Abstract
Esophageal cancer represents the 6th cause of cancer mortality in the World. New treatments led to outcome improvements, but patient selection and prognostic stratification is a critical aspect to gain maximum benefit from therapies. Today, patients are stratified into 9 prognostic groups, according to a staging system developed by the American Joint Committee on Cancer. Recently, trying to better select patients with curing possibilities several authors are reconsidering tumor length as a valuable prognostic parameter. Specifically, endoscopic tumor length can be easily measured with an esophageal endoscopy and, if its utility in esophageal cancer staging is demonstrated, it may represent a simple method to identify high risk patients and an easy-to-obtain variable in prognostic stratification. In this study we retrospectively analyzed 662 patients treated for esophageal cancer, stratified according to cancer histology and current staging system, to assess the possible role of endoscopic tumor length. We found a significant correlation between endoscopic tumor length, current staging parameters and 5-year survival, proving that endoscopic tumor length may be used as a simple risk stratification tool. Our results suggest a possible indication for preoperative therapy in early stage squamocellular carcinoma patients without lymph nodes involvement, who are currently treated with surgery alone.
Highlights
IntroductionDespite recent improvements in survival esophageal cancer remains one of the deadliest diseases, with an overall 5-year survival less than 20% [1,2,3,4,5]
Worldwide, esophageal cancer accounts for more than 400,000 deaths every year
N: number of patients; ETL: endoscopic tumor length; squamous cell carcinoma (SCC): squamocellular carcinoma; AC: adenocarcinoma, pathologically determined T (pT): pathological tumor depth, pathologically determined N (pN): pathological lymph node involvement, pTNM: pathological prognostic stage according to American Joint Committee on Cancer 7th Ed. (AJCC)
Summary
Despite recent improvements in survival esophageal cancer remains one of the deadliest diseases, with an overall 5-year survival less than 20% [1,2,3,4,5]. Prognostic stratification of these patients is crucial to provide them with the best multimodal treatment available. Disease staging is based on endoscopy and Computed Tomography (CT) scan, and often integrated with Positron Emission Tomography—Computed Tomography (FDG-PET-CT scan) and endoscopic ultrasonography (EUS); those exams are not always available and are not always so accurate. Esophageal endoscopy, used routinely to diagnose esophageal malignancies, is a simple exam, which is well standardized and usually available even in community hospitals and in low-income socioeconomic settings [9,10,11,12,13,14,15,16]
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