Rice T W, Rusch V W, Apperson-Hansen C, Allen M S, Chen L-Q, Hunter J G, Kesler K A, Law S, Lerut T E M R, Reed C E, Salo J A, Scott W J, Swisher S G, Watson T J, Blackstone E H
Department of Thoracic and CardiovascularSurgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Dis Esophagus. 2009;22(1):1-8. doi: 10.1111/j.1442-2050.2008.00901.x.
The aim of this study is to report assemblage of a large multi-institutional international database of esophageal cancer patients, patient and tumor characteristics, and survival of patients undergoing esophagectomy alone and its correlates. Forty-eight institutions were approached and agreed to participate in a worldwide esophageal cancer collaboration (WECC), and 13 (Asia, 2; Europe, 2; North America, 9) submitted data as of July 1, 2007. These were used to construct a de-identified database of 7884 esophageal cancer patients who underwent esophagectomy. Four thousand six hundred and twenty-seven esophagectomy patients had no induction or adjuvant therapy. Mean age was 62 +/- 11 years, 77% were men, and 33% were Asian. Mean tumor length was 3.3 +/- 2.5 cm, and esophageal location was upper in 4.1%, middle in 27%, and lower in 69%. Histopathologic cell type was adenocarcinoma in 60% and squamous cell in 40%. Histologic grade was G1 in 32%, G2 in 33%, G3 in 35%, and G4 in 0.18%. pT classification was pTis in 7.3%, pT1 in 23%, pT2 in 16%, pT3 in 51%, and pT4 in 3.3%. pN classification was pN0 in 56% and pN1 in 44%. The number of lymph nodes positive for cancer was 1 in 12%, 2 in 8%, 3 in 5%, and >3 in 18%. Resection was R0 in 87%, R1 in 11%, and R2 in 3%. Overall survival was 78, 42, and 31% at 1, 5, and 10 years, respectively. Unlike single-institution studies, in this worldwide collaboration, survival progressively decreases and is distinctively stratified by all variables except region of the world. A worldwide esophageal cancer database has been assembled that overcomes problems of rarity of this cancer. It reveals that survival progressively (monotonically) decreased and was distinctively stratified by all variables except region of the world. Thus, it forms the basis for data-driven esophageal cancer staging. More centers are needed and encouraged to join WECC.
本研究旨在报告一个大型多机构国际食管癌患者数据库的组建情况，包括患者和肿瘤特征，以及单纯接受食管切除术患者的生存率及其相关因素。我们联系了48家机构，它们同意参与一项全球食管癌合作研究（WECC），截至2007年7月1日，有13家机构（亚洲2家；欧洲2家；北美洲9家）提交了数据。这些数据被用于构建一个包含7884例接受食管切除术的食管癌患者的去识别数据库。4627例食管切除术患者未接受诱导或辅助治疗。平均年龄为62±11岁，77%为男性，33%为亚洲人。平均肿瘤长度为3.3±2.5 cm，食管位置上段占4.1%，中段占27%，下段占69%。组织病理学细胞类型腺癌占60%，鳞状细胞癌占40%。组织学分级G1占32%，G2占33%，G3占35%，G4占0.18%。pT分类pTis占7.3%，pT1占23%，pT2占16%，pT3占51%，pT4占3.3%。pN分类pN0占56%，pN1占44%。癌症阳性淋巴结数量为1个的占12%，2个的占8%，3个的占5%，大于3个的占18%。切除为R0的占87%，R1的占11%，R2的占3%。1年、5年和10年的总生存率分别为78%、42%和31%。与单机构研究不同，在这项全球合作研究中，生存率逐渐下降，并且除世界区域外，所有变量均有明显分层。已组建了一个全球食管癌数据库，克服了这种癌症罕见性的问题。它显示生存率逐渐（单调）下降，并且除世界区域外，所有变量均有明显分层。因此，它构成了数据驱动的食管癌分期的基础。需要并鼓励更多中心加入WECC。
