title: Is tumor length a prognostic indicator for esophageal squamous cell carcinoma? A single larger study among Chinese patients.
abstract: OBJECTIVE
  In esophageal cancer, depth of wall penetration, reflected by T classification, represents the most important prognostic variable. Our study aimed to investigate the impact of tumor length, measured as the longitudinal length, on the outcome of esophageal squamous cell carcinoma (ESCC) patients.
  
  
  METHODS
  The survival data of 362 ESCC patients who underwent surgical resection as the primary treatment between 1999 and 2007 were collected retrospectively. Receiver-operator characteristic analysis was applied to identify the optimal cut-off values.
  
  
  RESULTS
  4.0 cm was identified as the optimal cut-off value within the whole group. Tumor length greater than 4.0 cm was associated with increasing T stage (P=0.001), N stage (P=0.046), and tumor differentiation (P=0.033). Univariate analysis and multivariate analysis both found that tumor length greater than 4.0 cm was associated with worse overall survival compared with shorter tumors (P<0.001). It appeared to have a greater impact on N0-N1 (P<0.001, P=0.026, respectively) than N2-N3 and appeared to have a higher impact on the lower-stage patients than the higher-stage patients.
  
  
  CONCLUSIONS
  Tumor length proved to be an independent prognostic parameter for ESCC patients, especially for node-negative and lower-stage patients. More attention should be paid to its role in the management of ESCC.
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Ming-Quan
authors.initials: MQ
authors.lastname: Ma
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Zhen-Tao
authors.initials: ZT
authors.lastname: Yu
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Tang
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Hong-Jing
authors.initials: HJ
authors.lastname: Jiang
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Xi-Jiang
authors.initials: XJ
authors.lastname: Zhao
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Zhang
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Da-Wang
authors.initials: DW
authors.lastname: Qu
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Qing-Wen
authors.initials: QW
authors.lastname: Jin
authors.affiliation: Department of Esophageal Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer Tianjin 300060, China ; Key Laboratory of Cancer Prevention and Therapy Tianjin 300060, China.
authors.forename: Xi-Zeng
authors.initials: XZ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D044466:Asian People; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult
keywords: Esophageal cancer; cancer-specific survival; multivariate analysis; tumor length