title: The degree of circumferential tumour involvement as a prognostic factor in oesophageal cancer.
abstract: OBJECTIVE
  Tumour length is an adverse prognostic factor in oesophageal cancer. However, the prognostic role of the degree of oesophageal circumference (DOC) involved by tumour with or without resection margin invasion is not clear. This work assessed the relationship between DOC involved by tumour, clinico-pathological variables and prognosis.
  
  
  METHODS
  The clinico-pathological details of 320 patients who underwent potentially curative oesophagogastrectomy for cancer between 1994 and 2007 were analysed. The DOC involved with tumour measured macroscopically on the resected specimen was classified as small (<2.5 cm, n = 115), large (> or = 2.5 cm, n = 144) or circumferential (i.e. involving the whole circumference, n = 61). Univariate and multivariate survival analyses were carried out.
  
  
  RESULTS
  The DOC with tumour was higher in ulcerating tumours than stenosing or polypoidal types (p = 0.017). Tumour length, T-stage, neoadjuvant chemotherapy and vascular invasion were independently associated with DOC with tumour on multivariate analysis (p < 0.05 for all). DOC > or = 2.5 cm was an adverse prognostic factor in univariate analysis (p = 0.002) with a hazard ratio of 1.52 [95% CI 1.13-2.04] compared with those <2.5 cm. Circumferential tumours had a similar prognosis to tumours > or = 2.5 cm (p = 0.60). The prognostic significance of DOC with tumour was lost in multivariate analysis where the factors retaining independence were patient age, T-stage, lymph node metastasis, vascular invasion and positive resection margins. However, when patients were stratified by use of neoadjuvant chemotherapy (n = 121), the DOC with tumour retained prognostic significance on multivariate analysis in the 199 patients who did not undergo neoadjuvant chemotherapy (p = 0.04).
  
  
  CONCLUSIONS
  The DOC with tumour appears to provide prognostic information in oesophageal cancer surgery, especially in patients who do not undergo preoperative chemotherapy.
authors.affiliation: Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, South Moor Road, Wythenshawe, Manchester M23 9LT, United Kingdom.
authors.forename: Karim
authors.initials: K
authors.lastname: Sillah
authors.forename: Susan A
authors.initials: SA
authors.lastname: Pritchard
authors.forename: Gillian R
authors.initials: GR
authors.lastname: Watkins
authors.forename: James
authors.initials: J
authors.lastname: McShane
authors.forename: Catharine M
authors.initials: CM
authors.lastname: West
authors.forename: Richard
authors.initials: R
authors.lastname: Page
authors.forename: Ian M
authors.initials: IM
authors.lastname: Welch