Tumor volume as outcome determinant in patients treated with chemoradiation for locally advanced esophageal cancer

Objective: The currently used tumor-node metastasis (TNM) staging method is generally not applicable to patients with unresectable esophageal carcinomas. There is a need for both an efficient, easy-to-perform clinical classification and for identification of pretherapeutic prognostic factors that would be useful for oncologists, one of which is tumor volume. Methods: Records of 148 patients, admitted to hospital during the period January 1993 to December 2001, were evaluated retrospectively. Median age was 65.7 years (range, 35.5-85.5 years). Most patients had SCC (84.5%). Using the computed tomography (CT) scan classification, tumors were recorded as follows: 1 T1, 42 T2, 93 T3, 6 T4, 2 Nx, 72 NO, 74 N 1. Tumor volume from the CT scans was determined as the sum of 2 opposed truncated cones. Median tumor volume was 57.5 cm(3) (range, 0.6-288 cm(3)). Results: Median follow-up was 15.1 month (range, 0.3-82.8 months). Survival rates at 1, 2, and 3 years were 42.5%, 21.6%, and 8%, respectively. Prognostic factors identified by univariate analysis were: dysphagia grade >= 2, other histology than squamous cell, tumor location below the carina, age < 65 years and tumor volume >= 100 cm(3). Prognostic factors identified with multivariate analysis were: dysphagia grade >= 2 (P = 0.013), weight loss >= 10% (P = 0.047), tumor location below the carina (P = 0.002), and tumor volume >= 100 cm(3) (p = 0.041). Conclusions: For patients that the TNM staging system is not applicable, tumor volume is a new powerful determinant of survival. Further clinical trials need to be carried out to validate this prospectively.