Endoscopic Tumor Length Is an Independent Prognostic Factor in Esophageal Squamous Cell Carcinoma

To investigate the impact of endoscopic esophageal tumor length on survival for patients with resected esophageal squamous cell carcinoma (ESCC). We retrospectively reviewed the clinicopathologic characteristics of 244 ESCC patients who underwent curative resection as the primary treatment at Taipei Veterans General Hospital between January 2000 and November 2010. The endoscopic tumor length was defined as a uniform measurement before completion of the esophagectomy. The impact of endoscopic tumor length on a patient's overall survival (OS) and disease-free survival (DFS) were assessed. A Cox regression model was used to identify prognostic factors. The 1-, 3-, and 5-year OS rates were 81.2, 48.2, and 39.6%, respectively, with a median survival time of 18.0 months. The 1-, 3-, and 5-year DFS rates were 66.2, 34.7, and 32.4%, respectively, with a median DFS of 15.0 months. Endoscopic tumor length correlated with pathologic tumor length [Pearson correction (r) = 0.621; P < 0.001] Regression trees analyses suggested an optimum cutoff point of > 4 cm to identify patients with decreased long-term survival. In multivariate survival analysis, endoscopic tumor length (more or less than 4 cm) remained an independent prognostic factor for both OS (P = 0.006) and DFS (P = 0.002). Endoscopic tumor length could have a significant impact on both the OS and DFS of patients with resected ESCC and may provide additional prognostic value to the current tumor, node, and metastasis staging system before patients receive any cancer-specific treatment.