title: Proposed revision of the esophageal cancer staging system to accommodate pathologic response (pP) following preoperative chemoradiation (CRT).
abstract: OBJECTIVE
  To determine the impact of pathologic response following preoperative chemoradiation (CRT) on the AJCC esophageal cancer staging system.
  
  
  BACKGROUND
  Increasing numbers of locoregionally advanced esophageal cancer patients are treated with preoperative CRT prior to surgical resection.
  
  
  METHODS
  Five hundred ninety-three pts from 1985 to 2003 with esophageal cancer who underwent surgery with (n = 239) or without CRT (n = 354) were reviewed. Resected esophageal tumors were assessed for pathologic response by determining extent of residual tumor following CRT (P0, 0% residual; P1, 1%-50% residual; P2, >50% residual).
  
  
  RESULTS
  After CRT down-staging, pTNM specific survival was similar, irrespective of treatment group (P = 0.98). The pTNM stage distribution was more favorable in the CRT group (P < 0.001) despite a more advanced initial cTNM stage distribution (P < 0.001). Following CRT, the pathologic response (pP) at the primary tumor as defined by extent of residual tumor predicted overall survival (3 years: P0, 0% residual = 74%; P1, 1%-50% residual = 54%; P2, >50% residual = 24%, P < 0.001) and stage specific survival with greater accuracy than pTNM stage alone.
  
  
  CONCLUSIONS
  Our analyses demonstrate that following CRT, pTNM continues to predict survival. The extent of pathologic response following CRT is an independent risk factor for survival (pP) and should be incorporated in the pTNM esophageal cancer staging system to better predict patient outcome in esophageal cancer.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. sswisher@mdanderson.org
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Wayne
authors.initials: W
authors.lastname: Hofstetter
authors.forename: Tsung T
authors.initials: TT
authors.lastname: Wu
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Ritsuko R
authors.initials: RR
authors.lastname: Komaki
authors.forename: Lucian
authors.initials: L
authors.lastname: Chirieac
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Alexandria
authors.initials: A
authors.lastname: Phan
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016019:Survival Analysis