title: Prognostic impact of the 6th and 7th American Joint Committee on Cancer TNM staging systems on esophageal cancer patients treated with chemoradiotherapy.
abstract: OBJECTIVE
  The new 7th edition of the American Joint Committee on Cancer TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. There is no information available on evaluation of the new staging system with regard to prognosis of patients treated with chemoradiotherapy (CRT). The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal cancer patients treated with CRT.
  
  
  METHODS
  A retrospective review was performed on 301 consecutive esophageal squamous cell carcinoma patients treated with CRT. Comparisons were made of the prognostic impacts of the 6th and 7th staging systems and the prognostic impacts of stage and prognostic groups, which were newly defined in the 7th edition.
  
  
  RESULTS
  There were significant differences between Stages I and III (p < 0.01) according to both editions. However, the 7th edition poorly distinguishes the prognoses of Stages III and IV (p = 0.36 by multivariate analysis) in comparison to the 6th edition (p = 0.08 by multivariate analysis), although these differences were not significant. For all patients, T, M, and gender were independent prognostic factors by multivariate analysis (p < 0.05). For the Stage I and II prognostic groups, survival curves showed a stepwise decrease with increase in stage, except for Stage IIA. However, there were no significant differences seen between each prognostic stage.
  
  
  CONCLUSIONS
  Our study indicates there are several problems with the 7th TNM staging system regarding prognostic factors in patients undergoing CRT.
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, Japan.
authors.forename: Motoo
authors.initials: M
authors.lastname: Nomura
authors.forename: Kohei
authors.initials: K
authors.lastname: Shitara
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kodaira
authors.forename: Shunzo
authors.initials: S
authors.lastname: Hatooka
authors.forename: Ayako
authors.initials: A
authors.lastname: Mizota
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kondoh
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yokota
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takahari
authors.forename: Takashi
authors.initials: T
authors.lastname: Ura
authors.forename: Kei
authors.initials: K
authors.lastname: Muro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D002945:Cisplatin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods / Q000592:standards*; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D047368:Tumor Burden; D014481:United States
chemical_list: D009944:Organoplatinum Compounds; C053989:nedaplatin; D002945:Cisplatin; D005472:Fluorouracil