Long-term Results of the Patients with Esophageal Carcinoma According to the New TNM Staging System -A Proposal for Some Revision-

Heiji Yoshinaka, Hisaaki Shimazu, Toshitaka Fukumoto, Masamichi Baba, Shoji Natsugoe, Atsushi Kiire, Kazusada Shirao, Takashi Aikou

First Department of Surgery, Kagoshima University School of Medicine

Long-term results for 401 patients with esophageal carcinoma were reviewed according to the new TNM staging system (pTNM, 4th ed. 1987). The 5-year survival rates for patients with carcinoma classified as Stage 0, I, IIA, IIB, III and IV were 100%, 84%, 47%, 24%, 17% and 14%, respectively. Among the patients with early stages from 0 to IIA, stage grouping reflected survival rate well. However, among the patients with advanced stages from IIB to IV, the correlation was not as good. The survival rate for patients with Stage IIB was more similar to that for patients with Stage III or IV than was that for Stage IIA patients. Moreover, survival curves for patients with Stage III and IV overlapped and there was no difference between them. We propose the following revisions for this TNM staging system. Individualization should clarify two groups regarding lymph node involvement, one for patients with the involvement one for those without it; and similarly two groups for patients with and without a lesion invading adjacent structures, because statistically significant differences in survival rate were found between the pairs in both of these groups. Moreover, some metastases beyond regional nodes might be excluded from the M1 category falling under Stage IV and included in the N2 category ranking above organ metastasis, since a better survival rate could be expected to some extent as a result of dissection of such lymph nodes.

Key words
survival rate of esophageal carcinoma, new TNM staging classification, invasion to adjacent structures, lymph node metastasis, distant metastasis

Reprint requests
Heiji Yoshinaka First Department of Surgery, Kagoshima University School of Medicine
8-35-1 Sakuragaoka, Kagoshima City, 890 JAPAN

Accepted
March 13, 1991

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