Efficacy And Value Of Non-surgical Clinical Stage For Esophageal Carcinoma

Part I:Evaluation and accuracy of preoperative stage of esophageal carcinomaObjective The purpose of this study was to (1) assess endoscopic ultrasonography (EUS) staging, computed tomography (CT) staging and esophagography accuracy of esophageal cancer and to (2) evaluate the effort of the clinical stage grouping on survival in the same population.Methods A total of390esophageal cancer patients treated with surgery as first-time treatment were retrospectively reviewed for evaluation of preoperative EUS, CT and esophagography. The accuracy of T staging and N staging for each test were compared with the postoperative histopathological stage as the gold standard. The strength of the agreement between the radiological stage and the histopathological stage was determined by means of the Kappa statistic. Kaplan-Meier survival curves were generated for each stage and the log-rank test was used to test for significant differences in survival.Results The total accuracy and Kappa value of T stage was80.95%and0.671for EUS,71.25%and0.490for CT, and50.70%and0.386for esophagography. The accuracy and Kappa value of N stage was69.4%and0.243for EUS, and78.2%and0.467for CT. The accuracy of clinical stage based on T stage by EUS and N stage by CT was71.2%compared with UICC stage2002. Survival analysis showed the clinical stage to predict survival (p=0.000). An obstructing lesion and tumor length based (≤3cm vs.>3cm) on esophagography were prognostic factors (p=0.000,p=0.000)Conclusions The clinical stage grouping based on EUS T stage and CT N stage compares favorably with UICC stage2002. And the most important is the clinical stage grouping can predict survival in patients with esophageal cancer. Part II:Efficacy and predicting value of non-surgical clinical stage for esophageal carcinomaObjective To investigate the efficacy and predicting value of clinical stage in non-surgical patients with esophageal carcinoma (EC).Methods A retrospective study was conducted in358EC patients who received radical surgery in our hospital From April2003to October2010and had preoperative work-up such as EUS, thoracic CT scan. Positive (PPV) and negative (NPV) predictive value of Clinical T/N stage based on CT+EUS were calculated compared with pathological stage. And the overall survival (OS) and disease-free survival (DFS) were performed according to2002,2009UICC TNM stage and clinical stage groupings, respectively.Results The media following-up time was47months.305patients were analyzed with clinical stage based on EUS+CT. Among them, the predictive value of clinical T stage were0-88.6%, and88.6%for cTl. Predictive value of clinical N stage (N0/N1) were62.5%-100%. The significant differences in OS and DFS rates based on both2002and2009TNM stage were noted (p=0.000, p=0.000). For2002TNM stage, comparisons between the individual stage groupings showed a significant difference in overall survival in most of comparisons. There were305patients staged clinically based on EUS and CT according to2002TNM stage. A significant difference in OS and DFS rates based on clinical stage were noted (p=0.000, p=0.000).Conclusions1. Image modalities showed good predictive value for N stage (N0/N1), even they couldn’t provide precisely number of Lymph nodes metastasis.2. The clinical stage based on EUS+CT could predict the prognosis for non-surgical patients with esophageal carcinoma. Part Ⅲ:Clinical staging of non-surgical esophageal cancer based on endoscopic ultrasonography and CT and its prognostic valueObjective To investigate the clinic stageing of non-surgical esophageal cancer based on endoscopic ultrasonography (EUS) and computed tomography (CT) and its prognostic value.Methods A total of290patients with esophageal squamous cell carcinoma treated with non-surgical treatment were retrospectively reviewed from November2003to March2012. The clinical stage of each patient was evaluated based on EUS and CT according to the2002UICC TNM staging system. Kaplan-Meier survival curves were generated for each stage and significant differences in survival and univariate prognostic factor was analyzed by log-rank test. Multivariate prognostic factor was analyzed by Cox regression model.Results One hundred seventy eight patients (61.4%) were staged by EUS since EUS could be completely performed. Comparison of different EUS T-stages found no difference in overall survival (OS)(p=0.247). Comparison of different EUS T-stages among patients having EUS NO stage found significant difference in survivals (OS p=0.000; PFS p=0.006). EUS N-stages showed significant difference in survivals (OS p=0.012; PFS p=0.016). EUS was not completely performed in112patients (38.6%), and patients who had a stenotic tumor were poorer OS and PFS (OS p=0.001; PFS p=0.003). CT T-stages, and N-stages also affected OS and PFS(OS p=0.004, PFS p=0.030; OS p=0.024, PFS p=0.020).The1-,3-and5-OS rates were61.7%,27.8%,19.8%and the median survival time was16.7months. OS and PFS varied significantly between patients of different2002UICC clinical stages (p=0.000, p=0.000). The multivariate analyzed revealed sex, age and clinical stage were independent prognostic factors(p=0.004,0.020,0.002).Conclusions:The clinical stage grouping based on EUS and CT can predicts survival in esophageal carcinoma patients treated with non-surgical method. We recommend EUS as basic pretreatment examination was performed in patients with esophageal carcinoma in China.