Esophageal Tumor Length – An Underestimated Predictor of Survival After Esophageal Cancer Resection

Introduction. Esophageal cancer is one of the most aggressive visceral tumors with increasing frequency and poor prognosis. Differences in survival between patients in the same clinical tumor stage necessitate searching for additional prognostic markers to help identify patients at high risk of recurrence, metastasis or death. The aim of the study was to assess prognostic significance of tumor length on survival after esophageal cancer resection in patients operated at a center for esophageal surgery.

Materials and methods. This was a prospective cohort study including 117 patients who had undergone surgical resection with curative intent for esophageal cancer. The study was conducted at the First Surgical Clinic of UMHATEM “N. I. Pirogov”, Sofia, Bulgaria. The inclusion period was between 1st January 2013 and 31st December 2015 and the patients were followed – up until 10 April 2022. The patients were divided into two groups according to the tumor length – under 3 cm (group 1) and over 3 cm (group 2). The prognostic impact of tumor length on survival was analyzed with Cox regression analysis. Overall survival was presented by the Kaplan-Meier method with log-rank tests.

Results. The 5-year survival rate was 11.1%. Median survival rate was 26.0 months (95% CI 18.3-33.7 months) for the patients in the first group and 13.0 months (95% CI 10.3-15.7 months) for the second group patients. Tumor length over 3 cm was a negative prognostic factor (HR 2.36 95% CI 1.06-5.25; p = 0,03).

Conclusion. Length of esophageal cancer is a powerful independent predictor of survival in addition to the TNM stage.