PROPOSED REVISION OF THE STAGING CLASSIFICATION FOR ESOPHAGEAL CANCER

Objectives: This study analyzed survival with respect to lymph node in volvement to develop a new staging system for patients with esophageal cancer that accurately reflects prognosis, Methods: The records of pa tients undergoing resection of primary esophageal cancer from 1989 to 1993 were reviewed. The data collected included patient age and sex, t umor histologic characteristics and location, the use of preoperative or postoperative radiation and chemotherapy, the type of resection, th e depth of tumor invasion, the number and location of benign and malig nant lymph nodes in the resected specimen, the disease status at last follow-up, and the first site of relapse, With an anatomically specifi c lymph node map, tumors designated in the current American Joint Comm ittee on Cancer system as M1 because of extensive lymph node metastase s were reclassified as N2, reserving the M1 category for visceral meta stases. Survival was analyzed by the Kaplan-Meier method, and prognost ic factors were assessed by log-rank and Cox regression analyses, Resu lts: There were 216 patients (159 men, 57 women) with a median age of 63.5 years, Adenocarcinoma of the distal esophagus or gastroesophageal junction was the most common tumor (127 patients, 59%) and Ivor Lewis esophagogastrectomy was the most frequently performed operation, Both lymph node location (N1 versus N2) and number (0 vs 1 to 3 vs 4 or mo re) significantly influenced survival. Conclusions: A new staging syst em that adds an N2 M0 descriptor and reclassifies stage groupings refl ects prognosis more accurately than does the current American Joint Co mmittee on Cancer staging system. The number of positive lymph nodes i s also an important stratification factor.