[an error occurred while processing this directive] | [an error occurred while processing this directive]
Analysis of survival prediction value using modification 7th UICC esophageal cancer staging system for esophageal squamous cell carcinoma with preoperative radiotherapy
WANG Qi-feng, ZHANG Wen-cheng,XIAO Ze-fen, ZHANG Hong-xing, CHEN Dong-fu,FENG Qin-fu, ZHOU Zong-mei, Lv Ji-ma, LIANG Jun, WANG Lv-hua, YIN Wei-bo
Department of Radiation Oncology, Cancer Hospital (Institute), Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021, China Corresponding author:XIAO Ze-fen,Email:xiaozefen@sina.com
Abstract Objective To evaluate the value of the international union against cancer (UICC) stage, pathologic complete response (pCR), and the estimated treatment response as various means for prognostic stratifying patients after surgery in patients with squamous cell carcinoma of the esophagus who received preoperative radiotherapy (RT). Methods A retrospective review was performed on 311 patients with esophageal squamous cell carcinoma who received RT before the esophagectomy. Data collected included the demographics, the RT details, the pathologic findings, and the survival. Prognostic survival was analyzed by Kaplan-Meier method and Logrank test. Results The follow-up rate was 96.5%, 89 and 43 patients, respectively were followed up more than 5 and 10 years. In univariate analysis, residual disease and the number of positive lymph node were predictors of the overall survival (T-pCR,χ2=11.53,P=0.001;0,1－3,≥4,χ2=42.13,P=0.000,respectively). Further study found the 7th stage system of UICC cannot (can or cannot) entirely predict the prognosis of this group of patients. If categorizing the stages of their lymph nodes into three groups:N0(0), N1(1－3) and N2(≥4)), and the modified UICC system can accurately distinguish ypStage Ⅰ with ypStage Ⅱ(T0-3N1M0+T3N0M0)(χ2=11.15,P=0.001) and ypStage Ⅱ with ypStage Ⅲ(T4N0－1M0 and T0-3N2M0)(χ2=23.39,P=0.000). Conclusions The pathologic post-radiotherapy T stage and the number of positive lymph node are predictors for esophageal squamous cell carcinoma receiving preoperative radiotherapy. The modified UICC stage system can be a better survival predictor than the 7th UICC stage system.
WANG Qi-feng,ZHANG Wen-cheng,XIAO Ze-fen et al. Analysis of survival prediction value using modification 7th UICC esophageal cancer staging system for esophageal squamous cell carcinoma with preoperative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2012, 21(3): 217-220.
WANG Qi-feng,ZHANG Wen-cheng,XIAO Ze-fen et al. Analysis of survival prediction value using modification 7th UICC esophageal cancer staging system for esophageal squamous cell carcinoma with preoperative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2012, 21(3): 217-220.
[1] De Vita F, Di Martino N, Orditura M, et al. Preoperative chemoradiotherapy for squamous cell carcinoma and adenocarcinoma of the esophagus:a phase Ⅱ study. Chest,2002,122:1302-1308. [2] Stahl M, Wilke H, Fink U, et al. Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer. Interim analysis of a phase Ⅱ trial. J Clin Oncol,1996,14:829-837. [3] Urba SG, Orringer MB, Turrisi A, et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol,2001,19:305-313. [4] Seydel HG, Leichman L, Byhardt R, et al. Preoperative radiation and chemotherapy for localized squamous cell carcinoma of the esophagus:a RTOG Study. Int J Radiat Oncol Biol Phys,1988,14:33-35. [5] Chirieac LR, Swisher SG, Ajani JA, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer,2005,103:1347-1355. [6] Rizk NP, Venkatraman E, Bains MS, et al. American Joint Committee on Cancer staging system does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol,2007,25:507-512. [7] Heath EI, Burtness BA, Heitmiller RF, et al. Phase Ⅱ evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol,2000,18:868-876. [8] Kleinberg L, Knisely JP, Heitmiller R, et al. Mature survival results with preoperative cisplatin, protracted infusion 5-fluorouracil, and 44 Gy radiotherapy for esophageal cancer. Int J Radiat Oncol Biol Phys,2003,56:328-334. [9] Berger AC, Farma J, Scott WJ, et al. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol,2005,23:4330-4337. [10] Schneider PM, Baldus SE, Metzger R, et al. Histomorphologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer:implications for response classification. Ann Surg,2005,242:684-692. [11] Xiao ZF, Yang ZY, Miao YJ, et al. Influence of number of metastatic lymph nodes on survival of curative resected thoracic esophageal cancer patients and value of radiotherapy:report of 549 cases. Int J Radiat Oncol Biol Phys,2005,62:82-90. [12] Suntharalingam M, Haas ML, Sonett JR, et al. Accurate lymph node assessment prior to trimodality therapy for esophageal carcinoma. Cancer J,2001,7:509-515. [13] Gu Y, Swisher SG, Ajani JA, et al. The number of lymph nodes with metastasis predicts survival in patients with esophageal or esophagogastric junction adenocarcinoma who receive preoperative chemoradiation. Cancer,2006,106:1017-1025. [14] Rice TW, Rusch VW, Apperson-Hansen C, et al. Worldwide esophageal cancer collaboration. Dis Esophagus,2009,22:1-8. [15] 汪楣,谷铣之,黄国俊,等.食管癌术前放射治疗的前瞻性临床研究.中华放射肿瘤学杂志,2001,10:168-172.
2012, Vol. 21 
