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J Thorac Cardiovasc Surg 2003;125:992-993
© 2003 The American Association for Thoracic Surgery

Editorials

Should the esophageal cancer staging system be revised?

Valerie W. Rusch, MD

From the Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.

Received for publication Sept 20, 2002. Accepted for publication Oct 21, 2002. Address for reprints: Valerie W. Rusch, MD, Chief, Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021 (E-mail: ruschv@mskcc.org).

The first 20% of the full text of this article appears below.

See related article on page 1103.


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  		Dr Rusch

 
Accurate TNM staging plays a pivotal role in cancer management and research. The TNM staging system for esophageal cancer is frequently viewed with discontent by thoracic surgeons. Yet, the sixth editions of the American Joint Committee on Cancer (AJCC) and the Union Internationale Contre le Cancer (UICC) staging manuals, published in 2002, offered minimal changes in the chapter on esophageal staging.Go Go 1,2 The AJCC chapter notes the remarkable epidemiologic shift that has occurred in this disease with a rapid increase in the number of adenocarcinomas of the distal esophagus and gastroesophageal junction. The location of the lymph nodes involved by gastroesophageal junction tumors was added to the section on nodal descriptors, and a lymph node map previously proposed by Casson and colleaguesGo 3 was added to encourage uniform nomenclature of lymph nodes removed at surgery. However, the TNM descriptors and stage classifications were not changed from the previous editions of the staging manuals.

The lack of change in the esophageal staging system frustrates many surgeons who believe that it does not stratify patients appropriately for prognosis. However, a staging system must be evidence-based, prognostically accurate, easy to use, and internationally accepted. The AJCC task . . . [Full Text of this Article]


Related Article

Refining esophageal cancer staging
Thomas W. Rice, Eugene H. Blackstone, Lisa A. Rybicki, David J. Adelstein, Sudish C. Murthy, Malcolm M. DeCamp, and John R. Goldblum
J. Thorac. Cardiovasc. Surg. 2003 125: 1103-1113. [Abstract] [Full Text] [PDF]





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