Comparison between established and the Worldwide Esophageal Cancer Collaboration staging systems

Background: Controversy exists regarding the optimal staging system for patients with gastroesophageal junction adenocarcinoma (GEJA). The Worldwide Esophageal Cancer Collaboration (WECC) has organized a multi-institutional database from which a novel esophageal staging system has been organized. We used a single institution experience to validate the hypothesis that the WECC system more accurately predicts survival in GEJA patients than both the American Joint Commission on Cancer 6th edition esophageal and gastric systems.

Methods: We reviewed 449 GEJA patients (Siewert I-III) treated with neoadjuvant therapy followed by surgery or surgery-alone between 1990 and 2007. A blinded statistician performed a head-to-head comparison regarding the ability of each staging system to predict survival. A subgroup analysis of patients who underwent surgery only (n = 176) was also performed.

Results: All three systems predicted survival of patients with GEJA. However, a Bayesian variable selection model found that the WECC system was better than both American Joint Commission on Cancer esophageal and gastric systems (probability 0.99 and 0.98, respectively). Subset analysis suggested that the WECC staging was also optimum for predicting survival in surgery-alone patients.

Conclusions: While the esophageal staging system is better at predicting survival than the gastric staging system, the WECC system may be the most favorable single-system predictor of survival for patients with resected GEJA. As suggested by the WECC system, incorporating the number of positive lymph nodes within the staging system may present an advantage in predicting survival.