title: The revised American Joint Committee on Cancer staging system (7th edition) improves prognostic stratification after minimally invasive esophagectomy for esophagogastric adenocarcinoma.
abstract: BACKGROUND
  Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions.
  
  
  METHODS
  We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined.
  
  
  RESULTS
  A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P < .001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy.
  
  
  CONCLUSIONS
  AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition.
authors.affiliation: Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Haris
authors.initials: H
authors.lastname: Zahoor
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Division of Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Benny
authors.initials: B
authors.lastname: Weksler
authors.affiliation: Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Levy
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gibson
authors.affiliation: Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Jon M
authors.initials: JM
authors.lastname: Davison
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA. Electronic address: nasonks@upmc.edu.
authors.forename: Katie S
authors.initials: KS
authors.lastname: Nason
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D015996:Survival Rate; D014481:United States
keywords: Adenocarcinoma; Esophageal neoplasms; Esophagectomy; Neoplasm; Staging; Survival