ABSTRACT
<p><b>BACKGROUND</b>The latest version of the American Joint Committee on Cancer (AJCC) TNM staging system has not comprehensively evaluated the impact of tumour length on survival in patients with esophageal squamous cell carcinoma. Our study explored the relationship between tumour length and clinicopathological characteristics as well as long-term survival.</p><p><b>METHODS</b>All 202 cases of esophageal resections done from January 1, 2004 to December 31, 2008 in Huashan Hospital, Fudan University were reviewed and followed up.</p><p><b>RESULTS</b>Patients with tumour length = 3 cm were related to more advanced tumour stage (χ(2) = 55.9, P < 0.001), more metastatic lymph nodes (χ(2) = 14.6, P < 0.001), increased metastatic lymph node ratio χ(2) = 16.1, P < 0.001) and worse overall TNM stage (χ(2) = 48.1, P < 0.001). Univariate and multivariate analyses indicated that tumour length was a significant prognostic risk factor (95% CI 0.235 - 0.947, P = 0.035). Subgroup analyses disclosed that tumour length was a valuable prognostic predictor in patients with lower T stage, absence of metastatic lymph nodes and lower TNM stage.</p><p><b>CONCLUSIONS</b>Esophageal tumour length is a predictive factor for long-term survival especially for lower tumour stage, absence of metastatic lymph nodes and lower TNM stage patients. Tumour length should be incorporated in the staging system as an important grouping factor for better prognostic evaluation.</p>