The degree of circumferential tumour involvement as a prognostic factor in oesophageal cancer

• Published in: European journal of cardio-thoracic surgery Vol. 36; no. 2; pp. 368 - 373
• Main Authors: Sillah, Karim, Pritchard, Susan A., Watkins, Gillian R., McShane, James, West, Catharine M., Page, Richard, Welch, Ian M.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Science B.V 01-08-2009; Oxford University Press
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology. Vascular system; Chemotherapy, Adjuvant; Degree of oesophageal circumference; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Esophagus; Gastrectomy; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Lymphatic Metastasis; Medical sciences; Middle Aged; Neoplasm Staging; Oesophageal cancer; Pneumology; Prognosis; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Analysis; Treatment Outcome; Tumors; Young Adult; Oesophageal cancer; Degree of oesophageal circumference; Prognosis; Esophageal disease; Digestive diseases; Malignant tumor; Circulatory system; Cardiology; Esophagus cancer; Cancer; Esophagus; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2008.12.052

Objective: Tumour length is an adverse prognostic factor in oesophageal cancer. However, the prognostic role of the degree of oesophageal circumference (DOC) involved by tumour with or without resection margin invasion is not clear. This work assessed the relationship between DOC involved by tumour, clinico-pathological variables and prognosis. Methods: The clinico-pathological details of 320 patients who underwent potentially curative oesophagogastrectomy for cancer between 1994 and 2007 were analysed. The DOC involved with tumour measured macroscopically on the resected specimen was classified as small (≪2.5 cm, n = 115), large (≥2.5 cm, n = 144) or circumferential (i.e. involving the whole circumference, n = 61). Univariate and multivariate survival analyses were carried out. Results: The DOC with tumour was higher in ulcerating tumours than stenosing or polypoidal types (p = 0.017). Tumour length, T-stage, neoadjuvant chemotherapy and vascular invasion were independently associated with DOC with tumour on multivariate analysis (p ≪ 0.05 for all). DOC ≥2.5 cm was an adverse prognostic factor in univariate analysis (p = 0.002) with a hazard ratio of 1.52 [95% CI 1.13–2.04] compared with those ≪2.5 cm. Circumferential tumours had a similar prognosis to tumours ≥2.5 cm (p = 0.60). The prognostic significance of DOC with tumour was lost in multivariate analysis where the factors retaining independence were patient age, T-stage, lymph node metastasis, vascular invasion and positive resection margins. However, when patients were stratified by use of neoadjuvant chemotherapy (n = 121), the DOC with tumour retained prognostic significance on multivariate analysis in the 199 patients who did not undergo neoadjuvant chemotherapy (p = 0.04). Conclusion: The DOC with tumour appears to provide prognostic information in oesophageal cancer surgery, especially in patients who do not undergo preoperative chemotherapy.