Rice T W, Chen L-Q, Hofstetter W L, Smithers B M, Rusch V W, Wijnhoven B P L, Chen K L, Davies A R, D'Journo X B, Kesler K A, Luketich J D, Ferguson M K, Räsänen J V, van Hillegersberg R, Fang W, Durand L, Cecconello I, Allum W H, Cerfolio R J, Pera M, Griffin S M, Burger R, Liu J-F, Allen M S, Law S, Watson T J, Darling G E, Scott W J, Duranceau A, Denlinger C E, Schipper P H, Lerut T E M R, Orringer M B, Ishwaran H, Apperson-Hansen C, DiPaola L M, Semple M E, Blackstone E H
Cleveland Clinic, Cleveland, Ohio, USA.
West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Dis Esophagus. 2016 Oct;29(7):724-733. doi: 10.1111/dote.12520.
We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.
我们报告了来自全球食管癌协作组（WECC）的、未接受术前治疗的食管癌和食管胃交界癌患者术后或消融后的、数据简单的患者特征、癌症类别及非风险调整生存情况描述。来自六大洲的33个机构使用标准定义提交了去识别化数据：人口统计学、合并症、临床癌症类别以及首次治疗决策后的全因死亡率。在13,300例患者中，5,631例为鳞状细胞癌，7,558例为腺癌，85例为腺鳞癌，26例为未分化癌。患者多为老年（62岁）男性（80%），体重指数正常（51%），体重减轻少（1.8千克），东部肿瘤协作组（ECOG）体能状态为0 - 2级（83%），有吸烟史（70%）。癌症分期为pT1（24%）、pT2（15%）、pT3（50%）、pN0（52%）、pM0（93%）、pG2 - G3（78%）；大多数累及食管远端（71%）。鳞状细胞癌和腺癌的非风险调整生存情况在pTNM分期中呈单调且有差异。当按pN对pT进行排序时，腺癌的生存差异比鳞状细胞癌更明显。pTis - 1期腺癌的生存情况优于鳞状细胞癌，尽管两者均呈单调且有差异。与第7版相比，WECC病理分期数据有所改进，研究的患者更多，收集的患者和癌症变量也更多。这些数据将成为第8版癌症分期手册在对患者、癌症和治疗特征进行风险调整后的基础，并应指导第9版数据收集。然而，单纯病理分期作为食管癌分期主要参考依据的作用正在减弱。
