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

      Abstract

      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.

      Keywords

      Abbreviations:

      AEG (Adenocarcinoma of the esophago-gastric junction), AIC (Akaike Information Criterion), AJCC (American Joint Committee on Cancer), CT (Computerized tomography), EC (Esophageal cancer), EAC (Esophageal adenocarcinoma), GC (Gastric cancer), IGCA (International gastric cancer collaboration), NCDB (National Cancer Database), NT (Neoadjuvant treatment), OS (Overall survival), pCR (Pathological complete response), PS (Primary surgery), SBC (Schwarz Bayesian Information Criterion), THG (Transhiatal extended gastrectomy), UICC (Union Internationale Contre le Cancer), WECC (Worldwide esophageal cancer collaboration)
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