Esophageal cancer represents the 6th cause of cancer mortality on the planet. currently treated with surgical treatment only. Intro Worldwide, esophageal cancer accounts for more than 400,000 deaths every year. Despite recent improvements in survival esophageal cancer remains one of the deadliest diseases, with an overall 5-year survival less than 20% [1C5]. Prognostic GSS stratification of these patients is vital to provide them with the best multimodal treatment obtainable. Nowadays this stratification is based on the TNM system developed by the American Joint Committee on Cancer (AJCC); it is based on the Tumor depth of invasion (T), lymph Node status (N), presence of Metastases (M), tumor grading and, only for squamocellular cancer, the location of the tumor within the esophagus [6C8]. Disease staging is based on endoscopy and Computed Tomography (CT) scan, and often built-in with Positron Emission TomographyComputed Tomography (FDG-PET-CT scan) and endoscopic ultrasonography (EUS); those exams are not constantly obtainable and are not always so accurate. Esophageal endoscopy, used regularly to diagnose esophageal malignancies, is a simple 903565-83-3 exam, which is well standardized and usually obtainable actually in community hospitals and in low-income socioeconomic settings [9C16]. Historically, endoscopic length of the tumor was a staging parameter in the TNM system but was consequently abandoned in the 1987 version favoring tumor depth of invasion . Lately though, numerous authors posed their attention again to the prognostic part of tumor size; likewise, tumor steps represent an important staging variable in many other cancers. Recently, several studies have recognized a possible part for this parameter in the prognostic stratification of esophageal cancer. Some studies focused on the endoscopic size along with other on the space measured within the pathological specimen; some studies were carried out on squamous cell carcinoma (SCC) while others on adenocarcinoma (AC) [18C31]. The present study aims to investigate the part of endoscopic tumor size (ETL) like a prognostic factor in esophageal cancers (SCC and AC), through the analysis of a consistent study cohort staged and treated at one single Center. Methods All methods were carried out in accordance with approved guidelines. The study was authorized by the Research Committee of the Division of Surgical, Oncological and Gastroenterological SciencesUniversity of Padova. Individuals Study cohort was selected by analyzing a database of 5,636 individuals treated for esophageal cancer and prospectively collected at our Center from 1983 to 2014. Written knowledgeable consent was acquired for all individuals enrolled in the database; this consent process was authorized by our Study Committee. We selected all patients suitable for curative resection who underwent R0 esophagectomy (Ivor Lewis or Mckeown process [32C35]) for SCC or AC of the esophagus; from this initial pool we excluded all individuals who received preoperative chemo and/or radiotherapy in order to avoid a confounding bias within the pathological result, those with metastatic disease found during surgical treatment and individuals deceased within 2 weeks after surgery. Each selected individuals medical record was examined to double check dubious or missing data. All individuals for whom the required variables for our study were not obtainable were excluded. All individuals were analyzed before surgical treatment with endoscopy, contrast swallow radiograms and CT scan . Data collection The variables analyzed for the study were: demographics of individuals (age, gender), pathologically 903565-83-3 903565-83-3 identified T (pT) status, pathologically identified N (pN) status, endoscopic length of the tumor (ETL, defined as the total length of the lesion found on endoscopy and measured at our Center by equally qualified endoscopists), localization of the primary tumor, histologic type, grading, follow-up after surgical treatment. The TNM stage of disease was classified according to the AJCC 7th version , actually for pre 7th version patients, reviewing the required parameters. Observe S1 Table for study data. Statistical analysis We analyzed the cohort globally and then divided into two different organizations based on histological type: SCC Group (squamous cell cancer) and AC Group (adenocarcinoma). Cohort size allowed an additional subdivision of both SCC and AC organizations based on TNM stage grouping according to.