title: Evaluation of the 7th edition of the TNM classification in patients with resected esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To evaluate the prognostic factors and tumor stages of the 7(th) edition TNM classification for esophageal cancer.
  
  
  METHODS
  In total, 1033 patients with esophageal squamous cell carcinoma (ESCC) who underwent surgical resection with or without (neo)adjuvant therapy between January 2003 and June 2012 at the Thoracic Surgery Department II of the Beijing Cancer Hospital, Beijing, China were included in this study. The following eligibility criteria were applied: (1) squamous cell carcinoma of the esophagus or gastroesophageal junction identified by histopathological examination; (2) treatment with esophagectomy plus lymphadenectomy with curative intent; and (3) complete pathologic reports and follow-up data. Patients who underwent non-curative (R1) resection and patients who died in hospital were excluded. Patients who received (neo)adjuvant therapy were also included in this analysis. All patients were restaged using the 7(th) edition of the Union for International Cancer Control and the American Joint Committee on Cancer TNM staging systems. Univariate and multivariate analyses were performed to identify the prognostic factors for survival. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to evaluate differences between the subgroups.
  
  
  RESULTS
  Of the 1033 patients, 273 patients received (neo)adjuvant therapy, and 760 patients were treated with surgery alone. The median follow-up time was 51.6 mo (range: 5-112 mo) and the overall 5-year survival rate was 36.4%. Gender, "pT" and "pN" descriptors, (neo)adjuvant therapy, and the 7(th) edition TNM stage grouping were independent prognostic factors in the univariate and multivariate analyses. However, neither histologic grade nor cancer location were independent prognostic factors in the univariate and multivariate analyses. The 5-year stage-based survival rates were as follows: IA, 84.9%; IB, 70.9%; IIA, 56.2%; IIB, 43.3%; IIIA, 37.9%; IIIB, 23.3%; IIIC,12.9% and IV, 3.4%. There were significant differences between each adjacent staging classification. Moreover, there were significant differences between each adjacent pN and pM subgroup. According to the pT descriptor, there were significant differences between each adjacent subgroup except between pT3 and pT4 (P = 0.405). However, there was no significant difference between each adjacent histologic grade subgroup and between each adjacent cancer location subgroup.
  
  
  CONCLUSIONS
  The 7(th) edition is considered to be valid for patients with resected ESCC. However, the histologic grade and cancer location were not prognostic factors for ESCC.
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Wang
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Wu
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Qing-Feng
authors.initials: QF
authors.lastname: Zheng
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Yan
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Chao
authors.initials: C
authors.lastname: Lv
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Shao-Lei
authors.initials: SL
authors.lastname: Li
authors.affiliation: Jia Wang, Nan Wu, Qing-Feng Zheng, Shi Yan, Chao Lv, Shao-Lei Li, Yue Yang, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: Yue
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Esophageal squamous cell carcinoma; Prognosis; Staging; Surgery; Survival; TNM