Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data

Abstract

SUMMARY To address uncertainty of whether pathologic stage groupings after neoadjuvant therapy (ypTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data—simple descriptions of patient characteristics, cancer categories, and non–risk-adjusted survival—for pathologically staged cancers after neoadjuvant therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 7,773 pathologically staged neoadjuvant patients, 2,045 had squamous cell carcinoma, 5,686 adenocarcinoma, 31 adenosquamous carcinoma, and 11 undifferentiated carcinoma. Patients were older (61 years) men (83%) with normal (40%) or overweight (35%) body mass index, 0–1 Eastern Cooperative Oncology Group performance status (96%), and a history of smoking (69%). Cancers were ypT0 (20%), ypT1 (13%), ypT2 (18%), ypT3 (44%), ypN0 (55%), ypM0 (94%), and G2-G3 (72%); most involved the distal esophagus (80%). Non–risk-adjusted survival for yp categories was unequally depressed, more for earlier categories than later, compared with equivalent categories from prior WECC data for esophagectomy-alone patients. Thus, survival of patients with ypT0-2N0M0 cancers was intermediate and similar regardless of ypT; survival for ypN+ cancers was poor. Because prognoses for ypTNM and pTNM categories are dissimilar, prognostication should be based on separate ypTNM categories and groupings. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics and should direct 9th edition data collection.

Worldwide Esophageal Cancer Collaboration: pathologic staging data

“…These differences were far greater than those seen in patients receiving neoadjuvant therapy. 8 This likely reflects patient selection for neoadjuvant therapy. These differences necessitate risk adjustment in any future analysis.…”

“…However, the role of pure pathologic staging for treatment decision and prognostication for these cancers is waning. 4,8 …”

8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice

“…Staging of cancer of the esophagus and esophagogastric junction (EGJ), presented in chapter 16 of the 8th edition American Joint Committee on Cancer (AJCC) Cancer Staging Manual (1), was derived from a machine-learning analysis of data from six continents from the Worldwide Esophageal Cancer Collaboration (WECC) (2)(3)(4)(5)(6)(7). The purpose of this manuscript is to review staging in the 8th edition, which now includes clinical (cTNM), pathologic (pTNM), and postneoadjuvant therapy (ypTNM) stage groupings, and examine its application to clinical practice.…”

Neoadjuvant chemoradiation for patients with advanced oesophageal cancer – which response grading system best impacts prognostic discrimination?

“…Data for this system are derived from patients treated with surgery alone, and the prognostic value of the TNM staging system is limited for patients undergoing neoadjuvant therapy prior to surgery . There are recommendations by the American Joint Committee on Cancer (AJCC) for a neoadjuvant pathological staging system (ypTNM), but these have not yet been appended to the current TNM staging system.…”