Prognostic differences in 8th edition TNM staging of esophagogastric adenocarcinoma after neoadjuvant treatment.

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.

• Authors: Leila Sisic, Susanne Blank, Henrik Nienhüser, Sara Dorr, Georg Martin Haag, Dirk Jäger, Thomas Bruckner, Beat P Müller-Stich, Katja Ott, Markus W Büchler, Alexis Ulrich, Thomas Schmidt
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 44 Issue 10 Pg. 1646-1656 (10 2018) ISSN: 1532-2157 [Electronic] England
• PMID: 30082176 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Topics

• Adenocarcinoma (pathology, therapy)
• Aged
• Esophageal Neoplasms (pathology, therapy)
• Esophagectomy
• Female
• Gastrectomy
• Humans
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Staging (methods)
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Stomach Neoplasms (pathology, therapy)
• Survival Rate