Tomoya Yokota1, Takushi Yasuda2, Hiroyuki Kato3, Isao Nozaki4, Hiroshi Sato5, Yoshinori Miyata6, Yoshifumi Kuroki7, Ken Kato8, Yasuo Hamamoto9, Yasuhiro Tsubosa10, Hirofumi Ogawa11, Yoshinori Ito12, Yuko Kitagawa13. 1. Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. t.yokota@scchr.jp. 2. Department of Surgery, Faculty of Medicine, Kinki University, Osakasayama, Japan. 3. First Department of Surgery, Dokkyo Medical University, Shimotsuga, Japan. 4. Department of Surgery, Shikoku Cancer Center Hospital, Matsuyama, Japan. 5. Division of Upper Gastrointestinal Tract, Department of Surgery, Saitama Medical University International Medical Center, Saitama, Japan. 6. Department of Medical Oncology, Saku Central Hospital Advanced Care Center, Saku, Japan. 7. Department of Radiology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 8. Gastrointestinal Oncology Division, National Cancer Center Hospital, Tokyo, Japan. 9. Division of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan. 10. Division of Esophageal Surgery, Shizuoka Cancer Center, Sunto-gun, Japan. 11. Division of Radiation Oncology, Shizuoka Cancer Center, Sunto-gun, Japan. 12. Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan. 13. Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: We conducted a multicenter phase II trial assessing chemoselection with docetaxel plus 5-fluorouracil and cisplatin induction chemotherapy and subsequent conversion surgery for locally advanced, unresectable esophageal cancer. The aim of this study was to validate the concordance of clinical T diagnosis among physicians in the cases of this trial. METHODS: Computed tomography scans and esophagoscopic images of 48 patients taken at baseline were centrally reviewed by 6 senior physicians with experience in esophageal oncology. Individual reviewers voted for definitive T4, relative T4, relative T3, or definitive T3. Discordant diagnoses between reviewers were resolved by the majority opinion. The reviewers were blinded to patient clinical outcome data and to the vote of the other reviewers. RESULTS: Ninety percent of cases were diagnosed as clinical T4 by investigators, while 33.3-75.0% (median 70.8%) of cases were judged to be T4 by 6 reviewers. Discordant diagnosis between investigators and reviewers occurred in 33% (16/48) of all cases (Cohen's kappa coefficient 0.0519), including 12 cases where curative resection was considered possible (48%, n = 25) and 4 cases where curative resection was considered impossible (17%, n = 23). Critical discordance (one reviewer voted for definitive T3 but the other voted for definitive T4, and vice versa) between reviewers occurred in 0-12.5% of cases (median 2.1%). CONCLUSIONS: There were inter-observer variations in clinical diagnosis of the T category of locally advanced, unresectable esophageal cancer. Accurate clinical diagnosis of T classification is required for determining the optimum treatment for each patient.
BACKGROUND: We conducted a multicenter phase II trial assessing chemoselection with docetaxel plus 5-fluorouracil and cisplatin induction chemotherapy and subsequent conversion surgery for locally advanced, unresectable esophageal cancer. The aim of this study was to validate the concordance of clinical T diagnosis among physicians in the cases of this trial. METHODS: Computed tomography scans and esophagoscopic images of 48 patients taken at baseline were centrally reviewed by 6 senior physicians with experience in esophageal oncology. Individual reviewers voted for definitive T4, relative T4, relative T3, or definitive T3. Discordant diagnoses between reviewers were resolved by the majority opinion. The reviewers were blinded to patient clinical outcome data and to the vote of the other reviewers. RESULTS: Ninety percent of cases were diagnosed as clinical T4 by investigators, while 33.3-75.0% (median 70.8%) of cases were judged to be T4 by 6 reviewers. Discordant diagnosis between investigators and reviewers occurred in 33% (16/48) of all cases (Cohen's kappa coefficient 0.0519), including 12 cases where curative resection was considered possible (48%, n = 25) and 4 cases where curative resection was considered impossible (17%, n = 23). Critical discordance (one reviewer voted for definitive T3 but the other voted for definitive T4, and vice versa) between reviewers occurred in 0-12.5% of cases (median 2.1%). CONCLUSIONS: There were inter-observer variations in clinical diagnosis of the T category of locally advanced, unresectable esophageal cancer. Accurate clinical diagnosis of T classification is required for determining the optimum treatment for each patient.
Entities:
Keywords:
Central review; Clinical T diagnosis; Concordance; Esophageal squamous cell carcinoma
Authors: P van Hagen; M C C M Hulshof; J J B van Lanschot; E W Steyerberg; M I van Berge Henegouwen; B P L Wijnhoven; D J Richel; G A P Nieuwenhuijzen; G A P Hospers; J J Bonenkamp; M A Cuesta; R J B Blaisse; O R C Busch; F J W ten Kate; G-J Creemers; C J A Punt; J T M Plukker; H M W Verheul; E J Spillenaar Bilgen; H van Dekken; M J C van der Sangen; T Rozema; K Biermann; J C Beukema; A H M Piet; C M van Rij; J G Reinders; H W Tilanus; A van der Gaast Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245