Haris Zahoor1, James D Luketich2, Benny Weksler3, Daniel G Winger4, Neil A Christie2, Ryan M Levy2, Michael K Gibson5, Jon M Davison6, Katie S Nason7. 1. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. 2. Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA. 3. Division of Cardiothoracic Surgery, University of Tennessee Health Science Center, Memphis, TN, USA. 4. Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA. 5. Division of Hematology and Oncology, Department of Medicine, Case Western Reserve University, Cleveland, OH, USA. 6. Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA. 7. Department of Cardiothoracic Surgery, University of Pittsburgh, 5200 Centre Ave, Suite 715, Shadyside Medical Building, Pittsburgh, PA 15232, USA. Electronic address: nasonks@upmc.edu.
Abstract
BACKGROUND: Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions. METHODS: We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined. RESULTS: A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P < .001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy. CONCLUSION: AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition.
BACKGROUND: Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions. METHODS: We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined. RESULTS: A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P < .001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy. CONCLUSION: AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition.
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