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Comparison of the prognostic value of the 6th and 7th editions of the Union for International Cancer Control TNM staging system in patients with lower esophageal cancer undergoing neoadjuvant chemotherapy followed by surgery

Authors

  • S. P. Mehta,

    1. Department of Upper GI Surgery, Bexley Wing, St James's University Hospital, Leeds, UK
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  • P. Jose,

    1. Department of Upper GI Surgery, Bexley Wing, St James's University Hospital, Leeds, UK
    2. Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
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  • A. Mirza,

    1. Department of Upper GI Surgery and Histopathology, University Hospitals of South Manchester, Manchester, UK
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  • S. A. Pritchard,

    1. Department of Upper GI Surgery and Histopathology, University Hospitals of South Manchester, Manchester, UK
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  • J. D. Hayden,

    1. Department of Upper GI Surgery, Bexley Wing, St James's University Hospital, Leeds, UK
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  • H. I. Grabsch

    Corresponding author
    1. Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK
      Dr Heike Grabsch, MD, PhD, FRCPath, Pathology and Tumor Biology, Leeds Institute of Molecular Medicine, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: h.i.grabsch@leeds.ac.uk
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  • Author contributions: Dr Jose and Dr Mirza were involved in data acquisition. Dr Pritchard and Dr Grabsch involved in histopathologic analysis of specimens, and Dr Mehta involved in analysis and construction of the manuscript. Drs Hayden and Grabsch contributed to the manuscript.

  • Disclosure: The authors have no commercial interests to disclose.

  • Synopsis: Comparison of the prognostic value of the UICC TNM 6th and 7th edition in patients with esophageal carcinoma treated with chemotherapy followed by surgery. TNM 7th edition introduces a third tier in survival stratification for patients with lymph node involvement.

Dr Heike Grabsch, MD, PhD, FRCPath, Pathology and Tumor Biology, Leeds Institute of Molecular Medicine, Wellcome Trust Brenner Building, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK. Email: h.i.grabsch@leeds.ac.uk

SUMMARY

Carcinoma of the esophagus is classified according to the Union for International Cancer Control (UICC) TNM staging system. The 7th edition of the UICC TNM staging system was published in 2009. This is the first study to compare the prognostic value of the TNM 6th and 7th editions in patients with esophageal carcinoma treated with chemotherapy followed by surgery. Two hundred forty-three patients with esophageal carcinoma were retrospectively selected from two referral centers. All patients received chemotherapy before surgery. Histopathologic data from the resection specimens were retrieved and restaged according to the TNM 7th edition. Disease-specific survival curves were plotted for depth of tumor invasion (ypT), lymph node status (ypN), and ypTNM stage and then compared. Median follow-up after surgery was 2.5 years (range 0.2–9 years). Survival analysis using the log-rank method revealed that there was a significant difference in survival between ypT4 disease and ypT3 disease (P= 0.003), but no difference between ypT0, ypT1, ypT2, and ypT3 categories irrespective of TNM edition used. Survival probability was significantly different between ypN0 and ypN1 (P= 0.001 for TNM 6th and 7th edition), as well as ypN2 and ypN3 (TNM 7th edition, P= 0.004), but not between ypN1 and ypN2 (TNM 7th edition, P= 0.89). Neither the TNM 6th nor 7th edition T staging provides accurate survival probability stratification. However, the advantage of the 7th edition is the introduction of a third tier in survival stratification for patients with nodal involvement.

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