P1.229. Prognostic Value of Tumor Length in Clinical T1–2N0M0 Esophageal Squamous Cell Carcinoma

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background The TNM staging system for esophageal cancer defines the T stage by depth of invasion rather than tumor size. However, prognosis may vary within the same T stage. This study aimed to evaluate the prognostic value of tumor length in clinical T1–2N0M0 esophageal squamous cell carcinoma (ESCC). Methods This retrospective single-center study included 923 patients who underwent upfront surgery for cT1–2N0M0 ESCC between 2006 and 2023. The prognostic impact of tumor length was analyzed using Kaplan–Meier curves, log-rank tests, and Cox regression models. Since current guidelines define ≥30 mm as a high-risk threshold, survival outcomes were compared using both the 30 mm cutoff and a cohort-derived cutoff identified by a maximally selected log-rank test. Results The maximally selected log-rank test identified 40 mm as the optimal cutoff for tumor length. Kaplan–Meier analysis demonstrated a clear separation of curves: patients with tumor length ≥40 mm had significantly worse survival (5-year RFS 62% vs. 78%; 5-year OS 68% vs. 84%). Univariable Cox regression demonstrated that tumor length ≥40 mm was significantly associated with worse recurrence-free survival (HR 1.49, p=0.001) and overall survival (HR 1.57, p<0.001). However, in multivariable Cox regression, the prognostic effect of tumor length did not remain significant (p=0.076), being largely explained by pT and pN stage. Independent predictors included age, pT, and pN stage. Conclusion Tumor length ≥40 mm is associated with adverse survival in univariable analysis but does not act as an independent prognostic factor after adjustment for stage. Tumor length reflects tumor burden and should be considered a supportive marker rather than a standalone risk factor in early-stage ESCC.