Abstract
PurposeThe aim of this work was to evaluate the prognostic value of tumor length and diameter for patients with esophageal squamous cell cancer (ESCC) treated with definitive (chemo)radiotherapy to identify potential indicators for separate nonsurgical T staging, which are needed in clinical practice.Materials and MethodsA total of 682 patients with ESCC who underwent definitive (chemo)radiotherapy between 2009 and 2015 were reviewed. Esophageal tumor length and diameter were determined by barium esophagography and computed tomography before treatment. Univariate and multivariate analyses were used to assess the impact of tumor length and diameter on long‐term overall survival (OS) and progression‐free survival (PFS). Propensity score matching (PSM) analysis was also used to control intergroup heterogeneity.ResultsThe median OS and PFS were 22.2 months and 15.4 months, respectively, in the tumor length ≤ 6 cm group, which were significantly longer than those in the tumor length > 6 cm group (13.4 and 8.5 months, respectively). The median OS and PFS were 23.3 months and 15.9 months, respectively, in the tumor diameter ≤ 3.5 cm group, which were also significantly longer than those in the tumor diameter > 3.5 cm group (13.3 and 8.8 months, respectively). Similar results were found after PSM. Univariate and multivariate analyses showed that tumor length and diameter were both independent predictors of long‐term survival.ConclusionTumor length and diameter are both independent prognostic factors for ESCC patients treated with definitive (chemo)radiotherapy. These two imaging parameters have the potential for development and use in nonsurgical T staging.
Highlights
Esophageal cancer was the seventh most frequent malignancy and the sixth leading cause of cancer death worldwide in 2018
In 2010, the Chinese clinical staging expert group proposed that the tumor length determined by barium esophagography and the tumor diameter determined by the maximum esophageal diameter shown by computed tomography (CT) be considered criteria for the nonsurgical T staging of esophageal cancer.[22]
We found that the tumor length ≤ 6 cm group had a significantly better progression‐free survival (PFS)/overall survival (OS) than the tumor length > 6 cm group
Summary
Esophageal cancer was the seventh most frequent malignancy and the sixth leading cause of cancer death worldwide in 2018. Modern imaging techniques can somehow reflect these pathological parameters but are limited by the resolution of each individual modality.[5] Using histologic criteria but based largely on imaging makes this staging coarse in nature.[3] it is reasonable to develop a nonsurgical TNM staging system that is more practical and feasible for esophageal cancer, especially for patients mainly treated with radiation. With this purpose in mind, potential indicators for nonsurgical T staging were preliminarily investigated in this study. In this study, we targeted patients with esophageal squamous cell cancer (ESCC) treated with definitive (chemo)radiotherapy and aimed to identify whether tumor length and diameter could predict prognosis and serve as potential T staging indicators
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