title: Increasing tumor length is associated with regional lymph node metastases and decreased survival in esophageal cancer.
abstract: BACKGROUND
  Although tumor length has received little attention for staging of esophageal cancer, it may be a valid prognostic feature for node positivity and survival.
  
  
  METHODS
  Through retrospective review of a prospective institutional database, esophageal cancer patients who completed esophagectomy without neoadjuvant chemoradiation were analyzed. Pathologic tumor lengths were compared with node positivity and survival through a zero-inflated negative binomial regression model and multivariable Cox proportional hazards model, respectively.
  
  
  RESULTS
  Between January 2000 and July 2015, 98 patients met inclusion, criteria (84% male, median age of 65, 90% adenocarcinoma). Median tumor length was 2.5 cm with each 1-cm increase in length increasing the odds of node positivity (odds ratio 3.55, 95% confidence interval 1.50 to 8.40, P = .004) and decreasing overall survival (hazards ratio 1.18, 95% confidence interval 1.06 to 1.32, P < .003).
  
  
  CONCLUSIONS
  This study suggests an association among tumor length, lymph node metastasis, as well as overall survival in esophageal cancer patients who have not received neoadjuvant chemoradiotherapy.
authors.affiliation: Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, L223A Portland, OR 27239, USA.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Haisley
authors.affiliation: Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, L223A Portland, OR 27239, USA.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Hart
authors.affiliation: Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, L223A Portland, OR 27239, USA.
authors.forename: Laura E
authors.initials: LE
authors.lastname: Fischer
authors.affiliation: Advocate Medical Group, Division of General and Vascular Surgery, Department of Surgery, Elgin, IL, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Kunio
authors.affiliation: Department of Gastroenterology, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Gene
authors.initials: G
authors.lastname: Bakis
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Tieu
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Schipper
authors.affiliation: Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, L223A Portland, OR 27239, USA.
authors.forename: Brett C
authors.initials: BC
authors.lastname: Sheppard
authors.affiliation: Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, L223A Portland, OR 27239, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Hunter
authors.affiliation: Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Pk Rd, L223A Portland, OR 27239, USA. Electronic address: dolanj@ohsu.edu.
authors.forename: James P
authors.initials: JP
authors.lastname: Dolan
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods / Q000401:mortality*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D047368:Tumor Burden
keywords: Esophageal cancer; Node positive; Survival; Tumor length