Worldwide Esophageal Cancer Collaboration: pathologic staging data

Area of Science:

• Oncology
• Pathology
• Epidemiology

Background:

• Esophageal and esophagogastric junction cancers require accurate staging for effective treatment.
• Previous staging systems may not fully capture prognostic factors for these cancers.
• The Worldwide Esophageal Cancer Collaboration (WECC) aimed to improve pathological staging data.

Purpose of the Study:

• To describe patient characteristics and non-risk-adjusted survival for esophageal cancer.
• To evaluate pathological staging (pTNM) accuracy and its correlation with survival.
• To provide data for the 8th edition of cancer staging manuals.

Main Methods:

• Retrospective analysis of de-identified data from 13,300 patients across 33 institutions globally.
• Data included demographics, comorbidities, cancer type (squamous cell carcinoma, adenocarcinoma), and pathological staging (pTNM, Grade).
• All-cause mortality was tracked from the first management decision.

Main Results:

• Adenocarcinoma (7,558 patients) and squamous cell carcinoma (5,631 patients) showed distinct, monotonic survival curves across pathological stages.
• Survival differences between adenocarcinoma and squamous cell carcinoma were more pronounced when considering pT and pN stages together.
• Survival for early-stage (pTis-1) adenocarcinoma was better than for squamous cell carcinoma.

Conclusions:

• WECC pathological staging data offers improvements over the 7th edition, with a larger patient cohort and more variables.
• The collected data will inform the 8th edition cancer staging manual after risk adjustment.
• The reliance on pure pathological staging for esophageal cancer is diminishing.