Prognostic differences in 8th edition TNM staging of esophagogastric adenocarcinoma after neoadjuvant treatment. Issue 10 (October 2018)

• Record Type: Journal Article
• Authors: Sisic, Leila; Blank, Susanne; Nienhüser, Henrik; Dorr, Sara; Haag, Georg Martin; Jäger, Dirk; Bruckner, Thomas; Müller-Stich, Beat P.; Ott, Katja; Büchler, Markus W.; Ulrich, Alexis; Schmidt, Thomas
• Is Part Of: European journal of surgical oncology. Volume 44:Issue 10(2018)
• Page Start: 1646
• Page End: 1656
• Publication Date: 2018-10
• Subjects: Gastric cancer -- Esophageal cancer -- Neoadjuvant treatment -- Staging -- Prognosis; AEG Adenocarcinoma of the esophago-gastric junction -- AIC Akaike Information Criterion -- AJCC American Joint Committee on Cancer -- CT Computerized tomography -- EC Esophageal cancer -- EAC Esophageal adenocarcinoma -- GC Gastric cancer -- IGCA International gastric cancer collaboration -- NCDB National Cancer Database -- NT Neoadjuvant treatment -- OS Overall survival -- pCR Pathological complete response -- PS Primary surgery -- SBC Schwarz Bayesian Information Criterion -- THG Transhiatal extended gastrectomy -- UICC Union Internationale Contre le Cancer -- WECC Worldwide esophageal cancer collaboration; Oncology -- Periodicals; Cancer -- Surgery -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Cancérologie -- Périodiques; Oncologie; Chirurgie (geneeskunde); Electronic journals; Electronic journals -- Sciences; Electronic journals -- Medicine; Electronic journals; 616.994059005
• DOI: 10.1016/j.ejso.2018.06.030
• Languages: English
• ISSNs: 0748-7983

Abstract

Abstract: Background: Prognostic differences between pTN- and ypTN-categories and the prognostic accuracy of the 8th edition UICC-pTNM- and AJCC-ypTNM-staging-system for esophageal and gastric adenocarcinoma are unclear. Methods: We retrospectively analyzed data of 740 patients with esophagogastric adenocarcinoma, who underwent curative surgery (344 after neoadjuvant treatment [NT]) at our institution. Survival analyses were performed according to Kaplan-Meier (log-rank test). Multivariate analyses were performed using the Cox proportional hazard model. Results: Low ypT-categories did not discriminate overall survival (ypT0: reference; ypT1: HR1.0/p = 0.909; ypT2: HR0.9/p = 0.845; ypT3: HR1.5/p = 0.184; ypT4: HR2.8/p = 0.004) and no difference was found between ypN1- and ypN2-disease (ypN0: HR0.4/p < 0.001; ypN1: reference; ypN2: HR1.1/p = 0.653; ypN3: HR1.7/p = 0.014). In esophageal adenocarcinoma the UICC-TNM- and AJCC-ypTNM-staging-system was able to predict survival for patients after NT, while in gastric cancer it failed to provide sufficient prognostic information. A simplified staging system provided better stratification after NT and was an independent prognosticator for both esophageal and gastric adenocarcinoma (stage I: reference; stage II: HR2.2/p = 0.005; stage III: HR4.1/p < 0.001). Conclusion: Prognostic value of ypTN-categories seems limited. After NT the current UICC/AJCC-staging-system is able to predict survival in esophageal adenocarcinoma, but needs to be reevaluated in gastric cancer patients and modified if needed. A novel simplified staging system might be more practicable for patients after NT.