Tumor location is an independent prognostic factor of esophageal adenocarcinoma based on the eighth edition of TNM staging system in Chinese patients

Abstract

Background: Whether tumor location has any impact on the survival of esophageal adenocarcinoma patients remains unclear. Therefore, we aimed to investigate the prognostic value of tumor location for esophageal adenocarcinoma based on the eighth edition of tumor-node-metastasis (TNM) staging system in Chinese patients for the first time.Methods: We conducted a retrospective analysis of patients undergoing esophagectomy for esophageal adenocarcinoma in our department. We analyzed the data about demography, comorbidity, pathologic findings, surgical approach, adjuvant therapy, and survival time. Tumor location was categorized into two groups: adenocarcinomas at the esophagogastric junction (EGJ) and adenocarcinomas at other sites of the esophagus. Both univariate and multivariate analyses were applied. And propensity-score matched (PSM) analysis was also conducted for comparison.Results: A total of 107 patients from January 2009 to December 2015 were involved in the analysis. The median follow-up time was 60.0 months and the median survival time of all those patients was 41.0 months.In the univariate analysis, adenocarcinomas in the EGJ (P=0.047), early pT stage (P=0.030), and moderate/ well differentiation (P=0.022) were significantly correlated with better survival. Moreover, in the multivariate analysis, tumor site [hazard ratio (HR) =0.536; 95% confidence interval (CI) =0.300-0.958], pT stage (HR =0.298; 95% CI =0.124-0.717), and tumor differentiation (HR =0.437; 95% CI =0.238-0.802) were significant independent prognostic factors for overall survival of these esophageal adenocarcinoma patients.

Abdominal lymph node metastasis in non-surgical esophageal squamous cell carcinoma: prognostic significance and a novel staging strategy

“…The tumor’s location can affect the prognosis of surgical patients and is included in the pathological staging system. Although the impact of tumor location on the prognosis of surgical patients is still controversial, the studies showed that the tumor in the lower segment had a better prognosis as compared to those in the middle and upper segments, especially among the patients with T3N0M0 ( 27 – 30 ). Interestingly, this study identified the primary tumor location as an independent prognostic factor for the patients receiving radiotherapy; these results were consistent with previous studies ( 31 , 32 ).…”

Unraveling the identity of gastric cardiac cancer

“…gastric cancer and demonstrates better prognosis than EAC, especially for patients with stage III GCC. 35,127,128 In 2009 the seventh edition of the AJCC staging manual required GCC to be classified and staged like EAC. 3 This dramatic change in paradigm has invited intense debate on the predictive value of this decision on the prognosis of patients with GCC.…”

“…Accurate prognostic stratification of GCC patient survival remains an unmet, but urgent need. GCC is traditionally classified and staged as gastric cancer and demonstrates better prognosis than EAC, especially for patients with stage III GCC 35,127,128 . In 2009 the seventh edition of the AJCC staging manual required GCC to be classified and staged like EAC 3 .…”

Clinical significance and prognosis of supraclavicular lymph node metastasis in patients with thoracic esophageal cancer

“…However, the supraclavicular lymph nodes (SCLNs) remain as distant metastases (M1). Many clinicians believe that distant metastatic lesions should not be treated surgically, but some studies have shown that patients with SCLNs metastases have a better prognosis than other organs metastases (3,4). Therefore, whether there is a need for SCLNs dissection for thoracic esophageal cancer is still controversial (5,6).…”