2013 is the 100th anniversary of the first esophageal cancer resection in human history. Looking back on the development of esophageal cancer diagnostic and treatment technology in this century, we have made great progress, but still face many problems and challenges. Time flies like a white horse, and 2013 has passed by us again. Here, I would like to briefly review and summarize the progress in the field of esophageal cancer diagnosis and treatment in 2013. Updates of the 2013 edition of NCCN esophageal cancer guidelines The National Comprehensive Cancer Network (NCCN) is a non-profit academic institution consisting of 21 oncology research centers in the U.S. It brings together clinical experts in internal medicine, surgery, imaging, biology, epidemiology, nutrition, and other fields related to the field of oncology prevention and treatment and publishes annual clinical practice guidelines for a variety of malignant tumors, and the NCCN guidelines pay attention to the use of evidence-based medicine to reach a broad consensus, thus gaining global recognition. The NCCN guidelines have been recognized and followed by oncology clinicians around the world because they are based on evidence-based medical evidence to reach a broad consensus, and the American Association for Thoracic Surgery (AATS) Symposium on Esophageal Surgery was held in Boston from November 15-17, 2013, in which Professor D’Amico of the Department of Thoracic Surgery at Duke University was invited to speak at the symposium. Professor D’Amico of Duke University Thoracic Surgery, former president of AATS and a key participant in the development of NCCN guidelines, was invited to give a detailed explanation of the 2013 NCCN Clinical Practice Guidelines for Esophageal Cancer in the meeting. The author participated in the meeting and made a special trip to Duke University before the meeting to have in-depth exchanges with Prof. D’Amico and the following is an introduction of the update of the 2013 NCCN Clinical Practice Guidelines for Esophageal Cancer. Diagnosis and tumor staging Compared with the 2012 NCCN Esophageal Cancer/Gastroesophageal Junction Cancer Clinical Practice Guidelines, the 2013 version has made many modifications and updates, among which, the biggest highlight is that the new guideline has formulated independent “modular” treatment protocols according to the types of esophageal squamous and adenocarcinoma, respectively. In the diagnosis of esophageal cancer, the guideline further affirms the diagnostic and therapeutic value of endoscopic mucosal resection (EMR) for early esophageal cancer, which can provide accurate information on T stage, tumor differentiation, and choroidal infiltration, and can also evaluate Barrett’s esophagus or severe atypical hyperplasia. For lesions ≤3 cm in diameter, EMR can provide accurate T-staging for endoscopic ultrasound (EUS) supplementation. The long-term outcome of EMR will also be highly satisfactory when the esophageal cancer lesion resected by EMR is <2 cm in diameter, the pathology confirms moderate or high differentiation, the mucosal muscularis propria is not involved, and there is no vascular infiltration. The diagnostic value of esophageal cytology brushings is weakened, and it is foreseeable that this technique will face obsolescence in the future. Corresponding to the new TNM staging in 2009, the new 2013 NCCN guidelines also refine the classification of T4, stipulating that tumor invasion of the adjacent pleura, diaphragm, or pericardium is defined as T4a (resectable), whereas invasion of structures such as the trachea, aorta, vertebrae, lungs, heart, liver, or pancreas is defined as T4b (unresectable). One point to note is that the 2009 edition of TNM staging specifies that the number of lymph nodes cleared surgically for esophageal cancer should be ≥12, whereas the new NCCN guideline specifies ≥15 lymph nodes cleared. Comprehensive treatment of esophageal cancer The new addition to the guidelines suggests that perioperative chemotherapy can be one of the treatment options, but is not recommended as the first choice. Induction chemotherapy may be justified with clinical indications. According to the clinical evidence-based basis, the guideline specifically adjusted some preoperative neoadjuvant radiotherapy regimens: the evidence-based grade of oxaliplatin + 5-FU chemotherapy regimen was upgraded from 2A to 1, whereas the neoadjuvant chemotherapy regimens of paclitaxel + cisplatin regimen, carboplatin + 5-FU regimen, oxaliplatin + docetaxel + capecitabine, etc., were deleted; 5-FU + cisplatin was added as a perioperative chemotherapy regimen (the evidence-based grade of which is 1) ; oxaliplatin + docetaxel + capecitabine regimen in radical chemotherapy was deleted; capecitabine + cisplatin was added as a postoperative chemotherapy regimen; the new guideline also deleted the part of sequential chemotherapy and radiotherapy, and will not be recounted. For the principle of radiation therapy for esophageal cancer, the changes are more significant. The newly added viewpoint is that, in general, the radiotherapy guidelines for esophageal cancer are equally applicable to Siewert type I and II gastroesophageal junction tumors, while according to the patient's clinical status, Siewert type III tumors can be selected from the radiotherapy guidelines for esophageal or gastric cancers, and these recommended regimens can be adjusted according to the site where the main body of the tumor is located. Clinical attention should also be paid to the protection of the stomach during radiotherapy to avoid increasing the risk of possible reconstructive surgery of the digestive tract (e.g., gastroesophageal anastomosis) at a later stage. Compared with the 2012 version, which stated roughly that the dose of preoperative or postoperative radiotherapy should be 45-50.4 Gy (1.8-2 Gy/day), the new guideline recommends the dose of each type of radiotherapy in more detail, including the following: the dose of preoperative radiotherapy should be 41.4-50.4 Gy (1.8-2 Gy/day), the dose of postoperative radiotherapy should be 45-50.4 Gy (1.8-2 Gy/day), and the dose of postoperative radiotherapy should be 45-50.4 Gy (1.8-2 Gy/day). radiotherapy doses of 45 to 50.4 Gy (1.8 to 2 Gy/day), and radical radiotherapy doses of 50 to 50.4 Gy (1.8 to 2 Gy/day). Higher doses of radiotherapy may be more appropriate for cervical esophageal cancer (especially for inoperable patients). Clinical diagnosis and treatment guidelines play a very important role in guiding clinical work, which is based on the latest and strongest evidence-based medicine, so that the clinical diagnosis and treatment of diseases are standardized, standardized, and have wide clinical applicability. In 2013, the Esophageal Cancer Committee of the Chinese Anti-Cancer Association, based on the Standardized Diagnosis and Treatment Guidelines for Esophageal Cancer formulated in 2011, published a new guideline by Academician He Jie. In 2013, based on the Standardized Diagnostic and Treatment Guidelines for Esophageal Cancer formulated in 2011, the Chinese Anti-Cancer Association Esophageal Cancer Specialized Committee published the 2nd edition of the Guidelines, which was edited by academician Hejie. The new Guidelines more comprehensively reflect the current status of esophageal cancer treatment in China, and in particular, it is aimed at promoting the rapid standardization of minimally invasive treatment of esophageal cancer in China, and it focuses on the chapters of endoscopic and minimally invasive surgical treatment of esophageal cancer, so as to provide a better guidance to clinical work on esophageal cancer. In fact, from the NCCN guidelines and domestic esophageal cancer diagnosis and treatment guidelines, combined with the frequency of reports in related literature, it is not difficult to see that endoscopic treatment, minimally invasive surgery and comprehensive treatment of esophageal cancer have been a few hot topics in recent years, which represent the development direction of esophageal cancer diagnosis and treatment perspectives and technologies in the next few years. It can be expected that the new TNM staging of esophageal/gastroesophageal junction cancer will have the following three directions that are worthy of anticipation and attention: revising and expanding the existing standards, constructing clinical decision-making models, and constructing prognostic judgment models. Controversies and new perspectives of the new TNM staging Since 2010, the world has started to use the 2009 7th edition of TNM staging criteria for esophageal/gastroesophageal junction cancer, which for the first time included Chinese case data, and the author had the honor to take part in the discussion and formulation of the criteria. 2009 edition of the TNM staging criteria has increased the indicators of the pathological types of esophageal cancer (squamous carcinoma and adenocarcinoma), the tumor site, the degree of differentiation, etc., and the definition has been refined and refined. The main changes in the 2009 version of TNM staging increased the indicators of pathological types (squamous and adenocarcinoma), tumor sites, differentiation degree, etc., and refined the definitions of T1 (T1a/T1b), T4 (T4a/T4b), and N staging based on the number of metastases in lymph nodes. Through 4 years of clinical practice, the 7th edition of TNM staging criteria has also generated many new questions and controversies. We note that the 7th edition of TNM staging criteria for esophageal cancer has the following problems: the criteria are only applicable to the prognostic evaluation of patients with simple surgical resection without preoperative and postoperative adjuvant radiotherapy and chemotherapy; they are not applicable to patients with non-surgical treatment, inoperable patients, and patients who have been explored by simple surgical exploration; they are poorly representative of T4b and M1 patients; they are not applicable to patients with cervical segmental metastases. patients; cervical esophageal cancer and upper esophageal cancer treated as head and neck tumors are also outside the system. In addition, several papers have explored whether defining N-staging by the number of lymph node metastases is accurate and representative, and some scholars have proposed that the definition of N-staging by the region of lymph node metastases should be considered. The newly introduced tumor site index in the 7th edition of TNM criteria has also generated controversy, and the results of Professor Jianhua Fu's study at the Affiliated Cancer Hospital of Sun Yat-sen University have shown that in the Chinese esophageal cancer population, tumor site does not have an impact on postoperative long-term survival. The development of the 2016 8th edition of TNM staging for esophageal cancer/gastroesophageal junction cancer is already in full swing. The main work in 2013 was the collection and uploading of data and information from various centers, and in 2014, it will be planned to complete the analysis and discussion of the data and to start the writing of the first draft of the new edition of TNM staging. We can foresee that the new version of TNM staging for esophageal cancer/gastroesophageal junction cancer has the following 3 directions that are worthy of anticipation and attention: Revision and expansion of the existing criteria The staging evaluation of stage 0 and stage IV tumors needs to be improved, and the composition of stage IA and stage IIIC needs to be altered; the homogeneity between adenocarcinoma of stage IIB and squamous carcinoma of stages IIA and IIB needs to be improved; and the clinical staging (cStage), the cStage after induction therapy and the cStage after radical non-surgical treatment need to be increased; and the clinical staging of stage IIB is also increased. clinical staging (cStage), clinical staging after induction therapy (ycStage), and pathological staging after induction therapy (ypStage); add other non-anatomical factors affecting the prognosis, such as molecular indexes, etc.; add the survival data after non-esophagectomy: such as the prognosis of patients with stage 0 versus stage ⅠA endoscopic treatment, and the prognosis of stage Ⅳ tumors palliatively resected, etc.; and add the staging of cervical segmental esophageal cancers. Construct clinical decision-making model Establish an effective prediction model for tumor recurrence and death based on patients' clinical characteristics, clinical stage and other tumor characteristics known at the time of clinical decision-making; evaluate the possibility of clinical downstaging through different neoadjuvant treatments; prepare a smartphone-based clinical decision-making model program to predict tumor recurrence and survival time after different treatments based on clinical stage. Construct a prognostic judgment model Establish a model for predicting tumor recurrence and death in patients based on their clinical characteristics, revised pathological staging (pStage and ypStage), other tumor characteristics, and implemented treatment regimens; prepare a smartphone-based individualized prognostic assessment tool in order to predict the recurrence and metastasis of a given patient's tumor based on the pathological staging and the treatments received. Participated in the development of the 8th edition of the TNM staging criteria for esophageal/gastroesophageal junction cancer by adding 15 new renowned medical centers in addition to the 13 units in the 7th edition, and West China Hospital of Sichuan University was the only new unit in China (including Hong Kong, Macao, and Taiwan), and together with Toho University in Japan, representing Asia, we submitted clinicopathological data on patients with esophageal cancer in the Eastern population. China is a large country with the incidence of esophageal cancer, we need to actively participate in international exchanges and cooperation to expand our international influence, to develop international staging of esophageal cancer that is more suitable for our population, and to create our own influence in the international arena of esophageal cancer research.