title: All pathological T4 esophageal carcinomas should be categorized as stage IV.
abstract: 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.
authors.affiliation: 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
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Tabira
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yasunaga
authors.forename: Kan-yu
authors.initials: KY
authors.lastname: Nakano
authors.forename: Tomonori
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Nobuhide
authors.initials: N
authors.lastname: Nagamoto
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Matsushita
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fukunaga
mesh_terms: 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