Relative prognostic value of TNM7 vs TNM6 in staging oesophageal cancer. 2011

T D Reid, and L N Sanyaolu, and D Chan, and G T Williams, and W G Lewis
Department of Surgery, South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK.

BACKGROUND Stage migration consequent upon new cancer staging definitions may result in artifactual alterations in stage-specific survival and prognosis. The aim of this study was to determine the influence of the new TNM7 oesophageal cancer (OC) system on stage categorisation and survival when compared with historical controls. METHODS A total of 202 patients diagnosed with operable OC and undergoing oesophagectomy (118 neoadjuvant chemotherapy) were studied. Patients originally classified and staged using TNM6 were retrospectively re-staged using TNM7. RESULTS Re-classification of TNM7 resulted in stage migration in 11.9% of patients (9.9% downstaged, 2.0% upstaged) when compared with TNM6. Five-year survival for stages I, II and III was 78%, 46% and 18% using TNM6, compared with 62%, 51% and 18%, respectively, using TNM7. Univariable analysis revealed that histological grade (P = 0.006), pT (P < 0.0001), TNM6 pN (P < 0.0001), TNM7 pN (P < 0.0001), number of lymph node metastases (P < 0.0001), TNM6 stage group (P < 0.0001), TNM7 stage group (P < 0.0001) and TNM7 prognostic group (P < 0.0001) were all associated with survival. Multivariable analysis revealed that only the TNM7 prognostic group was independently and significantly associated with survival. CONCLUSIONS TNM7 is a better prognostic tool than TNM6 and represents an important advance in staging OC.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009367 Neoplasm Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Cancer Staging,Staging, Neoplasm,Tumor Staging,TNM Classification,TNM Staging,TNM Staging System,Classification, TNM,Classifications, TNM,Staging System, TNM,Staging Systems, TNM,Staging, Cancer,Staging, TNM,Staging, Tumor,System, TNM Staging,Systems, TNM Staging,TNM Classifications,TNM Staging Systems
D011379 Prognosis A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations. Prognostic Factor,Prognostic Factors,Factor, Prognostic,Factors, Prognostic,Prognoses
D004938 Esophageal Neoplasms Tumors or cancer of the ESOPHAGUS. Cancer of Esophagus,Esophageal Cancer,Cancer of the Esophagus,Esophagus Cancer,Esophagus Neoplasm,Neoplasms, Esophageal,Cancer, Esophageal,Cancer, Esophagus,Cancers, Esophageal,Cancers, Esophagus,Esophageal Cancers,Esophageal Neoplasm,Esophagus Cancers,Esophagus Neoplasms,Neoplasm, Esophageal,Neoplasm, Esophagus,Neoplasms, Esophagus
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D016019 Survival Analysis A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function. Analysis, Survival,Analyses, Survival,Survival Analyses

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