Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals

for the Worldwide Esophageal Cancer Collaboration Investigators

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

We report analytic and consensus processes that produced recommendations for neoadjuvant pathologic stage groups (ypTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration provided data for 22,654 patients with epithelial esophageal cancers; 7,773 had pathologic assessment after neoadjuvant therapy. Risk-adjusted survival for each patient was developed. Random forest analysis identified data-driven neoadjuvant pathologic stage groups wherein survival decreased monotonically with increasing group, was distinctive between groups, and homogeneous within groups. An additional analysis produced data-driven anatomic neoadjuvant pathologic stage groups based only on ypT, ypN, and ypM categories. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced consensus neoadjuvant pathologic stage groups. Grade and location were much less discriminating for stage grouping ypTNM than pTNM. Data-driven stage grouping without grade and location produced nearly identical groups for squamous cell carcinoma and adenocarcinoma. However, ypTNM groups and their associated survival differed from pTNM. The need for consensus process was minimal. The consensus groups, identical for both cell types were as follows: ypStage I comprised ypT0-2N0M0; ypStage II ypT3N0M0; ypStage IIIA ypT0-2N1M0; ypStage IIIB ypT3N1M0, ypT0-3N2, and ypT4aN0M0; ypStage IVA ypT4aN1-2, ypT4bN0-2, and ypTanyN3M0; and ypStage IVB ypTanyNanyM1. Absence of equivalent pathologic (pTNM) categories for the peculiar neoadjuvant pathologic categories ypTisN0-3M0 and ypT0N0-3M0, dissimilar stage group compositions, and markedly different early- and intermediate-stage survival necessitated a unified, unique set of stage grouping for patients of either cell type who receive neoadjuvant therapy.

Original languageEnglish (US)
Pages (from-to)906-912
Number of pages7
JournalDiseases of the Esophagus
Volume29
Issue number8
DOIs
StatePublished - Nov 1 2016

Fingerprint

Esophagogastric Junction
Esophageal Neoplasms
Neoadjuvant Therapy
Survival
Neoplasm Staging
Advisory Committees
Squamous Cell Carcinoma
Adenocarcinoma
Neoplasms

Keywords

  • chemotherapy
  • epidemiology
  • esophagectomy
  • oncology
  • radiotherapy

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. / for the Worldwide Esophageal Cancer Collaboration Investigators.

In: Diseases of the Esophagus, Vol. 29, No. 8, 01.11.2016, p. 906-912.

Research output: Contribution to journalArticle

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title = "Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals",
abstract = "We report analytic and consensus processes that produced recommendations for neoadjuvant pathologic stage groups (ypTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration provided data for 22,654 patients with epithelial esophageal cancers; 7,773 had pathologic assessment after neoadjuvant therapy. Risk-adjusted survival for each patient was developed. Random forest analysis identified data-driven neoadjuvant pathologic stage groups wherein survival decreased monotonically with increasing group, was distinctive between groups, and homogeneous within groups. An additional analysis produced data-driven anatomic neoadjuvant pathologic stage groups based only on ypT, ypN, and ypM categories. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced consensus neoadjuvant pathologic stage groups. Grade and location were much less discriminating for stage grouping ypTNM than pTNM. Data-driven stage grouping without grade and location produced nearly identical groups for squamous cell carcinoma and adenocarcinoma. However, ypTNM groups and their associated survival differed from pTNM. The need for consensus process was minimal. The consensus groups, identical for both cell types were as follows: ypStage I comprised ypT0-2N0M0; ypStage II ypT3N0M0; ypStage IIIA ypT0-2N1M0; ypStage IIIB ypT3N1M0, ypT0-3N2, and ypT4aN0M0; ypStage IVA ypT4aN1-2, ypT4bN0-2, and ypTanyN3M0; and ypStage IVB ypTanyNanyM1. Absence of equivalent pathologic (pTNM) categories for the peculiar neoadjuvant pathologic categories ypTisN0-3M0 and ypT0N0-3M0, dissimilar stage group compositions, and markedly different early- and intermediate-stage survival necessitated a unified, unique set of stage grouping for patients of either cell type who receive neoadjuvant therapy.",
keywords = "chemotherapy, epidemiology, esophagectomy, oncology, radiotherapy",
author = "{for the Worldwide Esophageal Cancer Collaboration Investigators} and Rice, {Thomas W.} and Hemant Ishwaran and Kelsen, {David P.} and Hofstetter, {Wayne L.} and Carolyn Apperson-Hansen and Blackstone, {Eugene H.} and Chen, {Ken N.} and Rice, {Thomas W.} and Blackstone, {Eugene H.} and Carolyn Apperson-Hansen and Wijnhoven, {Bas P L} and {van Lanschot}, Jan and Sjoerd Lagarde and Liu, {Jun Feng} and Scott, {Walter J.} and Donna Edmondson and Riette Burger and Davies, {Andrew R.} and Janine Zylstra and R{\"a}s{\"a}nen, {Jari V.} and Salo, {Jarmo A.} and Kenneth Kesler and Manuel Pera and D'Journo, {Xavier B.} and Kesler, {Kenneth A.} and Hofstetter, {Wayne L.} and Arlene Correa and Swisher, {Stephen G.} and Allen, {Mark S.} and Denlinger, {Chad E.} and Rusch, {Valerie W.} and Smithers, {B. Mark} and David Gotley and Andrew Barbour and Iain Thomson and Griffin, {S. Michael} and Jon Shenfine and Schipper, {Paul H.} and Hunter, {John G.} and Allum, {William H.} and {(Vincent) Fang}, Wentao and Darling, {Gail E.} and Lerut, {Tony E M R} and Nafteux, {Phillipe R.} and {van Hillegersberg}, Richard and Cerfolio, {Robert J.} and Luis Durand and {De Ant{\'o}n}, Roberto and Ferguson, {Mark K.} and Simon Law",
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T1 - Recommendations for neoadjuvant pathologic staging (ypTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals

AU - for the Worldwide Esophageal Cancer Collaboration Investigators

AU - Rice, Thomas W.

AU - Ishwaran, Hemant

AU - Kelsen, David P.

AU - Hofstetter, Wayne L.

AU - Apperson-Hansen, Carolyn

AU - Blackstone, Eugene H.

AU - Chen, Ken N.

AU - Rice, Thomas W.

AU - Blackstone, Eugene H.

AU - Apperson-Hansen, Carolyn

AU - Wijnhoven, Bas P L

AU - van Lanschot, Jan

AU - Lagarde, Sjoerd

AU - Liu, Jun Feng

AU - Scott, Walter J.

AU - Edmondson, Donna

AU - Burger, Riette

AU - Davies, Andrew R.

AU - Zylstra, Janine

AU - Räsänen, Jari V.

AU - Salo, Jarmo A.

AU - Kesler, Kenneth

AU - Pera, Manuel

AU - D'Journo, Xavier B.

AU - Kesler, Kenneth A.

AU - Hofstetter, Wayne L.

AU - Correa, Arlene

AU - Swisher, Stephen G.

AU - Allen, Mark S.

AU - Denlinger, Chad E.

AU - Rusch, Valerie W.

AU - Smithers, B. Mark

AU - Gotley, David

AU - Barbour, Andrew

AU - Thomson, Iain

AU - Griffin, S. Michael

AU - Shenfine, Jon

AU - Schipper, Paul H.

AU - Hunter, John G.

AU - Allum, William H.

AU - (Vincent) Fang, Wentao

AU - Darling, Gail E.

AU - Lerut, Tony E M R

AU - Nafteux, Phillipe R.

AU - van Hillegersberg, Richard

AU - Cerfolio, Robert J.

AU - Durand, Luis

AU - De Antón, Roberto

AU - Ferguson, Mark K.

AU - Law, Simon

PY - 2016/11/1

Y1 - 2016/11/1

N2 - We report analytic and consensus processes that produced recommendations for neoadjuvant pathologic stage groups (ypTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration provided data for 22,654 patients with epithelial esophageal cancers; 7,773 had pathologic assessment after neoadjuvant therapy. Risk-adjusted survival for each patient was developed. Random forest analysis identified data-driven neoadjuvant pathologic stage groups wherein survival decreased monotonically with increasing group, was distinctive between groups, and homogeneous within groups. An additional analysis produced data-driven anatomic neoadjuvant pathologic stage groups based only on ypT, ypN, and ypM categories. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced consensus neoadjuvant pathologic stage groups. Grade and location were much less discriminating for stage grouping ypTNM than pTNM. Data-driven stage grouping without grade and location produced nearly identical groups for squamous cell carcinoma and adenocarcinoma. However, ypTNM groups and their associated survival differed from pTNM. The need for consensus process was minimal. The consensus groups, identical for both cell types were as follows: ypStage I comprised ypT0-2N0M0; ypStage II ypT3N0M0; ypStage IIIA ypT0-2N1M0; ypStage IIIB ypT3N1M0, ypT0-3N2, and ypT4aN0M0; ypStage IVA ypT4aN1-2, ypT4bN0-2, and ypTanyN3M0; and ypStage IVB ypTanyNanyM1. Absence of equivalent pathologic (pTNM) categories for the peculiar neoadjuvant pathologic categories ypTisN0-3M0 and ypT0N0-3M0, dissimilar stage group compositions, and markedly different early- and intermediate-stage survival necessitated a unified, unique set of stage grouping for patients of either cell type who receive neoadjuvant therapy.

AB - We report analytic and consensus processes that produced recommendations for neoadjuvant pathologic stage groups (ypTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration provided data for 22,654 patients with epithelial esophageal cancers; 7,773 had pathologic assessment after neoadjuvant therapy. Risk-adjusted survival for each patient was developed. Random forest analysis identified data-driven neoadjuvant pathologic stage groups wherein survival decreased monotonically with increasing group, was distinctive between groups, and homogeneous within groups. An additional analysis produced data-driven anatomic neoadjuvant pathologic stage groups based only on ypT, ypN, and ypM categories. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced consensus neoadjuvant pathologic stage groups. Grade and location were much less discriminating for stage grouping ypTNM than pTNM. Data-driven stage grouping without grade and location produced nearly identical groups for squamous cell carcinoma and adenocarcinoma. However, ypTNM groups and their associated survival differed from pTNM. The need for consensus process was minimal. The consensus groups, identical for both cell types were as follows: ypStage I comprised ypT0-2N0M0; ypStage II ypT3N0M0; ypStage IIIA ypT0-2N1M0; ypStage IIIB ypT3N1M0, ypT0-3N2, and ypT4aN0M0; ypStage IVA ypT4aN1-2, ypT4bN0-2, and ypTanyN3M0; and ypStage IVB ypTanyNanyM1. Absence of equivalent pathologic (pTNM) categories for the peculiar neoadjuvant pathologic categories ypTisN0-3M0 and ypT0N0-3M0, dissimilar stage group compositions, and markedly different early- and intermediate-stage survival necessitated a unified, unique set of stage grouping for patients of either cell type who receive neoadjuvant therapy.

KW - chemotherapy

KW - epidemiology

KW - esophagectomy

KW - oncology

KW - radiotherapy

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