Abstract
BackgroundThe current TNM classification system does not consider tumor length for patients with esophageal carcinoma (EC). This study explored the effect of tumor length, in addition to tumor depth and lymph node involvement, on survival in patients with esophageal squamous cell carcinoma (ESCC).MethodsA total of 498 ESCC patients who underwent surgical resection as the primary treatment were selected in the retrospective study. Pathological details were collected, which included tumor type, TNM stage, differentiation. Other collected information were: the types of esophageal resection, ABO blood group, family history and demographic and lifestyle factors. A time-dependent receiver operating characteristic (ROC) curve and a regression tree for survival were used to identify the cut-off point of tumor length, which was 3 cm. Univariate and multivariate Cox proportional hazard regression models were used to identify the prognostic factors to ESCC.Results & DiscussionThe 1-, 3-, 5-year overall survival rates were found to be 82.5%, 55.6%, and 35.1%, respectively. Patients who had larger tumor length (>3 cm) had a higher risk for death than the rest patients. From the univariate Cox proportional hazards regression model, the overall survival rate was significantly influenced by the depth of the tumor and lymph node involvement (either as dummy or continuous variables), Sex, and tumor length. Using these four variables in the multivariate Cox proportional hazard regression model, we found that the overall survival was significantly influenced by all variables except Sex. Therefore, in addition to the depth of the tumor and lymph node involvement (as either dummy or continuous variables), the tumor length is also an independent prognostic factor for ESCC. The overall survival rate was higher in a group with smaller tumor length (≤3 cm) than those patients with larger tumor length (>3 cm), no matter what the tumor stage was.ConclusionThe tumor length was found to be an important prognostic factor for ESCC patients without receiving neoadjuvant therapy. The modification of EC staging system may consider tumor length to better predict ESCC survival and identify higher risk patients for postoperative therapy.
Highlights
Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death from cancer (Ferlay et al, 2010)
Our study indicated that T classification and N classification both were independent prognostic factors in esophageal carcinoma (EC)
Our results showed that the survival rate decreased as either tumor depth or lymph node involvement increased after controlling the other variables
Summary
Esophageal cancer is the eighth most common cancer worldwide and the sixth most common cause of death from cancer (Ferlay et al, 2010). In China, a few studies were conducted to show the association between the overall survival (OS) rate and the tumor length, among the survival of ESCC patients (Feng, Huang & Zhao, 2013; Ma et al, 2015; Wang et al, 2011; Wang et al, 2012). This study explored the effect of tumor length, in addition to tumor depth and lymph node involvement, on survival in patients with esophageal squamous cell carcinoma (ESCC). From the univariate Cox proportional hazards regression model, the overall survival rate was significantly influenced by the depth of the tumor and lymph node involvement (either as dummy or continuous variables), Sex, and tumor length. The modification of EC staging system may consider tumor length to better predict ESCC survival and identify higher risk patients for postoperative therapy
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