Craig S Brown1, Natalie Gwilliam2, Alex Kyrillos3, Waseem Lutfi3, Brittany Lapin3, Ki Wan Kim4, Seth B Krantz4, John A Howington4, Katherine Yao4, Michael B Ujiki5. 1. University of Chicago, Pritzker School of Medicine, Chicago, IL, USA. 2. Department of Surgery, University of Chicago, Chicago, IL, USA. 3. NorthShore University Health System, Evanston, IL, USA. 4. Department of Surgery, University of Chicago, Chicago, IL, USA; NorthShore University Health System, Evanston, IL, USA. 5. Department of Surgery, University of Chicago, Chicago, IL, USA; NorthShore University Health System, Evanston, IL, USA. Electronic address: mujiki@northshore.org.
Abstract
BACKGROUND: Upstaging in early esophageal adenocarcinoma (EAC) patients happens at a high rate and has implications for treatment. We sought to identify risk factors predicting upstaging. STUDY DESIGN: The National Cancer Database (2010-2013) was queried for all patients with clinical T1/T2 and N0 EAC who underwent esophagectomy without neoadjuvant therapy. Logistic regression models were developed to investigate risk factors for upstaging. RESULTS: A total of 1120 patients were included. Pathologic upstaging occurred in 21.3% (n = 239). After adjustment, risk of upstaging increased with tumor size (tumor size 1-3 cm, OR 4.57,95% CI 2.58-8.10, tumor size >3 cm, OR 10.57, 95% CI 5.77-19.35, as compared to tumors <1 cm) as well as with positive margins (OR 4.13, 95% CI 2.17-7.87) and > than 10 lymph nodes examined (OR 1.85, 95% CI 1.29-2.63), while facility volume was not significant. Odds of upstaging increased linearly with number of lymph nodes examined (OR 1.02 per node). CONCLUSION: Our data underscore the importance of tumor size as a predictor for upstaging and of completing a thorough lymph node dissection for staging purposes.
BACKGROUND: Upstaging in early esophageal adenocarcinoma (EAC) patients happens at a high rate and has implications for treatment. We sought to identify risk factors predicting upstaging. STUDY DESIGN: The National Cancer Database (2010-2013) was queried for all patients with clinical T1/T2 and N0 EAC who underwent esophagectomy without neoadjuvant therapy. Logistic regression models were developed to investigate risk factors for upstaging. RESULTS: A total of 1120 patients were included. Pathologic upstaging occurred in 21.3% (n = 239). After adjustment, risk of upstaging increased with tumor size (tumor size 1-3 cm, OR 4.57,95% CI 2.58-8.10, tumor size >3 cm, OR 10.57, 95% CI 5.77-19.35, as compared to tumors <1 cm) as well as with positive margins (OR 4.13, 95% CI 2.17-7.87) and > than 10 lymph nodes examined (OR 1.85, 95% CI 1.29-2.63), while facility volume was not significant. Odds of upstaging increased linearly with number of lymph nodes examined (OR 1.02 per node). CONCLUSION: Our data underscore the importance of tumor size as a predictor for upstaging and of completing a thorough lymph node dissection for staging purposes.
Authors: Gerd Jomrich; Marlene Hollenstein; Max John; Robin Ristl; Matthias Paireder; Ivan Kristo; Reza Asari; Sebastian F Schoppmann Journal: Ann Surg Oncol Date: 2019-01-31 Impact factor: 5.344
Authors: Ali Al-Kaabi; Rachel S van der Post; Jonathan Huising; Camiel Rosman; Iris D Nagtegaal; Peter D Siersema Journal: United European Gastroenterol J Date: 2019-09-25 Impact factor: 4.623