Resident Cleveland Clinic Cleveland, Ohio, United States
Disclosure(s):
Sadia Tasnim, MD: No financial relationships to disclose
Purpose: Management of clinical T2N0M0 (cT2N0M0) esophageal cancer is controversial due to inaccuracy in clinical staging. This prevents recognition of an underlying advanced-stage disease and is a missed opportunity to administer neoadjuvant treatment. Our aim is to identify preoperative clinical, imaging, or endoscopic factors that upstages patients with cT2N0M0 esophageal cancer. Methods: All cT2N0M0 patients who underwent upfront surgery between the years 2000-2020 in our institution were included in this study. Patients who received neoadjuvant chemo and/or radiotherapy were excluded. Age, sex, smoking status, weight loss, presence of dysphagia, ulcer, stricture, size of the tumor (>3.25cm), standardized uptake values (SUV>5) on PET scans, and time between EUS and Surgery were evaluated as preoperative markers. Chi-square test was used for categorical variables. Wilcoxon rank-sum test was used for continuous variables. All statistical calculations were conducted in STATA. Results: Sixty patients who underwent upfront esophagectomy for cT2N0M0 were included in this study with a median age of 63 years (IQR 58-70) and 78% male patients. Of these, only eight (8/60, 13%) were pathologic stage T2N0M0. Fifteen (15/60, 25%) were downstaged and thirty-seven (37/60, 62%) were upstaged on surgical pathology. Upstaging was characterized as pT3 in 21 patients, pT4 in 1 patient, and pN+ in 21 patients. The presence of dysphagia (p=0.01) and tumor SUV>5 (p=0.04) were predictors of upstaging on pathology from cT2N0M0. The presence of weight loss demonstrated a trend towards upstaging but was non-significant. Conclusion: Accurate clinical staging of esophageal cancer is essential in making clinical decisions for treatment. The presence of dysphagia and tumor SUV>5 are predictive of a more advanced underlying disease stage for patients with cT2N0M0 esophageal cancer.
Identify the source of the funding for this research project: The authors disclose no funding source for this project
