All pathological T4 esophageal carcinomas should be categorized as stage IV.
OBJECTIVE
The prognosis of pathological T4 (pT4) esophageal carcinoma is still dismal, however, the current TNM classification categorizes some pT4 cancers (pT4M0) as stage III. The purpose of this study was to evaluate of the relevance of this classification.


METHODS
One hundred and thirty-five patients who underwent esophagectomy for pathological stage III (n = 85) and IV (n = 50) esophageal tumors were enrolled in the study. The outcomes and prognostic factors for these patients were examined. After the reclassification that pT4M0 tumors were categorized as stage IV, the two survival curves were compared between new stage III and IV.


RESULTS
The 5-year survival rates for stage III and IV were 14.6%, 19.1%, respectively (P = 0.9). The 5-year survival rates for pT3N1M0 and pT4M0 were 21.1%, 0%, respectively (P < 0.0001). After the reclassification, the overall 5-year survival rates for new stage III and IV were 24.0%, 14.2%, respectively (P = 0.004). Curative resection (P = 0.002), radiotherapy (P = 0.001), depth of tumor invasion (pT3; P = 0.0004, pT1; P = 0.04) were the significant prognostic factors for stage III and IV carcinomas. Thirty-one (83.8%) of 37 patients with pT4 tumor had received non-curative esophagectomy.


CONCLUSIONS
All pathological T4 esophageal carcinomas should be categorized as stage IV in the TNM classification.
Tabira
Yoichi
Y
Department of Surgery I, Kumamoto University School of Medicine, 1-1-1, Honjo, Kumamoto City, Kumamoto, 860-0811, Japan. makihisa@kaiju.medic.kumamoto-u.ac.jp
Yasunaga
Masahiro
M
Nakano
Kan-yu
KY
Sakaguchi
Tomonori
T
Nagamoto
Nobuhide
N
Matsushita
Hisayuki
H
Fukunaga
Yoshitaka
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis