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. 2013 Aug;118(3):145-52.
doi: 10.3109/03009734.2013.792887. Epub 2013 Apr 26.

Tumor length in elderly patients with esophageal squamous cell carcinoma: is it a prognostic factor?

Ji-Feng Feng  1 , Ying Huang, Qiang Zhao
Affiliations

Tumor length in elderly patients with esophageal squamous cell carcinoma: is it a prognostic factor?

Ji-Feng Feng et al. Ups J Med Sci. 2013 Aug.

Abstract

Background: Several researchers have determined the tumor length to be an important prognostic indictor of esophageal cancer (EC). However, controversy exists concerning the optimal cut-off points for tumor length to predict overall survival. The aim of this study was to determine the prognostic value of tumor length and propose the optimum cut-off point for tumor length in predicting survival difference in elderly patients with esophageal squamous cell carcinoma (ESCC).

Methods: From January 2001 to December 2009, a retrospective analysis of 132 consecutive patients older than 70 years with ESCC was conducted. A receiver-operating characteristic (ROC) curve for survival prediction was plotted to verify the optimum cut-off point for tumor length. Univariate and multivariate analyses were performed to evaluate prognostic parameters for survival.

Results: A ROC curve for survival prediction was plotted to verify the optimum cut-off point for tumor length, which was 4.0 cm. Patients with tumor length ≤ 4.0 cm had significantly better 5-year survival rate than patients with a tumor length >4.0 cm (60.7% versus 31.6%, P = 0.007). Multivariate analyses showed that tumor length (>4.0 cm versus ≤ 4.0 cm, P = 0.036), differentiation (poor versus well/moderate, P = 0.032), N staging (N1-3 versus N0, P = 0.018), and T grade (T3-4 versus T1-2, P = 0.002) were independent prognostic factors.

Conclusion: Tumor length is a predictive factor for long-term survival in elderly patients with ESCC, especially in T3-4 grade or nodal-negative patients. We conclude that 4.0 cm may be the optimum cut-off point for tumor length in predicting survival in elderly patients with ESCC.

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Figures

Figure 1.
Figure 1.
A ROC curve plots the sensitivity on the y-axis against 1 minus the specificity on the x-axis. A diagonal line at 45 degrees, known as the line of chance, would result from a test which allocated subjects randomly. Each point on the ROC curve corresponds to a value of tumor length. In general, a good cut-off point is one which produces both a large sensitivity and a large specificity. This can be interpreted as choosing the point on the ROC curve with the largest vertical distance from the line of chance (two-way arrow). The AUC for tumor length was 67.1% with a sensitivity of 79.7% and a specificity of 53.4% (1 – 46.6%) by Youden index (dotted lines). The threshold value corresponding to the tumor length was 4.0 cm.
Figure 2.
Figure 2.
Patients with tumor length ≤4.0 cm had a significantly better 5-year survival rate than patients with a tumor length >4.0 cm (60.7% versus 31.6%, P = 0.007).
Figure 3.
Figure 3.
Kaplan–Meier survival curves stratified by tumor length in (A) T1-2 patients, (B) T3-4 patients, (C) N0 patients, and (D) N1-3 patients.
See this image and copyright information in PMC

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