O2-11-3 - Implications for the Ajcc Staging Systems on Esophageal Squamous Cell Cancer Patients Receiving Multimodality Therapy

Abstract

Background: The 7th edition of the American Joint Committee on Cancer (AJCC) staging system is based on pathologic data from esophageal cancers treated by surgery alone. The objective of this study was to evaluate the prognostic impact of the pre-treatment clinical stage (cTNM) and post-treatment pathologic stage (ypTNM) on esophageal cancer patients undergoing neoadjuvant chemotherapy followed by surgery (NAC-S).Methods: Information on 235 consecutive esophageal squamous cell carcinoma patients undergoing NAC-S was reviewed. Data collected included demographics, cTNM, ypTNM, and survival. Statistical methods included the Cox regression model, Akaike information criterion (AIC) within the Cox proportional hazard regression model, and Kaplan-Meier analyses.Results: The overall three-year survival rate was 67.6%. There were significant differences between stages II and III in cTNM and ypTNM stage, respectively (P < 0.01, respectively). There were no significant survival differences between stages I and II, between stages III and IV in each TNM stage. For all patients, cN stage (cN0 vs. cN1-3), ypT stage (ypT0-2 vs. ypT3-4), and ypM stage were the better predictor of outcome for patients who underwent Neo-S than downstage or treatment effect by multivariate analysis (P < 0.05). Compared with cTNM stage, ypTNM stage has a smaller AIC value, which described the optimum prognostic stratification.Conclusions: Our study indicates that the cTNM stage of 7th edition of AJCC staging system also does not accurately predict survival in esophageal squamous cell cancer patients receiving multimodality therapy.