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A Role for Tumor Volume Assessment in Resectable Esophageal Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Esophageal cancer has a poor prognosis, and many patients undergoing surgery have a low chance of cure. Imaging studies suggest that tumor volume is prognostic. The study aimed to evaluate pathological tumor volume (PTV) as a prognostic variable in esophageal cancer.

Methods

This single-center cohort study included 283 patients who underwent esophageal cancer resections between 2000 and 2012. PTVs were obtained from pathological measurements using a validated volume formula. The prognostic value of PTV was analyzed using multivariable regression models, adjusting for age, tumor grade, tumor (T) stage, nodal stage, lymphovascular invasion, resection margin, resection type, and chemotherapy response, which provided hazard ratios (HRs) with 95 % confidence intervals (CIs). Primary outcomes were time to death and time to recurrence. Secondary outcomes were margin involvement and lymph node positivity. Correlation analysis was performed between imaging and PTVs.

Results

On unadjusted analysis, increasing PTV was associated with worse overall mortality (HR 2.30, 95 % CI 1.41–3.73) and disease recurrence (HR 1.87, 95 % CI 1.14–3.07). Adjusted analysis demonstrated worse overall mortality with increasing PTV but reached significance in only one subgroup (HR 1.70, 95 % CI 1.09–2.38). PTV was an independent predictor of margin involvement (OR 2.28, 95 % CI 1.02–5.13) and lymph node–positive status (OR 2.77, 95 % CI 1.23–6.28). Correlation analyses demonstrated significant positive correlation between computed tomography (CT) software and formula tumor volumes (r = 0.927, p < 0.0001), CT and positron emission tomography tumor volumes (r = 0.547, p < 0.0001), and CT and PTVs (r = 0.310, p < 0.001).

Conclusions

Tumor volume may predict survival, margin status, and lymph node positivity after surgery for esophageal cancer.

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Acknowledgment

This research was undertaken as an ESSQ MSc thesis (L.G.C.T.).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, St. Thomas’ Hospital, Guy’s and St. Thomas’ Oesophago-Gastric Centre, London, UK

    Lucinda G. C. Tullie MSc, MRCS, Janine Zylstra Dip Med Tech, Lisa Ramage MRCS, James A. Gossage MD, FRCS, Robert C. Mason MD, FRCS, Jesper Lagergren MD, PhD & Andrew R. Davies MD, FRCS

  2. Department of Radiology, St. Thomas’ Hospital, Guy’s and St. Thomas’ Oesophago-Gastric Centre, London, UK

    Nyree Griffin MD, FRCR, Naveen Sharma FRCR, Francois Porté FRCR & Gary J. Cook MD, FRCR

  3. Gastrointestinal Cancer, Division of Cancer Studies, King’s College London, London, UK

    Hyon-Mok Sohn BSc, Janine Zylstra Dip Med Tech, Nyree Griffin MD, FRCR, Gary J. Cook MD, FRCR, James A. Gossage MD, FRCS, Robert C. Mason MD, FRCS, Jesper Lagergren MD, PhD & Andrew R. Davies MD, FRCS

  4. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    Fredrik Mattsson BSc, James A. Gossage MD, FRCS, Robert C. Mason MD, FRCS, Jesper Lagergren MD, PhD & Andrew R. Davies MD, FRCS

Authors
  1. Lucinda G. C. Tullie MSc, MRCS
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  2. Hyon-Mok Sohn BSc
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  3. Janine Zylstra Dip Med Tech
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  4. Fredrik Mattsson BSc
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  5. Nyree Griffin MD, FRCR
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  6. Naveen Sharma FRCR
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  7. Francois Porté FRCR
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  8. Lisa Ramage MRCS
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  9. Gary J. Cook MD, FRCR
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  10. James A. Gossage MD, FRCS
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  11. Robert C. Mason MD, FRCS
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  12. Jesper Lagergren MD, PhD
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  13. Andrew R. Davies MD, FRCS
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Corresponding author

Correspondence to Lucinda G. C. Tullie MSc, MRCS.

Additional information

For the Guy’s St. Thomas’ Oesophago-Gastric Research Group.

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Tullie, L.G.C., Sohn, HM., Zylstra, J. et al. A Role for Tumor Volume Assessment in Resectable Esophageal Cancer. Ann Surg Oncol 23, 3063–3070 (2016). https://doi.org/10.1245/s10434-016-5228-x

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  • DOI: https://doi.org/10.1245/s10434-016-5228-x

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