Abstract
Background. Several researchers have determined the tumor length to be an important prognostic indictor of esophageal cancer (EC). However, controversy exists concerning the optimal cut-off points for tumor length to predict overall survival. The aim of this study was to determine the prognostic value of tumor length and propose the optimum cut-off point for tumor length in predicting survival difference in elderly patients with esophageal squamous cell carcinoma (ESCC).Methods. From January 2001 to December 2009, a retrospective analysis of 132 consecutive patients older than 70 years with ESCC was conducted. A receiver-operating characteristic (ROC) curve for survival prediction was plotted to verify the optimum cut-off point for tumor length. Univariate and multivariate analyses were performed to evaluate prognostic parameters for survival.Results. A ROC curve for survival prediction was plotted to verify the optimum cut-off point for tumor length, which was 4.0 cm. Patients with tumor length ≤4.0 cm had significantly better 5-year survival rate than patients with a tumor length >4.0 cm (60.7% versus 31.6%, P = 0.007). Multivariate analyses showed that tumor length (>4.0 cm versus ≤4.0 cm, P = 0.036), differentiation (poor versus well/moderate, P = 0.032), N staging (N1-3 versus N0, P = 0.018), and T grade (T3-4 versus T1-2, P = 0.002) were independent prognostic factors.Conclusion. Tumor length is a predictive factor for long-term survival in elderly patients with ESCC, especially in T3-4 grade or nodal-negative patients. We conclude that 4.0 cm may be the optimum cut-off point for tumor length in predicting survival in elderly patients with ESCC.
Highlights
Esophageal cancer (EC) is the eighth most common type of cancer worldwide
All of the patients included in the analysis fit the following criteria: 1) esophageal squamous cell carcinoma (ESCC) confirmed by histopathology; 2) older than 70 years; 3) curative esophagectomy with R0 resection; 4) at least six lymph nodes were examined for pathological diagnosis; and 5) surgery was neither preceded nor followed by adjuvant chemotherapy and/or radiotherapy
It was found that tumor length is a predictive factor for long-term survival in elderly patients with ESCC, especially in T3-4 grade or nodal-negative patients
Summary
Esophageal cancer (EC) is the eighth most common type of cancer worldwide. It is endemic in many parts of the world, in developing nations, and accounts for more than 200,000 deaths every year in China [1]. Controversy exists concerning the optimal cut-off points for tumor length to predict overall survival [4,5,8]. Different histological types, variable inclusion criteria, and, most importantly, unreliable statistical methods used to determine the cut-off points have contributed to this controversy [4,5,8,9,10]. Controversy exists concerning the optimal cut-off points for tumor length to predict overall survival. The aim of this study was to determine the prognostic value of tumor length and propose the optimum cut-off point for tumor length in predicting survival difference in elderly patients with esophageal squamous cell carcinoma (ESCC). We conclude that 4.0 cm may be the optimum cut-off point for tumor length in predicting survival in elderly patients with ESCC
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