A comparative study of new clinical staging systems for esophageal carcinoma treated with non-surgical therapy

Objective To evaluate the predictive values of different systems for clinical staging of esophageal carcinoma in one group of patients and improve the criteria for T staging, and to provide a basis for accurate clinical staging. Methods A retrospective study was performed in 701 patients with esophageal carcinoma who received radical radiotherapy in our hospital. The prognosis was performed according to American Joint Committee on Cancer (AJCC) tumor-node-metastasis staging system, Chinese 2004 staging system, the draft of Chinese 2009 staging system, and gross tumor volume of the primary tumor (GTV-T). Results In terms of T stage, patients evaluated according to the AJCC staging system were in relatively early stages; 23.1% of them were in stage T1, and the survival curves of T3 and T4 patients were close to each other; the survival curves plotted according to the Chinese 2004 staging system were well separated, but relatively few patients were in stages T1 and T4, yielding an uneven distribution; according to the draft of Chinese 2009 staging system, the survival curve of T3 patients intersected that of T4 patients, and up to 43.2% of patients were in stage T4.The new T staging was performed based on GTV and the extent of tumor invasion into the adjacent tissue and organ, and the results showed that there was no intersection between survival curves and a relatively balanced T stage distribution. In terms of N staging, patients were divided into stages N0, N1, and N2.The TNM staging was performed by a combination of N staging and new T staging, resulting in significant separation between survival curves (P=0.000). Conclusions The combination of T staging, which is based on GTV and the extent of tumor invasion, and N staging, which is based on metastasis of lymph nodes, can accurately predict the survival of non-surgically treated patients with esophageal carcinoma. Key words: Esophageal neoplasm; Non-surgical treatment; Clinical staging; Compare study