A Role for Tumor Volume Assessment in Resectable Esophageal Cancer.
Esophageal cancer has a poor prognosis, and many patients undergoing surgery have a low chance of cure. Imaging studies suggest that tumor volume is prognostic. The study aimed to evaluate pathological tumor volume (PTV) as a prognostic variable in esophageal cancer.



This single-center cohort study included 283 patients who underwent esophageal cancer resections between 2000 and 2012. PTVs were obtained from pathological measurements using a validated volume formula. The prognostic value of PTV was analyzed using multivariable regression models, adjusting for age, tumor grade, tumor (T) stage, nodal stage, lymphovascular invasion, resection margin, resection type, and chemotherapy response, which provided hazard ratios (HRs) with 95 % confidence intervals (CIs). Primary outcomes were time to death and time to recurrence. Secondary outcomes were margin involvement and lymph node positivity. Correlation analysis was performed between imaging and PTVs.



On unadjusted analysis, increasing PTV was associated with worse overall mortality (HR 2.30, 95 % CI 1.41-3.73) and disease recurrence (HR 1.87, 95 % CI 1.14-3.07). Adjusted analysis demonstrated worse overall mortality with increasing PTV but reached significance in only one subgroup (HR 1.70, 95 % CI 1.09-2.38). PTV was an independent predictor of margin involvement (OR 2.28, 95 % CI 1.02-5.13) and lymph node-positive status (OR 2.77, 95 % CI 1.23-6.28). Correlation analyses demonstrated significant positive correlation between computed tomography (CT) software and formula tumor volumes (r = 0.927, p < 0.0001), CT and positron emission tomography tumor volumes (r = 0.547, p < 0.0001), and CT and PTVs (r = 0.310, p < 0.001).



Tumor volume may predict survival, margin status, and lymph node positivity after surgery for esophageal cancer.
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK. ltullie@googlemail.com.
Lucinda G C
LG
Tullie
Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.
Hyon-Mok
HM
Sohn
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.
Janine
J
Zylstra
Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Fredrik
F
Mattsson
Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.
Nyree
N
Griffin
Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.
Naveen
N
Sharma
Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.
Francois
F
Porté
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.
Lisa
L
Ramage
Department of Radiology, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.
Gary J
GJ
Cook
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.|Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
James A
JA
Gossage
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.|Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Robert C
RC
Mason
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.|Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Jesper
J
Lagergren
Department of Upper Gastrointestinal Surgery, St. Thomas' Hospital, Guy's and St. Thomas' Oesophago-Gastric Centre, London, UK.|Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK.|Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Andrew R
AR
Davies
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome; D047368:Tumor Burden