ABSTRACT
For a long time, the diagnosis and treatment protocol for esophageal cancer has been made either entirely based on the experience of Western countries or on our own experience alone. A suitable standardized guideline for diagnosis and treatment of esophageal cancer in our country has not been established until 2010. Due to lack of opportunities for mutual exchange and learning, the overall level of standardized diagnosis and treatment was relatively low in China. In addition, less advanced technologies were applied and varying treatment protocols were implemented in different districts, the treatment results has been unsatisfactory, and the overall 5-year survival rate after surgical treatment has been maintained from 30% to 40%. Therefore, it is imperative that China needs to conduct its own clinical studies and establish its own suitable standardized treatment and diagnosis guideline for esophageal cancer. This article reviews and also made comments on the process of academic speaking tour and development of standardized diagnosis and treatment guidelines as well as the problems resolved by these activities for esophageal cancer since the beginning of this century.
Subject(s)
Humans , China , Esophageal Neoplasms , Diagnosis , General Surgery , Therapeutics , Practice Guidelines as TopicABSTRACT
<p><b>OBJECTIVE</b>To compare the instructive value of the 6th and 7th editions of the UICC-AJCC staging system in prognosis of esophageal cancer (EC) patients.</p><p><b>METHODS</b>The staging and prognosis of 1397 esophageal carcinoma patients undergoing curative resection from Jan. 2003 to Dec. 2006 in our hospital were retrospectively reviewed and analyzed according to the 6th AJCC staging system and the 7th UICC-AJCC staging system.</p><p><b>RESULTS</b>The 5-year overall survival (OS) of EC patients with curative resection was 38.5% (481/1250 cases), with a follow-up rate of 89.5% (1250/1397 case). In overall terms, both the editions were statistically significant discriminators of OS (P < 0.05). The 5-year OS of stages I, II and III patients were 64.9%, 43.5%, 25.2% according to the 6th edition, and 63.5%, 44.5%, 23.5% according to the 7th edition, respectively. Distinct differences in survival were present among patients categorized as stage Ia and Ib according to the 7th edition (P < 0.05), with a 5-year OS of 80.0% and 58.3%, respectively. Similarly, according to the 7th edition, the 5-year overall survivals (OS) of the stages IIIa, IIIb and IIIc patients were 28.2%, 18.4% and 16.7%, respectively, showing that the prognoses were significantly different (P < 0.05). In addition, according to the 7th edition, the prognoses of patients in stages N0, N1, N2 and N3 were also significantly different (P < 0.01), and the 5-year OS were 50.0%, 31.5%, 18.7% and 16.7%, respectively.</p><p><b>CONCLUSIONS</b>Both the 6th and 7th editions of UICC-AJCC staging system are significant discriminators for survival of esophageal cancer patients. The 7th edition is proved to be more accurate in prognosis. The number of lymph node metastases is an important predictor of prognosis.</p>