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

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 adenoc...

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Main Authors: Peters, Leila (Author) , Blank, Susanne (Author) , Nienhüser, Henrik (Author) , Dorr, Sara (Author) , Haag, Georg Martin (Author) , Jäger, Dirk (Author) , Bruckner, Thomas (Author) , Müller, Beat P. (Author) , Ott, Katja (Author) , Büchler, Markus W. (Author) , Ulrich, Alexis (Author) , Schmidt, Thomas (Author)
Format: Article (Journal)
Language:English
Published: 7 July 2018
In: European journal of surgical oncology
Year: 2018, Volume: 44, Issue: 10, Pages: 1646-1656
ISSN:1532-2157
DOI:10.1016/j.ejso.2018.06.030
Online Access:Verlag, Volltext: https://doi.org/10.1016/j.ejso.2018.06.030
Verlag, Volltext: http://www.sciencedirect.com/science/article/pii/S0748798318311740
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Author Notes: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
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Summary: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.
Item Description:Gesehen am 14.10.2019
Physical Description:Online Resource
ISSN:1532-2157
DOI:10.1016/j.ejso.2018.06.030

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