治疗前临床分期用于决定早期食管癌的治疗过程。很少有研究评估不准确的临床分期对肿瘤学结果的影响。我们查询了国家癌症数据库，以识别 2010 年至 2019 年间因临床分期 cT1bN0 食管癌接受食管切除术的患者。如果患者在最终病理学上具有组织病理学结果，则被归类为被升级分期。需要新辅助治疗的疾病。教科书中的肿瘤学结果定义为切缘阴性、检查了 15 个淋巴结、住院时间 <21 天、无计划外 30 天再入院或死亡、以及分期适当使用新辅助治疗。总共有 916 名患者符合纳入标准标准; 378 例 (41.2%) 的病理分期与其治疗前的临床分期不同。通过多变量回归，与升期相关的因素包括：2015 年至 2019 年之间的就诊（比值比 1.92 95% 置信区间 [1.19, 3.13]）、食管切除术延迟 >30 天（比值比 2.38 95% 置信区间 [1.13, 5.57]） 、较大的肿瘤尺寸（>2 cm 相对于 <2 cm，比值比 2.73 95% 置信区间 [1.72, 4.39]），以及低分化的组织学（比值比 2.79 95% 置信区间 [1.75, 4.49]）。假定临床分期可靠的教科书肿瘤学结果率为 43.8%；考虑到升期，教科书肿瘤学结果的发生率为 22.5% (P < .001)。 在 cT1bN0 食管癌患者中，肿瘤大小和组织学与治疗前临床分期不准确的风险相关。临床分期的不准确会影响提供者实现最佳肿瘤结果的速度。版权所有 © 2023。由 Elsevier Inc. 出版。

Pretreatment clinical staging is used to decide the course of treatment in early-stage esophageal cancer. Few studies assess the effect of inaccurate clinical staging on oncologic outcomes.We queried the National Cancer Database to identify patients undergoing esophagectomy for clinical stage cT1bN0 esophageal carcinoma between 2010 and 2019. Patients were categorized as being upstaged if, on final pathology, they had histopathologic disease that would have warranted treatment with neoadjuvant therapy. The textbook oncologic outcome was defined as margin-negative resection, 15 lymph nodes examined, a hospital stay of <21 days, no unplanned 30-day readmission or mortality, and stage-appropriate use of neoadjuvant therapy.In total, 916 patients met inclusion criteria; 378 (41.2%) had a pathologic stage that differed from their pretreatment clinical stage. By multivariable regression, factors associated upstaging included: presentation between 2015 and 2019 (odds ratio 1.92 95% confidence interval [1.19, 3.13]), delay to esophagectomy of >30 days (odds ratio 2.38 95% confidence interval [1.13, 5.57]), larger tumor size (>2 cm relative to <2 cm, odds ratio 2.73 95% confidence interval [1.72, 4.39]), and poorly differentiated histology (odds ratio 2.79 95% confidence interval [1.75, 4.49]). The rate of textbook oncologic outcome assuming reliable clinical staging was 43.8%; accounting for upstaging, the rate of textbook oncologic outcome was 22.5% (P < .001).In patients with cT1bN0 esophageal cancer, tumor size and histology are associated with the risk of inaccurate pretreatment clinical staging. Inaccuracies in clinical staging impact the rate at which providers achieve optimal oncologic outcomes.Copyright © 2023. Published by Elsevier Inc.