Concordance of studies for nodal staging is prognostic for worse survival in esophageal cancer

Abstract

Pretreatment clinical staging in esophageal cancer influences prognosis and treatment strategy. Current staging strategies utilize multiple imaging modalities, and often the results are contradictory. No studies have examined the implications of concordance of computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS) when used for the evaluation of nodal disease. The objective of this study was to determine if concordance of CT, PET, or EUS for nodal disease predicts worse overall survival. We reviewed 615 esophageal cancer patients with pretreatment CT, PET, and EUS that underwent esophagectomy for survival outcomes based on concordance of studies for nodal disease. Concordant N+ is defined as two or three studies positive for nodal disease; non-concordant N+ is defined as only one positive study. Node-positive disease by any study predicted shorter survival than node-negative disease (42% vs. 73% 5-year survival; P<0.001). Additionally, non-concordant N+ patients had shorter survival than N- patients (52% vs. 73% 5-year survival; P<0.001). Concordant N+ patients had shorter survival than non-concordant N+ patients (38- vs. 61-month median survival; P=0.017). There were no statistically significant differences in survival based on specific combinations of studies. When PET was disregarded, patients with both CT+ and EUS+ had shorter survival than patients with either CT+ or EUS+ (39- vs. 58-month median survival; P=0.029). Pretreatment CT, PET, or EUS concordance for node-positive disease predicts shorter overall survival in patients that undergo esophagectomy for esophageal cancer. Predicting survival in esophageal cancer should consider the synergistic capabilities of CT, PET, and EUS in evaluating nodal status.

UBE2D3 is a positive prognostic factor and is negatively correlated with hTERT expression in esophageal cancer

“…The present univariate and multivariate analysis indicated that tumor location (upper versus middle and lower thoracic) was associated with survival rate and may be an independent prognostic factor in esophageal cancer. In addition, the present study identified that lymph node involvement may be an independent prognostic factor for esophageal cancer, which was consistent with the results of previous studies (28,29). …”

Discordant nodal staging identifies intermediate-risk group for overall survival in patients with cT3 oesophageal adenocarcinoma

“…These results are consistent with data from a cohort of oesophageal cancer patients who underwent oesophagectomy [12]. This study also described an intermediate-risk group comprising patients with discordant staging investigations, in which DC patients had better over survival than C+ve patients.…”

“…Important treatment decisions often hinge on the classification of nodal metastases on PET/CT and EUS examinations. In a previous study, Dhupar et al [12] reviewed 615 patients with oesophageal cancer from a single centre who underwent oesophagectomy for survival outcomes based on concordance of staging investigations for nodal disease. In summary, the study found that patients with discordance in nodal staging between imaging modalities had a better overall survival than patients with positively concordant nodal staging.…”

Preoperative Chemoradiation Therapy Versus Chemotherapy in Patients Undergoing Modified En Bloc Esophagectomy for Locally Advanced Esophageal Adenocarcinoma: Is Radiotherapy Beneficial?

“…Indeed, these patients were clustered early in the study period when diagnostic modalities, such as EUS and PET/CT, were less frequently applied, resulting in a high proportion of clinically understaged patients in this subgroup. Nonetheless, even with the most modern and thorough use of clinical staging modalities, discrepancies with pathologic stage continue to occur in as many as 20% of patients [10].…”