Impact of Tumor Length on Survival for Patients with Resected Esophageal Cancer

Background: Tumor length in patients with esophageal cancer (EC) has recently received great attention.However, its prognostic role for EC is controversial. The purpose of our study was to characterize the prognosticvalue of tumor length in EC patients and offer the optimum cut-off point of tumor length by reliable statisticalmethods. Materials and
Methods: A retrospective analysis was conducted on 71 consecutive patients with ECwho underwent surgery. ROC curve analysis was used to determine the optimal cut-off point for tumor length,measured with a handheld ruler after formalin fixation. Correlations between tumor length and other factorswere surveyed, and overall survival (OS) rates were compared between the two groups. Potential prognosticfactors were evaluated by univariate Kaplan-Meier survival analysis. A P value less than 0.05 was consideredsignificant.
Results: There were a total of 71 patients, with a male/ female divide of 43/28 and a median age of59. Characteristics were as follows: squamous/adenocarcinoma, 65/6; median tumor length, 4 (0.9–10); cut-offpoint for tumor length, 4cm. Univariate analysis prognostic factors were tumor length and modality of therapy.One, three and five year OS rates were 84, 43 and 43% for tumors with ≤4cm length, whereas the rates were75, 9 and 0% for tumors >4 cm. There was a significant association between tumor length and age, sex, weightloss, tumor site, histology, T and N scores, differentiation, stage, modality of therapy and longitudinal margininvolvement.
Conclusions: Future studies for modification of the EC staging system might consider tumor lengthtoo as it is an important prognostic factor. Further assessment with larger prospective datasets and practicalmethods (such as endoscopy) is needed to establish an optimal cut-off point for tumor length.