Increasing tumor length is associated with regional lymph node metastases and decreased survival in esophageal cancer

Am J Surg. 2016 May;211(5):860-6. doi: 10.1016/j.amjsurg.2016.01.007. Epub 2016 Feb 23.

Abstract

Background: Although tumor length has received little attention for staging of esophageal cancer, it may be a valid prognostic feature for node positivity and survival.

Methods: Through retrospective review of a prospective institutional database, esophageal cancer patients who completed esophagectomy without neoadjuvant chemoradiation were analyzed. Pathologic tumor lengths were compared with node positivity and survival through a zero-inflated negative binomial regression model and multivariable Cox proportional hazards model, respectively.

Results: Between January 2000 and July 2015, 98 patients met inclusion, criteria (84% male, median age of 65, 90% adenocarcinoma). Median tumor length was 2.5 cm with each 1-cm increase in length increasing the odds of node positivity (odds ratio 3.55, 95% confidence interval 1.50 to 8.40, P = .004) and decreasing overall survival (hazards ratio 1.18, 95% confidence interval 1.06 to 1.32, P < .003).

Conclusion: This study suggests an association among tumor length, lymph node metastasis, as well as overall survival in esophageal cancer patients who have not received neoadjuvant chemoradiotherapy.

Keywords: Esophageal cancer; Node positive; Survival; Tumor length.

MeSH terms

  • Adenocarcinoma / mortality
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Aged
  • Analysis of Variance
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery
  • Confidence Intervals
  • Disease-Free Survival
  • Esophageal Neoplasms / mortality*
  • Esophageal Neoplasms / pathology*
  • Esophageal Neoplasms / surgery
  • Esophagectomy / methods
  • Esophagectomy / mortality*
  • Esophagus / pathology*
  • Female
  • Humans
  • Lymph Nodes / pathology*
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Invasiveness / pathology
  • Neoplasm Staging
  • Prognosis
  • Registries
  • Retrospective Studies
  • Survival Analysis
  • Tumor Burden