Endoscopic esophageal tumor length: A prognostic factor for patients with esophageal cancer

BACKGROUND: Pathologic esophageal tumor length (pL) is an independent predictor of long-term survival. However, whether patients with longer (high-risk) tumors can be identified by endoscopy before surgery has not been established. The objective of the current study was to determine the value of endoscopically measured tumor length (cL) in predicting overall survival in patients with esophageal adenocarcinoma. METHODS: All patients with esophageal adenocarcinoma who had undergone resection without neoadjuvant therapy and who had documented preoperative endoscopy findings were identified retrospectively by using prospectively collected databases at 2 institutions: The University of Texas M. D. Anderson Cancer Center (n = 164; training set) and University of Rochester Medical Center (n = 109; validation set). Esophageal tumors were assessed preoperatively by endoscopy for cL, depth (cT), and lymph node involvement (cN). Univariate and multivariate analyses of cL and other standard prognostic factors were performed. RESULTS: In the training set, cL was correlated directly with pL (Pearson correlation [r] = 0.683; P <.001). Regression tree analyses suggested an optimum cutoff point of cL >2 cm to identify patients with decreased long-term survival (5-year survival rate: cL >2 cm, 29%; cL ≤2 cm, 78%; P <.001). Multivariate Cox regression analysis demonstrated that cL >2 cm was an independent risk factor for long-term survival (hazard ratio, 2.3; 95% confidence interval, 1.1-4.4; P =.02) even after controlling for age, cT, and cN. Validation with the validation dataset confirmed that cL was correlated directly with pL (r = 0.657; P <.001) and predicted long-term survival using a cL cutoff point of >2 cm (hazard ratio, 2.8; 95% confidence interval, 1.4-5.8; P =.004; univariate analysis). CONCLUSIONS: Endoscopic esophageal tumor length was identified as an independent predictor of long-term survival and may help to identify high-risk patients before they receive cancer-directed therapy.