Specific Tumor Characteristics Predict Upstaging in Early-Stage Esophageal Cancer

Kelly R. Haisley, Christopher M. Hart, Andy J. Kaempf, Nihar R. Dash, James Dolan, John Hunter

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Abstract

Background: Early-stage esophageal cancer (stages 0–1) has been shown to have relatively good outcomes after local endoscopic or surgical resection. For this reason, neoadjuvant chemoradiation usually is reserved for higher-stage disease. Some early tumors, however, are found after resection to be more advanced than predicted based on initial clinical staging, termed pathologic upstaging. Such tumors may have benefited from alternate treatment models had their true stage been known preoperatively. This study aimed to identify high-risk features in early esophageal cancers that might predict tumor upstaging and guide more individualized treatment algorithms. Methods: Through retrospective review of a single-institution foregut disease registry, we evaluated patients who underwent esophagectomy for high-grade dysplasia (Tis) or stage 1 esophageal cancer, searching for factors associated with pathologic upstaging. Results: The review included 110 patients (88% male, median age at diagnosis, 64.5 years) treated between January 2000 and June 2016. Upstaging occurred for 20.9% of the patients, and was more common for patients with angiolymphatic invasion (odds ratio [OR], 11.07; 95% confidence interval [CI], 2.96–41.44; P < 0.001) or signet-ring features (OR, 23.9; 95% CI, 2.6–216.8; P = 0.005). In the absence of other predictors, upstaging was associated with decreased overall survival (P = 0.006). Conclusions: Approximately 20% of patients with early-stage esophageal cancer may be upstaged at resection. Angiolymphatic invasion and signet-ring features may predict tumors likely to be upstaged, resulting in decreased overall survival.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Jan 1 2018

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Esophageal Neoplasms
Neoplasms
Odds Ratio
Confidence Intervals
Esophagectomy
Survival
Registries
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Specific Tumor Characteristics Predict Upstaging in Early-Stage Esophageal Cancer. / Haisley, Kelly R.; Hart, Christopher M.; Kaempf, Andy J.; Dash, Nihar R.; Dolan, James; Hunter, John.

In: Annals of Surgical Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Haisley, Kelly R. ; Hart, Christopher M. ; Kaempf, Andy J. ; Dash, Nihar R. ; Dolan, James ; Hunter, John. / Specific Tumor Characteristics Predict Upstaging in Early-Stage Esophageal Cancer. In: Annals of Surgical Oncology. 2018.
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abstract = "Background: Early-stage esophageal cancer (stages 0–1) has been shown to have relatively good outcomes after local endoscopic or surgical resection. For this reason, neoadjuvant chemoradiation usually is reserved for higher-stage disease. Some early tumors, however, are found after resection to be more advanced than predicted based on initial clinical staging, termed pathologic upstaging. Such tumors may have benefited from alternate treatment models had their true stage been known preoperatively. This study aimed to identify high-risk features in early esophageal cancers that might predict tumor upstaging and guide more individualized treatment algorithms. Methods: Through retrospective review of a single-institution foregut disease registry, we evaluated patients who underwent esophagectomy for high-grade dysplasia (Tis) or stage 1 esophageal cancer, searching for factors associated with pathologic upstaging. Results: The review included 110 patients (88{\%} male, median age at diagnosis, 64.5 years) treated between January 2000 and June 2016. Upstaging occurred for 20.9{\%} of the patients, and was more common for patients with angiolymphatic invasion (odds ratio [OR], 11.07; 95{\%} confidence interval [CI], 2.96–41.44; P < 0.001) or signet-ring features (OR, 23.9; 95{\%} CI, 2.6–216.8; P = 0.005). In the absence of other predictors, upstaging was associated with decreased overall survival (P = 0.006). Conclusions: Approximately 20{\%} of patients with early-stage esophageal cancer may be upstaged at resection. Angiolymphatic invasion and signet-ring features may predict tumors likely to be upstaged, resulting in decreased overall survival.",
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AU - Hart, Christopher M.

AU - Kaempf, Andy J.

AU - Dash, Nihar R.

AU - Dolan, James

AU - Hunter, John

PY - 2018/1/1

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N2 - Background: Early-stage esophageal cancer (stages 0–1) has been shown to have relatively good outcomes after local endoscopic or surgical resection. For this reason, neoadjuvant chemoradiation usually is reserved for higher-stage disease. Some early tumors, however, are found after resection to be more advanced than predicted based on initial clinical staging, termed pathologic upstaging. Such tumors may have benefited from alternate treatment models had their true stage been known preoperatively. This study aimed to identify high-risk features in early esophageal cancers that might predict tumor upstaging and guide more individualized treatment algorithms. Methods: Through retrospective review of a single-institution foregut disease registry, we evaluated patients who underwent esophagectomy for high-grade dysplasia (Tis) or stage 1 esophageal cancer, searching for factors associated with pathologic upstaging. Results: The review included 110 patients (88% male, median age at diagnosis, 64.5 years) treated between January 2000 and June 2016. Upstaging occurred for 20.9% of the patients, and was more common for patients with angiolymphatic invasion (odds ratio [OR], 11.07; 95% confidence interval [CI], 2.96–41.44; P < 0.001) or signet-ring features (OR, 23.9; 95% CI, 2.6–216.8; P = 0.005). In the absence of other predictors, upstaging was associated with decreased overall survival (P = 0.006). Conclusions: Approximately 20% of patients with early-stage esophageal cancer may be upstaged at resection. Angiolymphatic invasion and signet-ring features may predict tumors likely to be upstaged, resulting in decreased overall survival.

AB - Background: Early-stage esophageal cancer (stages 0–1) has been shown to have relatively good outcomes after local endoscopic or surgical resection. For this reason, neoadjuvant chemoradiation usually is reserved for higher-stage disease. Some early tumors, however, are found after resection to be more advanced than predicted based on initial clinical staging, termed pathologic upstaging. Such tumors may have benefited from alternate treatment models had their true stage been known preoperatively. This study aimed to identify high-risk features in early esophageal cancers that might predict tumor upstaging and guide more individualized treatment algorithms. Methods: Through retrospective review of a single-institution foregut disease registry, we evaluated patients who underwent esophagectomy for high-grade dysplasia (Tis) or stage 1 esophageal cancer, searching for factors associated with pathologic upstaging. Results: The review included 110 patients (88% male, median age at diagnosis, 64.5 years) treated between January 2000 and June 2016. Upstaging occurred for 20.9% of the patients, and was more common for patients with angiolymphatic invasion (odds ratio [OR], 11.07; 95% confidence interval [CI], 2.96–41.44; P < 0.001) or signet-ring features (OR, 23.9; 95% CI, 2.6–216.8; P = 0.005). In the absence of other predictors, upstaging was associated with decreased overall survival (P = 0.006). Conclusions: Approximately 20% of patients with early-stage esophageal cancer may be upstaged at resection. Angiolymphatic invasion and signet-ring features may predict tumors likely to be upstaged, resulting in decreased overall survival.

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