Worldwide Esophageal Cancer Collaboration: pathologic staging data

Abstract

SUMMARYWe report data-simple descriptions of patient characteristics, cancer categories, and non-riskadjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. 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. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.

Clinical outcomes of video-assisted thoracoscopic surgery esophagectomy for esophageal cancer: a propensity score-matched analysis

“…Our overall incidence of pulmonary complications and pneumonia in OE was comparable with that of other previous studies (5). The number of harvested lymph nodes was not significantly different (31 vs. 33, P=0.198) between the two groups, satisfying the requirements for the Worldwide Esophageal Cancer Collaboration data (12,13). Lagerson and colleagues suggested that a higher number of harvested lymph nodes provided better survival in esophageal cancer (2).…”

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

“…That prognostication based on cTNM differs from that based on pTNM reflects inaccuracies of obtaining cancer facts by current clinical staging modalities. These inaccuracies result in dissimilar stage group composition and survival profiles of cTNM vs. pTNM groups (2,(5)(6)(7).…”

“…Clinical staging: prognostication Survival according to cTNM stage groups is "pinched together" compared with pathologic stage groups (2,3,5,6). …”

“…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.…”

Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals

“…Finally, to simplify prognostication, the consensus pTNM 5 stage group with equivalent survival to each consensus ypTNM stage group was identified.…”