Association of Women SurgeonsThe revised American Joint Committee on Cancer staging system (7th edition) improves prognostic stratification after minimally invasive esophagectomy for esophagogastric adenocarcinoma
Section snippets
Patient selection and data acquisition
We reviewed all patients (n = 836) with esophagogastric adenocarcinoma who underwent minimally invasive esophagectomy—the preferred approach to esophagectomy at our center (January 1, 1997 to July 31, 2011). For this study, only patients having minimally invasive esophagectomy were included to minimize confounding of approach to operation on the completeness of pathologic staging (such as potential differences in node dissection between a transhiatal esophagectomy and minimally invasive
Results
Patients were predominantly Caucasian men in their 6th decade, with a slightly younger age and fewer comorbidities (including smoking and obesity) present in patients receiving neoadjuvant therapy (Table 1). Tumor characteristics in patients receiving neoadjuvant therapy showed a trend toward slightly larger tumor size, with a higher proportion of poorly differentiated tumors. These patients were more likely to receive adjuvant therapy compared with primary esophagectomy patients. Median
Comments
In this study, we have examined the application and strengths of the 7th edition AJCC staging system for esophageal adenocarcinoma in a large cohort of patients who underwent minimally invasive esophagectomy, with a separate analysis in patients who underwent neoadjuvant therapy. We observed stronger monotone trend and greater discriminatory power with AJCC 7th edition; this superior performance was observed in the overall cohort and in the subset of patients who underwent minimally invasive
Conclusions
In conclusion, we found that AJCC 7th edition esophageal cancer staging system improves prognostic stratification of surgically resected esophagogastric adenocarcinoma patients, including patients who received neoadjuvant therapy, when compared with the 6th edition. To improve on the current system, future editions will likely expand beyond pathologic variables to include tumor-specific biomarkers.
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The project described was supported by award numbers K07CA511613 (KSN), UL1 RR024153, and UL1TR000005 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.