title: Worldwide Esophageal Cancer Collaboration: clinical staging data.
abstract: To address uncertainty of whether clinical stage groupings (cTNM) 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 clinically staged patients 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 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg2, 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, 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: 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: 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, Queensland, 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.
authors.forename: B P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.affiliation: Beijing Cancer Hospital, Beijing, China.
authors.forename: K N
authors.initials: KN
authors.lastname: Chen
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
authors.initials: R
authors.lastname: van Hillegersberg
authors.affiliation: Shanghai Chest Hospital, Shanghai, China.
authors.forename: W
authors.initials: W
authors.lastname: Fang
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.
authors.forename: M S
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 and 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: 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* / Q000601:surgery; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D006801:Humans; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000401:mortality*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods
keywords: cancer staging; data sharing; decision-making; prognostication; survival