title: Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data.
abstract: To address uncertainty of whether pathologic stage groupings after neoadjuvant therapy (ypTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for pathologically staged cancers after neoadjuvant therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 7,773 pathologically staged neoadjuvant patients, 2,045 had squamous cell carcinoma, 5,686 adenocarcinoma, 31 adenosquamous carcinoma, and 11 undifferentiated carcinoma. Patients were older (61 years) men (83%) with normal (40%) or overweight (35%) body mass index, 0-1 Eastern Cooperative Oncology Group performance status (96%), and a history of smoking (69%). Cancers were ypT0 (20%), ypT1 (13%), ypT2 (18%), ypT3 (44%), ypN0 (55%), ypM0 (94%), and G2-G3 (72%); most involved the distal esophagus (80%). Non-risk-adjusted survival for yp categories was unequally depressed, more for earlier categories than later, compared with equivalent categories from prior WECC data for esophagectomy-alone patients. Thus, survival of patients with ypT0-2N0M0 cancers was intermediate and similar regardless of ypT; survival for ypN+ cancers was poor. Because prognoses for ypTNM and pTNM categories are dissimilar, prognostication should be based on separate ypTNM categories and groupings. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics and should direct 9th edition data collection.
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA. ricet@ccf.org.
authors.forename: T W
authors.initials: TW
authors.lastname: Rice
authors.affiliation: University Ziekenhuizen Leuven, Leuven, Belgium.
authors.forename: T E M R
authors.initials: TE
authors.lastname: Lerut
authors.affiliation: University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Orringer
authors.affiliation: West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: L-Q
authors.initials: LQ
authors.lastname: Chen
authors.affiliation: University of Texas MD Anderson Hospital, Houston, Texas, USA.
authors.forename: W L
authors.initials: WL
authors.lastname: Hofstetter
authors.affiliation: University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.
authors.forename: B M
authors.initials: BM
authors.lastname: Smithers
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
authors.forename: V W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: Erasmus Medical Center, Rotterdam, The Netherlands.
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authors.affiliation: Beijing Cancer Hospital, Beijing, China.
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authors.initials: KN
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authors.affiliation: Guy's & St. Thomas' Hospitals, London, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Davies
authors.affiliation: Hôpital Nord, Marseille, France.
authors.forename: X B
authors.initials: XB
authors.lastname: D'Journo
authors.affiliation: Indiana University Medical Center, Indianapolis, Indiana, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Kesler
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Department of Surgery, The University of Chicago, Chicago, Illinois, USA.
authors.forename: M K
authors.initials: MK
authors.lastname: Ferguson
authors.affiliation: Helsinki University Hospital, Helsinki, Finland.
authors.forename: J V
authors.initials: JV
authors.lastname: Räsänen
authors.affiliation: University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R
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authors.lastname: van Hillegersberg
authors.affiliation: Shanghai Chest Hospital, Shanghai, China.
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authors.affiliation: Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina.
authors.forename: L
authors.initials: L
authors.lastname: Durand
authors.affiliation: Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: W H
authors.initials: WH
authors.lastname: Allum
authors.affiliation: University of São Paulo, São Paulo, Brazil.
authors.forename: I
authors.initials: I
authors.lastname: Cecconello
authors.affiliation: University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Cerfolio
authors.affiliation: Hospital Universitario del Mar, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pera
authors.affiliation: University of Newcastle upon Tyne, Newcastle, UK.
authors.forename: S M
authors.initials: SM
authors.lastname: Griffin
authors.affiliation: Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
authors.forename: R
authors.initials: R
authors.lastname: Burger
authors.affiliation: Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
authors.forename: J-F
authors.initials: JF
authors.lastname: Liu
authors.affiliation: Mayo Clinic, Rochester, Minnesota, USA.
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authors.initials: MS
authors.lastname: Allen
authors.affiliation: University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China.
authors.forename: S
authors.initials: S
authors.lastname: Law
authors.affiliation: University of Rochester, Rochester, New York, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Watson
authors.affiliation: Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: G E
authors.initials: GE
authors.lastname: Darling
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
authors.forename: W J
authors.initials: WJ
authors.lastname: Scott
authors.affiliation: University of Montreal, Montreal, Quebec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Duranceau
authors.affiliation: Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Denlinger
authors.affiliation: Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: P H
authors.initials: PH
authors.lastname: Schipper
authors.affiliation: University of Miami, Miami, Florida, USA.
authors.forename: H
authors.initials: H
authors.lastname: Ishwaran
authors.affiliation: Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: C
authors.initials: C
authors.lastname: Apperson-Hansen
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: DiPaola
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Semple
authors.affiliation: Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: E H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D005260:Female; D006801:Humans; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000401:mortality*; D009367:Neoplasm Staging / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods
keywords: cancer staging; chemotherapy; prognostication; radiotherapy; survival