title: Prognostic significance of total disease length in esophageal cancer.
abstract: BACKGROUND
  This study tested the hypothesis that endoluminal ultrasound (EUS) defined total length of disease (including both the primary tumor and the position and number of proximal and distal lymph nodes-ELoD) and the associated EUS lymph node metastasis count (ELNMC) are better predictors of outcome than endoscopic esophageal cancer (OC) length and radiological tumor node metastasis stage in patients who undergo potentially curative treatment with surgery or definitive chemoradiotherapy (dCRT).
  
  
  METHODS
  A total of 645 consecutive patients diagnosed with OC and managed by a multidisciplinary team were staged by CT and EUS. The primary outcome measure was survival from date of diagnosis.
  
  
  RESULTS
  A total of 323 patients received surgery (208 neoadjuvant chemotherapy), and 322 who were deemed unsuitable for surgery received dCRT. Univariable analysis revealed that survival was related to EUS T (p < 0.0001), N (p < 0.0001), EUS primary tumor length (p = 0.037), ELoD (p = 0.011), ELNMC (p < 0.0001), and treatment type (p = 0.001). Multivariable analysis revealed two factors: ELoD (hazard ratio (HR), 0.961; 95 % confidence interval (CI), 0.925-0.998; p = 0.041) and ELNMC (HR, 1.08; 95 % CI, 1.015-1.15; p = 0.016) were independently associated with survival.
  
  
  CONCLUSIONS
  ELoD and ELNMC should become part of routine OC radiological staging to optimize stage-directed therapeutic outcomes.
authors.affiliation: South East Wales Cancer Network, Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK. illiondavies@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Davies
authors.forename: J D
authors.initials: JD
authors.lastname: Mason
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: D
authors.initials: D
authors.lastname: Chan
authors.forename: T D
authors.initials: TD
authors.lastname: Reid
authors.forename: M
authors.initials: M
authors.lastname: Robinson
authors.forename: S
authors.initials: S
authors.lastname: Gwynne
authors.forename: T D
authors.initials: TD
authors.lastname: Crosby
authors.forename: W G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000556:secondary* / Q000628:therapy; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011859:Radiography; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D014463:Ultrasonography