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

Worldwide Esophageal Cancer Collaboration: clinical staging data

T W Rice  1 , C Apperson-Hansen  2 , L M DiPaola  3 , M E Semple  3 , T E M R Lerut  4 , M B Orringer  5 , L-Q Chen  6 , W L Hofstetter  7 , B M Smithers  8 , V W Rusch  9 , B P L Wijnhoven  10 , K N Chen  11 , A R Davies  12 , X B D'Journo  13 , K A Kesler  14 , J D Luketich  15 , M K Ferguson  16 , J V Räsänen  17 , R van Hillegersberg  18 , W Fang  19 , L Durand  20 , W H Allum  21 , I Cecconello  22 , R J Cerfolio  23 , M Pera  24 , S M Griffin  25 , R Burger  26 , J-F Liu  27 , M S Allen  28 , S Law  29 , T J Watson  30 , G E Darling  31 , W J Scott  32 , A Duranceau  33 , C E Denlinger  34 , P H Schipper  35 , H Ishwaran  36 , E H Blackstone  3
Affiliations

Worldwide Esophageal Cancer Collaboration: clinical staging data

T W Rice et al. Dis Esophagus. 2016 Oct.

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.

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Figures

Fig. 1
Fig. 1
Survival by clinical cT category. Kaplan–Meier estimates accompanied by vertical bars representing 68% confidence limits, equivalent to ±1 standard error. (A) Squamous cell carcinoma and (B) adenocarcinoma. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Fig. 2
Fig. 2
Survival by clinical cN category. Format is as in Fig. 1. (A) Squamous cell carcinoma and (B) adenocarcinoma. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Fig. 3
Fig. 3
Survival by cT category for cN0 cancers. Format is as in Fig. 1. (A) Squamous cell carcinoma and (B) adenocarcinoma. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Fig. 4
Fig. 4
Survival by cT category for cN+ cancers. Format is as in Fig. 1. (A) Squamous cell carcinoma and (B) adenocarcinoma. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
Fig. 5
Fig. 5
Survival by clinical cM category. Format is as in Fig. 1. (A) Squamous cell carcinoma and (B) adenocarcinoma. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]
See this image and copyright information in PMC

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