Worldwide Esophageal Cancer Collaboration: clinical staging data

T. W. Rice, C. Apperson-Hansen, L. M. DiPaola, M. E. Semple, T. E M R Lerut, M. B. Orringer, L. Q. Chen, W. L. Hofstetter, B. M. Smithers, V. W. Rusch, B. P L Wijnhoven, K. N. Chen, A. R. Davies, X. B. D'Journo, K. A. Kesler, J. D. Luketich, M. K. Ferguson, J. V. Räsänen, R. van Hillegersberg, W. FangL. Durand, W. H. Allum, I. Cecconello, R. J. Cerfolio, M. Pera, S. M. Griffin, R. Burger, J. F. Liu, M. S. Allen, S. Law, T. J. Watson, G. E. Darling, W. J. Scott, A. Duranceau, C. E. Denlinger, Paul Schipper, H. Ishwaran, E. H. Blackstone

    Research output: Contribution to journalArticle

    43 Citations (Scopus)

    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.

    Original languageEnglish (US)
    Pages (from-to)707-714
    Number of pages8
    JournalDiseases of the Esophagus
    Volume29
    Issue number7
    DOIs
    StatePublished - Oct 1 2016

    Fingerprint

    Esophageal Neoplasms
    Neoplasms
    Survival
    Squamous Cell Carcinoma
    Adenocarcinoma
    Adenosquamous Carcinoma
    Risk Adjustment
    Esophagectomy
    Neoplasm Staging
    Esophagus
    Uncertainty
    Comorbidity
    Weight Loss
    Body Mass Index
    Therapeutics
    Smoking
    Demography
    Carcinoma
    Mortality

    Keywords

    • cancer staging
    • data sharing
    • decision-making
    • prognostication
    • survival

    ASJC Scopus subject areas

    • Gastroenterology

    Cite this

    Rice, T. W., Apperson-Hansen, C., DiPaola, L. M., Semple, M. E., Lerut, T. E. M. R., Orringer, M. B., ... Blackstone, E. H. (2016). Worldwide Esophageal Cancer Collaboration: clinical staging data. Diseases of the Esophagus, 29(7), 707-714. https://doi.org/10.1111/dote.12493

    Worldwide Esophageal Cancer Collaboration : clinical staging data. / Rice, T. W.; Apperson-Hansen, C.; DiPaola, L. M.; Semple, M. E.; Lerut, T. E M R; Orringer, M. B.; Chen, L. Q.; Hofstetter, W. L.; Smithers, B. M.; Rusch, V. W.; Wijnhoven, B. P L; Chen, K. N.; Davies, A. R.; D'Journo, X. B.; Kesler, K. A.; Luketich, J. D.; Ferguson, M. K.; Räsänen, J. V.; van Hillegersberg, R.; Fang, W.; Durand, L.; Allum, W. H.; Cecconello, I.; Cerfolio, R. J.; Pera, M.; Griffin, S. M.; Burger, R.; Liu, J. F.; Allen, M. S.; Law, S.; Watson, T. J.; Darling, G. E.; Scott, W. J.; Duranceau, A.; Denlinger, C. E.; Schipper, Paul; Ishwaran, H.; Blackstone, E. H.

    In: Diseases of the Esophagus, Vol. 29, No. 7, 01.10.2016, p. 707-714.

    Research output: Contribution to journalArticle

    Rice, TW, Apperson-Hansen, C, DiPaola, LM, Semple, ME, Lerut, TEMR, Orringer, MB, Chen, LQ, Hofstetter, WL, Smithers, BM, Rusch, VW, Wijnhoven, BPL, Chen, KN, Davies, AR, D'Journo, XB, Kesler, KA, Luketich, JD, Ferguson, MK, Räsänen, JV, van Hillegersberg, R, Fang, W, Durand, L, Allum, WH, Cecconello, I, Cerfolio, RJ, Pera, M, Griffin, SM, Burger, R, Liu, JF, Allen, MS, Law, S, Watson, TJ, Darling, GE, Scott, WJ, Duranceau, A, Denlinger, CE, Schipper, P, Ishwaran, H & Blackstone, EH 2016, 'Worldwide Esophageal Cancer Collaboration: clinical staging data', Diseases of the Esophagus, vol. 29, no. 7, pp. 707-714. https://doi.org/10.1111/dote.12493
    Rice TW, Apperson-Hansen C, DiPaola LM, Semple ME, Lerut TEMR, Orringer MB et al. Worldwide Esophageal Cancer Collaboration: clinical staging data. Diseases of the Esophagus. 2016 Oct 1;29(7):707-714. https://doi.org/10.1111/dote.12493
    Rice, T. W. ; Apperson-Hansen, C. ; DiPaola, L. M. ; Semple, M. E. ; Lerut, T. E M R ; Orringer, M. B. ; Chen, L. Q. ; Hofstetter, W. L. ; Smithers, B. M. ; Rusch, V. W. ; Wijnhoven, B. P L ; Chen, K. N. ; Davies, A. R. ; D'Journo, X. B. ; Kesler, K. A. ; Luketich, J. D. ; Ferguson, M. K. ; Räsänen, J. V. ; van Hillegersberg, R. ; Fang, W. ; Durand, L. ; Allum, W. H. ; Cecconello, I. ; Cerfolio, R. J. ; Pera, M. ; Griffin, S. M. ; Burger, R. ; Liu, J. F. ; Allen, M. S. ; Law, S. ; Watson, T. J. ; Darling, G. E. ; Scott, W. J. ; Duranceau, A. ; Denlinger, C. E. ; Schipper, Paul ; Ishwaran, H. ; Blackstone, E. H. / Worldwide Esophageal Cancer Collaboration : clinical staging data. In: Diseases of the Esophagus. 2016 ; Vol. 29, No. 7. pp. 707-714.
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    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.",
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    AU - Apperson-Hansen, C.

    AU - DiPaola, L. M.

    AU - Semple, M. E.

    AU - Lerut, T. E M R

    AU - Orringer, M. B.

    AU - Chen, L. Q.

    AU - Hofstetter, W. L.

    AU - Smithers, B. M.

    AU - Rusch, V. W.

    AU - Wijnhoven, B. P L

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    AU - Räsänen, J. V.

    AU - van Hillegersberg, R.

    AU - Fang, W.

    AU - Durand, L.

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    AU - Cecconello, I.

    AU - Cerfolio, R. J.

    AU - Pera, M.

    AU - Griffin, S. M.

    AU - Burger, R.

    AU - Liu, J. F.

    AU - Allen, M. S.

    AU - Law, S.

    AU - Watson, T. J.

    AU - Darling, G. E.

    AU - Scott, W. J.

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    AU - Denlinger, C. E.

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