title: Pathological stage after neoadjuvant chemoradiation and esophagectomy superiorly predicts survival in patients with esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  To assess the usefulness of pathological stage according to the 7th edition of the Union for International Cancer Control-American Joint Committee on Cancer (UICC-AJCC) as a prognostic tool in patients undergoing neoadjuvant chemoradiation followed by esophagectomy (trimodality therapy, TMT) for locally advanced esophageal squamous cell carcinoma.
  
  
  METHODS
  One hundred twenty-five eligible patients completing TMT were enrolled for analysis. The clinical (cTNM7) and pathological (ypTNM7) stage groups of their tumors were prospectively classified, and re-grouped by the 6th edition (ypTNM6). Survival was analyzed using the Kaplan-Meier method. The Cox proportional hazard model and the Akaike information criterion (AIC) were used to compare the performance of staging systems.
  
  
  RESULTS
  With a median follow-up of 24.6 months, 54 patients (43.2%) died. Forty patients (32%) achieved pathological complete remission (pCR). The median survival was 31.8 months. On multivariate analysis, ypTNM7 (but not pCR or pN) was the only independent factor affecting overall survival (p<0.001). The ypTNM7 was superior to cTNM7 or ypTNM6 in predicting both overall and recurrence-free survival after TMT based on AIC values and Cox proportional hazard model analysis.
  
  
  CONCLUSIONS
  In patients with locally advanced esophageal squamous cell carcinoma undergoing TMT, ypTNM7 is the best predictor of survival.
authors.affiliation: Department of Oncology, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Chia-Chun
authors.initials: CC
authors.lastname: Wang
authors.affiliation: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Jason Chia-Hsien
authors.initials: JC
authors.lastname: Cheng
authors.affiliation: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chiao-Ling
authors.initials: CL
authors.lastname: Tsai
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jang-Ming
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Pei-Ming
authors.initials: PM
authors.lastname: Huang
authors.affiliation: Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chia-Chi
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Medical Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chih-Hung
authors.initials: CH
authors.lastname: Hsu
authors.affiliation: Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Min-Shu
authors.initials: MS
authors.lastname: Hsieh
authors.affiliation: Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yih-Leong
authors.initials: YL
authors.lastname: Chang
authors.affiliation: Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: hsufengming@ntuh.gov.tw.
authors.forename: Feng-Ming
authors.initials: FM
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models
keywords: Esophageal squamous cell carcinoma; Neoadjuvant; Trimodality therapy; UICC–AJCC Stage