Impact of Tumor Length on Survival for Patients with Resected Esophageal Cancer

Abstract

Background: Tumor length in patients with esophageal cancer (EC) has recently received great attention. However, its prognostic role for EC is controversial. The purpose of our study was to characterize the prognostic value of tumor length in EC patients and offer the optimum cut-off point of tumor length by reliable statistical methods. Materials and Methods: A retrospective analysis was conducted on 71 consecutive patients with EC who underwent surgery. ROC curve analysis was used to determine the optimal cut-off point for tumor length, measured with a handheld ruler after formalin fixation. Correlations between tumor length and other factors were surveyed, and overall survival (OS) rates were compared between the two groups. Potential prognostic factors were evaluated by univariate Kaplan-Meier survival analysis. A P value less than 0.05 was considered significant. Results: There were a total of 71 patients, with a male/ female divide of 43/28 and a median age of 59. Characteristics were as follows: squamous/adenocarcinoma, 65/6; median tumor length, 4 (0.9-10); cut-off point for tumor length, 4cm. Univariate analysis prognostic factors were tumor length and modality of therapy. One, three and five year OS rates were 84, 43 and 43% for tumors with ≤4cm length, whereas the rates were 75, 9 and 0% for tumors >4 cm. There was a significant association between tumor length and age, sex, weight loss, tumor site, histology, T and N scores, differentiation, stage, modality of therapy and longitudinal margin involvement. Conclusions: Future studies for modification of the EC staging system might consider tumor length too as it is an important prognostic factor. Further assessment with larger prospective datasets and practical methods (such as endoscopy) is needed to establish an optimal cut-off point for tumor length.

Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer

“…Historically, tumor length was included as part of the TNM staging, but this was abandoned in 1987 . Nevertheless, in recent years studies have demonstrated tumor length to have potential in predicting prognosis . However, these studies had variable methodology: with some using tumor lengths determined by surgeons immediately postoperation, while others only measured using endoscopy .…”

“…However, these studies had variable methodology: with some using tumor lengths determined by surgeons immediately postoperation, while others only measured using endoscopy . In addition, some studies only included squamous cell carcinomas and others had small sample sizes . There is debate as to the optimal cut‐off value for tumor length as a negative prognostic factor, with studies suggesting either 3, 3.5, and 4 cm measurements.…”

“…16 Nevertheless, in recent years studies have demonstrated tumor length to have potential in predicting prognosis. [16][17][18][19][20][21][22] However, these studies had variable methodology: with some using tumor lengths determined by surgeons immediately postoperation, 17 while others only measured using endoscopy. 18 In addition, some studies only included squamous cell carcinomas 19 and others had small sample sizes.…”

Retrospective Study of Adjuvant Chemotherapy Effects on Survival Rate after Three-Field Lymph Node Dissection for Stage IIA Esophageal Cancer

“…Surgical resection still remains the preferred treatment and the best choice for ESCC (Mirinezhad et al, 2014). Despite of surgery alone is usually curative for early stage tumor, the 5 year survival rate of those postoperative patients remains low, even after extended surgery (Mariette et al, 2007).…”

Efficacy of Taxane-Based Regimens in a First-line Setting for Recurrent and/or Metastatic Chinese Patients with Esophageal Cancer

“…More than two-thirds of patients would be initially diagnosed as unresectable or metastatic disease (Thallinger, et al, 2011). Even patients with resectable disease have a high rate of recurrence with the expected median survival being only 24 months, and 5-year survival rate lower than 30% (Thallinger, et al, 2011;Mirinezhad, et al, 2014). The combination chemotherapy of 5-fluorouracil and cisplatin (PF) is the mainstay of palliative treatment for advanced or recurrent cancer (Nakajima, et al, 2013), however, their poor outcomes require urgently new researches been conducted.…”