Patient selection: Stage II or III esophageal carcinoma (T2 to T4 with or without nodal metastases but no distant metastases). T2 is extension into the muscularis propria.
Prognostic factors identified on multivariate analysis:
(1) length of the tumor in cm
(2) dose of radiation therapy given (as equivalent dose in 2-gray fractions, or EQD2)
(3) number of rounds of chemotherapy
(4) pretreatment hemoglobin in g/dL
|
Parameter
|
Finding
|
Points
|
|
length of the tumor in cm
|
>= 7 cm
|
0
|
|
|
< 7 cm
|
1
|
|
dose of radiation therapy given
|
<= 54 Gy
|
0
|
|
|
>= 58 Gy
|
1
|
|
number of rounds of chemotherapy
|
0 or 1
|
0
|
|
|
2 to 4
|
1
|
|
pretreatment hemoglobin
|
<= 12 g/dL
|
0
|
|
|
12.1 to 14 g/dL
|
1
|
|
|
>= 14.1 g/dL
|
0
|
where:
• I am surprised that the hemoglobin cutoffs were not gender dependent.
number of favorable factors =
= SUM(points for all 4 parameters)
Interpretation:
• minimum number of favorable factors: 0
• maximum number of favorable factors: 4
• Survival was only reported for the individual factors. The 2 year overall survival for each favorable finding ranged from 25 to 35%.
Limitation:
• The extent of disease represented by Stage II and III is fairly broad. It ranges from invasion into the muscularis propria without nodal metastases to invasion of adjacent organs with nodal metastases.
