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The degree of circumferential tumour involvement as a prognostic factor in oesophageal cancer

^a Department of Gastrointestinal Surgery, University Hospital of South Manchester NHS Foundation Trust, South Moor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
^b Department of Histopathology, University Hospital of South Manchester NHS Foundation Trust, South Moor Road, Wythenshawe, Manchester M23 9LT, United Kingdom
^c Academic Radiation Oncology, University of Manchester, Christie Hospital, Wilmslow Road, Manchester M20 4BX, United Kingdom
^d The Liverpool Chest and Heart Hospital, Liverpool NHS Trust, Thomas Drive, Liverpool L14 3PE, United Kingdom

Received 11 August 2008; received in revised form 15 December 2008; accepted 18 December 2008.

^_* Corresponding author. Tel.: +44 161 291 6650; fax: +44 161 291 6613. (Email: Ian.welch{at}UHSM.nwest.nhs.uk; Ian.Welch{at}uhsm.nhs.uk).

Objective: Tumour length is an adverse prognostic factor in oesophageal cancer. However, the prognostic role of the degree of oesophageal circumference (DOC) involved by tumour with or without resection margin invasion is not clear. This work assessed the relationship between DOC involved by tumour, clinico-pathological variables and prognosis. Methods: The clinico-pathological details of 320 patients who underwent potentially curative oesophagogastrectomy for cancer between 1994 and 2007 were analysed. The DOC involved with tumour measured macroscopically on the resected specimen was classified as small (<2.5 cm, n = 115), large (2.5 cm, n = 144) or circumferential (i.e. involving the whole circumference, n = 61). Univariate and multivariate survival analyses were carried out. Results: The DOC with tumour was higher in ulcerating tumours than stenosing or polypoidal types (p = 0.017). Tumour length, T-stage, neoadjuvant chemotherapy and vascular invasion were independently associated with DOC with tumour on multivariate analysis (p < 0.05 for all). DOC 2.5 cm was an adverse prognostic factor in univariate analysis (p = 0.002) with a hazard ratio of 1.52 [95% CI 1.13–2.04] compared with those <2.5 cm. Circumferential tumours had a similar prognosis to tumours 2.5 cm (p = 0.60). The prognostic significance of DOC with tumour was lost in multivariate analysis where the factors retaining independence were patient age, T-stage, lymph node metastasis, vascular invasion and positive resection margins. However, when patients were stratified by use of neoadjuvant chemotherapy (n = 121), the DOC with tumour retained prognostic significance on multivariate analysis in the 199 patients who did not undergo neoadjuvant chemotherapy (p = 0.04). Conclusion: The DOC with tumour appears to provide prognostic information in oesophageal cancer surgery, especially in patients who do not undergo preoperative chemotherapy.

Key Words: Oesophageal cancer • Degree of oesophageal circumference • Prognosis