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Dis Esophagus. 2016 Oct;29(7):707-714. doi: 10.1111/dote.12493.

Worldwide Esophageal Cancer Collaboration: clinical staging data.

Author information

1
Cleveland Clinic, Cleveland, Ohio, USA. ricet@ccf.org.
2
Case Western Reserve University, Cleveland, Ohio, USA.
3
Cleveland Clinic, Cleveland, Ohio, USA.
4
University Ziekenhuizen Leuven, Leuven, Belgium.
5
University of Michigan, Ann Arbor, Michigan, USA.
6
West China Hospital of Sichuan University, Chengdu, Sichuan, China.
7
University of Texas MD Anderson Hospital, Houston, Texas, USA.
8
University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
9
Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
10
Erasmus Medical Center, Rotterdam, The Netherlands.
11
Beijing Cancer Hospital, Beijing, China.
12
Guy's & St Thomas' Hospitals, London, UK.
13
Hôpital Nord, Marseille, France.
14
Indiana University Medical Center, Indianapolis, Indiana, USA.
15
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
16
Department of Surgery, The University of Chicago, Chicago, Illinois, USA.
17
Helsinki University Hospital, Helsinki, Finland.
18
University Medical Center Utrecht, Utrecht, The Netherlands.
19
Shanghai Chest Hospital, Shanghai, China.
20
Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina.
21
Royal Marsden NHS Foundation Trust, London, UK.
22
University of São Paulo, São Paulo, Brazil.
23
University of Alabama at Birmingham, Birmingham, Alabama, USA.
24
Hospital Universitario del Mar, Barcelona, Spain.
25
University of Newcastle upon Tyne, Newcastle, UK.
26
Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
27
Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
28
Mayo Clinic, Rochester, Minnesota, USA.
29
University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China.
30
University of Rochester, Rochester, New York, USA.
31
Toronto General Hospital, Toronto, Ontario, Canada.
32
Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
33
University of Montreal, Montreal, Quebec, Canada.
34
Medical University of South Carolina, Charleston, South Carolina, USA.
35
Oregon Health and Science University, Portland, Oregon, USA.
36
University of Miami, Miami, Florida, USA.

Abstract

To address uncertainty of whether clinical stage groupings (cTNM) 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 clinically staged patients 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 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.

KEYWORDS:

cancer staging; data sharing; decision-making; prognostication; survival

PMID:
27731549
PMCID:
PMC5591441
DOI:
10.1111/dote.12493
[Indexed for MEDLINE]
Free PMC Article

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