2009 UICC TNM classification.For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification,significant differences in OS and DFS rates were noted (P =0.000 and 0.000).Conclusions Imaging modalities show good predictive value for N stage (N0/N1),even though they cannot accurately provide the number of metastatic lymph nodes.The clinical stage based on EUS + CT can effectively predict the prognosis of non-surgical EC patients. Key words: Esophageal neoplasms; Non-surgical clinical stage; UICC stage grouping; Prognosis