Comparison of the 6th and 7th Editions of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System in Patients With Resected Esophageal Carcinoma

Hsu, Po‐Kuei; Wu, Yu‐Chung; Chou, Teh-Ying; Huang, Chang‐Hung; Hsu, Wen Hu

doi:10.1016/j.athoracsur.2010.01.017

Cited by 99 publications

(79 citation statements)

References 20 publications

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“…Compared with the 6 th edition, the 7 th edition was more complicated, and the most significant distinctions were adding the histological type, differentiation, tumor location besides for the T-and N-category. As for the tumor grade and location, the results were still inconsistent (5,14,21,22). Agree with the views of our results, a 292 patient-based study also showed grade of differentiation of esophageal cancer as a prognostic factor in univariate analysis but not in multivariate analysis (22).…”

Section: Discussionsupporting

confidence: 57%

“…Agree with the views of our results, a 292 patient-based study also showed grade of differentiation of esophageal cancer as a prognostic factor in univariate analysis but not in multivariate analysis (22). Based on analysis of 392 ESCC patients who underwent primary surgical resection, Hsu et al did not find tumor grade and location to be significant prognostic factors in their database (5). Although many studies showed that survival improves in the lower third location esophageal cancer, these studies mainly consisted of a large portion of EAC, and the results may not reflect the exact impact of tumor location on ESCC prognosis (23)(24)(25) I, II, III, and IV) did not reveal any significant prognostic impact of tumor location (21).…”

Section: Discussionmentioning

confidence: 72%

“…Our results demonstrated that significant discrepancy of 3-year survival were seen among T3 (54.4%), T4a (39.1%) and T4b (18.5%). Both in EAC and ESCC patients, the differentiation among pT3, pT4a and pT4b also showed statistically significant differences in prognosis (P<0.001) (5,13,18). Thus, the 7 th edition for T stratification provided a better prognostic power, and discriminated effectively for patients with esophageal cancer with resection.…”

Section: Discussionmentioning

confidence: 89%

“…Union for International Cancer Control-American Joint Committee on Cancer (UICC-AJCC) tumor, node, metastasis (TNM) staging system for esophageal cancer has been used worldwide to predict the prognosis, to minimize inappropriate treatment, and allowing for the communications conveniently among different institutions. Previous studies have shown the implication of the 7 th UICC-AJCC TNM staging system in a better prognostic stratification for patients' overall survival (OS) in comparison with the 6 th edition (3)(4)(5). However, most studies were from western countries.…”

Section: Original Articlementioning

confidence: 90%

“…Previous studies based on the data mainly from EAC patients, concluded that the 7 th edition AJCC TNM staging system was a better model for predicting outcomes (5,10). However, in comparison with EAC, patients with ESCC has worse prognosis and a distinct pattern of lymphatic spread, and are susceptible to spread locally rather than systemically (11,12).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the 7th edition of the UICC-AJCC tumor, node, metastasis classification for esophageal cancer in a Chinese cohort

et al. 2016

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Background: To assess and evaluate the prognostic value of the 7 th edition of the Union for InternationalCancer Control-American Joint Committee on Cancer (UICC-AJCC) tumor, node, metastasis (TNM) staging system for Chinese patients with esophageal cancer in comparison with the 6 th edition. Methods: A retrospective review was performed on 766 consecutive esophageal cancer patients treated with esophagectomy between 2008 and 2012. Patients were staged according to the 6 th and 7 th editions for esophageal cancer respectively. Survival was calculated by the Kaplan-Meier method, and multivariate analysis was performed using Cox regression model. Results: Overall 3-year survival rate was 59.5%. There were significant differences in 3-year survival rates among T stages both according to the 6 th edition and the 7 th edition (P<0.001). According to the 7 th edition, the 3-year survival rates of N0 (75.4%), N1 (65.2%), N2 (39.7%) and N3 (27.3%) patients were significant differences (P<0.001). Kaplan-Meier curve revealed a good discriminatory ability from stage I to IV, except for stage IB, IIA and IIB in the 7 th edition staging system. Based on the 7 th edition, the degree of differentiation, tumor length and tumor location were not independent prognostic factors on multivariate analysis. The multivariate analyses suggested that pT-, pN-, pTNM-category were all the independent prognostic factors based on the 6 th and 7 th edition staging system. Conclusions: The 7 th edition of AJCC TNM staging system of esophageal cancer should discriminate pT2-3N0M0 (stage IB, IIA and IIB) better when considering the esophageal squamous cell cancer patients.Therefore, to improve and optimize the AJCC TNM classification for Chinese patients with esophageal cancer, more considerations about the value of tumor grade and tumor location in pT2-3N0M0 esophageal squamous cell cancer should be taken in the next new TNM staging system.

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