Proposed revision of the esophageal cancer staging system to accommodate pathologic response (PP) following preoperative chemoradiation (CRT)

Stephen G. Swisher, Wayne Hofstetter, Tsung T. Wu, Arlene M. Correa, Jaffer A. Ajani, Ritsuko R. Komaki, Lucian Chirieac, Kelly K. Hunt, Zhongxing Liao, Alexandria Phan, David C. Rice, Ara A. Vaporciyan, Garrett L. Walsh, Jack A. Roth, Kelly M. McMasters, Joseph Locicero, Gerard M. Doherty, Nipun Merchant, Edward M. Copeland, Frederick L. GreeneStephen B. Vogel

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Abstract

Objective: To determine the impact of pathologic response following preoperative chemoradiation (CRT) on the AJCC esophageal cancer staging system. Summary Background Data: Increasing numbers of locoregionally advanced esophageal cancer patients are treated with preoperative CRT prior to surgical resection. Methods: Five hundred ninety-three pts from 1985 to 2003 with esophageal cancer who underwent surgery with (n = 239) or without CRT (n = 354) were reviewed. Resected esophageal tumors were assessed for pathologic response by determining extent of residual tumor following CRT (P0, 0% residual; P1, 1%-50% residual; P2, >50% residual). Results: After CRT down-staging, pTNM specific survival was similar, irrespective of treatment group (P = 0.98). The pTNM stage distribution was more favorable in the CRT group (P < 0.001) despite a more advanced initial cTNM stage distribution (P < 0.001). Following CRT, the pathologic response (pP) at the primary tumor as defined by extent of residual tumor predicted overall survival (3 years: P0, 0% residual = 74%; P1, 1%-50% residual = 54%; P2, >50% residual = 24%, P < 0.001) and stage specific survival with greater accuracy than pTNM stage alone. Conclusions: Our analyses demonstrate that following CRT, pTNM continues to predict survival. The extent of pathologic response following CRT is an independent risk factor for survival (pP) and should be incorporated in the pTNM esophageal cancer staging system to better predict patient outcome in esophageal cancer.

Original languageEnglish (US)
Pages (from-to)810-820
Number of pages11
JournalAnnals of Surgery
Volume241
Issue number5
DOIs
StatePublished - May 2005
Externally publishedYes

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Neoplasm Staging
Esophageal Neoplasms
Survival
Residual Neoplasm
Neoplasms

ASJC Scopus subject areas

  • Surgery

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Proposed revision of the esophageal cancer staging system to accommodate pathologic response (PP) following preoperative chemoradiation (CRT). / Swisher, Stephen G.; Hofstetter, Wayne; Wu, Tsung T.; Correa, Arlene M.; Ajani, Jaffer A.; Komaki, Ritsuko R.; Chirieac, Lucian; Hunt, Kelly K.; Liao, Zhongxing; Phan, Alexandria; Rice, David C.; Vaporciyan, Ara A.; Walsh, Garrett L.; Roth, Jack A.; McMasters, Kelly M.; Locicero, Joseph; Doherty, Gerard M.; Merchant, Nipun; Copeland, Edward M.; Greene, Frederick L.; Vogel, Stephen B.

In: Annals of Surgery, Vol. 241, No. 5, 05.2005, p. 810-820.

Research output: Contribution to journalArticle

Swisher, SG, Hofstetter, W, Wu, TT, Correa, AM, Ajani, JA, Komaki, RR, Chirieac, L, Hunt, KK, Liao, Z, Phan, A, Rice, DC, Vaporciyan, AA, Walsh, GL, Roth, JA, McMasters, KM, Locicero, J, Doherty, GM, Merchant, N, Copeland, EM, Greene, FL & Vogel, SB 2005, 'Proposed revision of the esophageal cancer staging system to accommodate pathologic response (PP) following preoperative chemoradiation (CRT)', Annals of Surgery, vol. 241, no. 5, pp. 810-820. https://doi.org/10.1097/01.sla.0000161983.82345.85
Swisher, Stephen G. ; Hofstetter, Wayne ; Wu, Tsung T. ; Correa, Arlene M. ; Ajani, Jaffer A. ; Komaki, Ritsuko R. ; Chirieac, Lucian ; Hunt, Kelly K. ; Liao, Zhongxing ; Phan, Alexandria ; Rice, David C. ; Vaporciyan, Ara A. ; Walsh, Garrett L. ; Roth, Jack A. ; McMasters, Kelly M. ; Locicero, Joseph ; Doherty, Gerard M. ; Merchant, Nipun ; Copeland, Edward M. ; Greene, Frederick L. ; Vogel, Stephen B. / Proposed revision of the esophageal cancer staging system to accommodate pathologic response (PP) following preoperative chemoradiation (CRT). In: Annals of Surgery. 2005 ; Vol. 241, No. 5. pp. 810-820.
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abstract = "Objective: To determine the impact of pathologic response following preoperative chemoradiation (CRT) on the AJCC esophageal cancer staging system. Summary Background Data: Increasing numbers of locoregionally advanced esophageal cancer patients are treated with preoperative CRT prior to surgical resection. Methods: Five hundred ninety-three pts from 1985 to 2003 with esophageal cancer who underwent surgery with (n = 239) or without CRT (n = 354) were reviewed. Resected esophageal tumors were assessed for pathologic response by determining extent of residual tumor following CRT (P0, 0{\%} residual; P1, 1{\%}-50{\%} residual; P2, >50{\%} residual). Results: After CRT down-staging, pTNM specific survival was similar, irrespective of treatment group (P = 0.98). The pTNM stage distribution was more favorable in the CRT group (P < 0.001) despite a more advanced initial cTNM stage distribution (P < 0.001). Following CRT, the pathologic response (pP) at the primary tumor as defined by extent of residual tumor predicted overall survival (3 years: P0, 0{\%} residual = 74{\%}; P1, 1{\%}-50{\%} residual = 54{\%}; P2, >50{\%} residual = 24{\%}, P < 0.001) and stage specific survival with greater accuracy than pTNM stage alone. Conclusions: Our analyses demonstrate that following CRT, pTNM continues to predict survival. The extent of pathologic response following CRT is an independent risk factor for survival (pP) and should be incorporated in the pTNM esophageal cancer staging system to better predict patient outcome in esophageal cancer.",
author = "Swisher, {Stephen G.} and Wayne Hofstetter and Wu, {Tsung T.} and Correa, {Arlene M.} and Ajani, {Jaffer A.} and Komaki, {Ritsuko R.} and Lucian Chirieac and Hunt, {Kelly K.} and Zhongxing Liao and Alexandria Phan and Rice, {David C.} and Vaporciyan, {Ara A.} and Walsh, {Garrett L.} and Roth, {Jack A.} and McMasters, {Kelly M.} and Joseph Locicero and Doherty, {Gerard M.} and Nipun Merchant and Copeland, {Edward M.} and Greene, {Frederick L.} and Vogel, {Stephen B.}",
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T1 - Proposed revision of the esophageal cancer staging system to accommodate pathologic response (PP) following preoperative chemoradiation (CRT)

AU - Swisher, Stephen G.

AU - Hofstetter, Wayne

AU - Wu, Tsung T.

AU - Correa, Arlene M.

AU - Ajani, Jaffer A.

AU - Komaki, Ritsuko R.

AU - Chirieac, Lucian

AU - Hunt, Kelly K.

AU - Liao, Zhongxing

AU - Phan, Alexandria

AU - Rice, David C.

AU - Vaporciyan, Ara A.

AU - Walsh, Garrett L.

AU - Roth, Jack A.

AU - McMasters, Kelly M.

AU - Locicero, Joseph

AU - Doherty, Gerard M.

AU - Merchant, Nipun

AU - Copeland, Edward M.

AU - Greene, Frederick L.

AU - Vogel, Stephen B.

PY - 2005/5

Y1 - 2005/5

N2 - Objective: To determine the impact of pathologic response following preoperative chemoradiation (CRT) on the AJCC esophageal cancer staging system. Summary Background Data: Increasing numbers of locoregionally advanced esophageal cancer patients are treated with preoperative CRT prior to surgical resection. Methods: Five hundred ninety-three pts from 1985 to 2003 with esophageal cancer who underwent surgery with (n = 239) or without CRT (n = 354) were reviewed. Resected esophageal tumors were assessed for pathologic response by determining extent of residual tumor following CRT (P0, 0% residual; P1, 1%-50% residual; P2, >50% residual). Results: After CRT down-staging, pTNM specific survival was similar, irrespective of treatment group (P = 0.98). The pTNM stage distribution was more favorable in the CRT group (P < 0.001) despite a more advanced initial cTNM stage distribution (P < 0.001). Following CRT, the pathologic response (pP) at the primary tumor as defined by extent of residual tumor predicted overall survival (3 years: P0, 0% residual = 74%; P1, 1%-50% residual = 54%; P2, >50% residual = 24%, P < 0.001) and stage specific survival with greater accuracy than pTNM stage alone. Conclusions: Our analyses demonstrate that following CRT, pTNM continues to predict survival. The extent of pathologic response following CRT is an independent risk factor for survival (pP) and should be incorporated in the pTNM esophageal cancer staging system to better predict patient outcome in esophageal cancer.

AB - Objective: To determine the impact of pathologic response following preoperative chemoradiation (CRT) on the AJCC esophageal cancer staging system. Summary Background Data: Increasing numbers of locoregionally advanced esophageal cancer patients are treated with preoperative CRT prior to surgical resection. Methods: Five hundred ninety-three pts from 1985 to 2003 with esophageal cancer who underwent surgery with (n = 239) or without CRT (n = 354) were reviewed. Resected esophageal tumors were assessed for pathologic response by determining extent of residual tumor following CRT (P0, 0% residual; P1, 1%-50% residual; P2, >50% residual). Results: After CRT down-staging, pTNM specific survival was similar, irrespective of treatment group (P = 0.98). The pTNM stage distribution was more favorable in the CRT group (P < 0.001) despite a more advanced initial cTNM stage distribution (P < 0.001). Following CRT, the pathologic response (pP) at the primary tumor as defined by extent of residual tumor predicted overall survival (3 years: P0, 0% residual = 74%; P1, 1%-50% residual = 54%; P2, >50% residual = 24%, P < 0.001) and stage specific survival with greater accuracy than pTNM stage alone. Conclusions: Our analyses demonstrate that following CRT, pTNM continues to predict survival. The extent of pathologic response following CRT is an independent risk factor for survival (pP) and should be incorporated in the pTNM esophageal cancer staging system to better predict patient outcome in esophageal cancer.

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