J Thorac Cardiovasc Surg 2003;125:988-991
© 2003 The American Association for Thoracic Surgery
Staging of esophageal carcinoma
Jeffrey A. Hagen, MD,
Tom R. DeMeester, MD
From the University of Southern California, Department of Surgery, Keck School of Medicine.
Received for publication Aug 6, 2002. Accepted for publication Aug 15, 2002.
Address for reprints: Tom R. DeMeester, MD, USC HealthCare Consultation Center, 1510 San Pablo St, Suite 514, Los Angeles, CA 90033-4612 (E-mail: cbernolak@surgery.usc.edu).
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USC Thoracic and Foregut Research
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In this month's issue of the Journal, Rice and colleagues
1 report a thorough retrospective analysis of prospectively collected data titled "Role of Clinically Determined Depth of Tumor Invasion in the Treatment of Esophageal Carcinoma" The report has 3 major conclusions. First, the authors conclude that clinical staging with endoscopic ultrasonography (EUS) reliably reflects pathologic staging with an accuracy of 87%. This observation adds to the growing body of data indicating that EUS is the most reliable method available for the clinical staging of esophageal cancer. Second, they conclude that the tumor and nodal responses to induction therapy (chemoradiotherapy) are linked. This implies that a benefit seen in downstaging T (tumor) indicates a similar downstaging of N (nodal disease). They then ask the following pertinent question: Does downstaging T portend an improved survival? The answer is partially provided in their third conclusion that when nodal disease persists, the downstaging of the tumor does not improve survival. This implies that even though T and N stage are linked in both their occurrence and response to induction therapy, N is predominant and independent of T in predicting survival. With these points made, they attempt to identify, with clinical staging methodology, subgroups of patients who are likely to benefit from induction therapy. Overall, the report is a movement away from the current trend toward the belief that neoadjuvant therapy is the standard of care for all patients with esophageal cancer. Their movement is justified by the failure of prospective randomized clinical trials to show a convincing and consistent benefit of neoadjuvant therapy in carcinoma of the esophagus (Table 1). 2-8
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Table 1. Randomized trials of neoadjuvant chemoradiotherapy followed by surgical intervention versus surgical intervention alone for esophageal cancer
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In an effort to identify . . . [Full Text of this Article]
Related Article
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Role of clinically determined depth of tumor invasion in the treatment of esophageal carcinoma
- Thomas W. Rice, Eugene H. Blackstone, David J. Adelstein, Gregory Zuccaro, Jr, John J. Vargo, John R. Goldblum, Sudish C. Murthy, Malcolm M. DeCamp, and Lisa A. Rybicki
J. Thorac. Cardiovasc. Surg. 2003 125: 1091-1102.
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Copyright © 2003 by The American Association for Thoracic Surgery.
