Proposed Revision of the Esophageal Cancer Staging System to Accommodate Pathologic Response (pP) Following Preoperative Chemoradiation (CRT)
| Autor: | Lucian R. Chirieac, Jaffer A. Ajani, Frederick L. Greene, Ara A. Vaporciyan, Wayne L. Hofstetter, Alexandria T. Phan, Kelly K. Hunt, Nipun B. Merchant, Garrett L. Walsh, Kelly M. McMasters, Jack A. Roth, Ritsuko Komaki, Zhongxing Liao, David C. Rice, Tsung T. Wu, Joseph Locicero, Edward M. Copeland, Stephen G. Swisher, Arlene M. Correa, Stephen B. Vogel, Gerard M. Doherty |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male medicine.medical_specialty genetic structures Esophageal Neoplasms medicine.medical_treatment Adenocarcinoma medicine Carcinoma Humans Neoplasm Invasiveness Esophagus Aged Neoplasm Staging Preoperative chemoradiotherapy Chemotherapy business.industry Esophageal disease Cancer Original Articles Middle Aged Esophageal cancer medicine.disease Combined Modality Therapy Survival Analysis Neoadjuvant Therapy Surgery Radiation therapy medicine.anatomical_structure Multivariate Analysis Female Radiology business |
| Zdroj: | Annals of Surgery. 241:810-820 |
| ISSN: | 0003-4932 |
| Popis: | Carcinoma of the esophagus and gastroesophageal junction (GEJ) is an aggressive disease with a poor prognosis.1–3 Because of poor outcomes with surgery alone, an increasing number of patients with locoregionally advanced esophageal cancer are treated with preoperative chemoradiation (CRT) and surgery.4,5 The impact of this treatment paradigm shift on the pathologic stage (pTNM) esophageal cancer staging system has not been clearly defined. When surgery alone is the primary therapy, the best predictor of survival and long-term survival is the surgical pathologic stage according to the American Joint Committee on Cancer (AJCC) staging criteria.6,7 Because of pathologic down-staging, the possibility exists that CRT-treated patients may have different survivals than patients treated with surgery alone. Additionally, it is well known that a complete pathologic response (pP) (path CR, 0% residual cancer) following CRT is associated with improved long-term survival.8–10 We have recently demonstrated that a partial pP is also prognostic following CRT, with improved outcomes in patients who have partial pPs (1%–50% residual cancer) compared with no pP (>50% residual cancer).11 This manuscript extends these initial observations and evaluates the impact of complete and partial pPs on the pTNM esophageal cancer staging system. Our study shows that pP is an independent predictor for long-term survival in patients treated with CRT. In this manuscript, we propose a modified pTNM esophageal cancer staging system to incorporate this prognostic factor (pP: P0, 0% residual; P1, 1%–50% residual; P2, >50% residual) into the pTNM staging system to better predict long-term outcome for esophageal cancer patients treated with CRT. |
| Databáze: | OpenAIRE |
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