Tumor Length as a Prognostic Factor in Esophageal Squamous Cell Carcinoma

Background. Tumor size is an important prognostic factor in many cancers, but its role in esophageal cancer remained undetermined. The aim of this study is to investigate the impact of tumor length on survival for patients with resected esophageal squamous cell carcinoma. Methods. A total 582 esophageal squamous cell carcinoma patients underwent surgical resection as the primary treatment was enrolled into this retrospective review. The longitudinal tumor length was defined as a uniformly measurement from the surgeons in the operating room immediately after completion of the esophagectomy. The impact of tumor length on patient's overall survival was assessed and compared with the factors among the current tumor-nodes-metastasis (TNM) staging system published in 2009. Results. The overall 1-, 3-, and 5-year survival rates were 70.4%, 37.8%, and 30.0%, respectively, with a median for 22 months. The length adversely affected the overall survival, and the 5-year survival rate was 77.3%, 48.1%, 38.5%, and 23.3 % for tumor lengths of 1 cm, 2 cm, 3 cm, and more than 3 cm, respectively (p < 0.001). In multivariate survival analysis, tumor length (more or less than 3 cm) remained an independent prognostic factor (p = 0.020) as did the other current TNM factors. For subgroup analysis, the predictive value of tumor length was significant in patients with T1 or T2 disease (p < 0.001), T3 or T4 disease (p = 0.029), and patients with N0 disease (p < 0.001), but not for patients with N1, N2, or N3 disease. Conclusions. Tumor length, which represents longitudinal spreading of the cancerous cells, could impact the overall survival of patients with resected esophageal squamous cell carcinoma, especially among those with nodal-negative disease. It may provide additional prognostic information to the current TNM staging system. (Ann Thorac Surg 2011;91:887-93) (C) 2011 by The Society of Thoracic Surgeons