PROGNOSTIC FACTORS AND SURVIVAL ANALYSIS IN ESOPHAGEAL CARCINOMA

Variables Associated to Pathologic Complete Response, Overall Survival and Disease-Free Survival in the Neoadjuvant Setting for Esophageal Cancer: A Retrospective Cohort Analysis

Objective:

The aim of the study was to evaluate prognostic factors during neoadjuvant therapy that can predict pathologic complete response (pCR), overall survival (OS), or disease-free survival (DFS).

Summary of background data:

Variables that can predict tumor response to neoadjuvant therapy are required for esophageal cancer management.

Methods:

A retrospective cohort was performed with esophageal cancer patients submitted to neoadjuvant therapy. pCR, OS, and DFS were evaluated. Logistic regression was used to evaluate prognostic factors. This study covered 140 patients, 94 squamous cell carcinomas (SCC), and 44 adenocarcinomas. SCC is more often associated with pCR (compared to adenocarcinoma, OR: 8.07, 95% CI: 2.91–22.38); it has higher probability of DFS (HR for death or recurrence was 0.6, 95% CI: 0.37–0.98); and a higher probability of OS (HR for death was 0.59, 95% CI: 0.35–1). Gender, age, grade of cellular differentiation, chemotherapy regimen, and neoplasm circumferential involvement before neoadjuvant therapy are variables that are unrelated to DFS. Relief of dysphagia, and weight gain were also unrelated to the outcomes. In the multivariate analysis, the weight loss during neoadjuvant therapy was related to higher risk for recurrence or death (HR 1.02, 95% CI: 1–1.04). SCC histologic type was associated with higher probability of pCR, and higher OS and DFS rates. Gender, grade of cellular differentiation, and chemotherapy regimen are variables that are unrelated to pCR, OS, and DFS. Relief of dysphagia and increased levels of albumin after neoadjuvant therapy were also unrelated to the studied outcomes. Weight loss during neoadjuvant chemotherapy was associated with poor DFS rate in the multivariate analysis.

Investigating Esophageal Stent-Placement Outcomes in Patients with Inoperable Non-Cervical Esophageal Cancer

Background: Esophageal stent insertion in patients with inoperable esophageal cancer is usually accompanied with relatively high adverse symptoms and even mortality. The current study aims at investigating the outcomes of esophageal stenting in patients with inoperable non-cervical esophageal cancer. Materials and Methods: The current descriptive-analytical research evaluates 25 patients with esophageal cancer. The stent was placed in esophagus based upon endoscopy analysis with or without fluoroscopy and then the stent position and its opening was investigated by making use of CXRand Gastrografin studies. Demographic characteristics, dysphagia scores, stent placement side effects and the dysphagia-related indices were recorded and examined by taking advantage of a questionnaire which was administered pre and post stent insertion. Results: The study population was comprised of 15 women and 10 men. The individuals' average age was 69.20 ± 11.25 years. Dysphagia mean score was lowered from a value of 4.32 ± 0.80 to 2.00 ± 1.22 (P-value<0.05). The prevalent side effects were chest pain (64%), dysphagia recurrence (40%), stent blockage (20%), stent migration (16%), GI bleeding (8%), and malposition (8%). Also, it was found out that 64% of the patients survived for 6 months. Conclusion: The results indicated that although esophageal stenting is accompanied with side effects in patients with inoperable esophageal cancer, but it is the most frequently used and the most reliable method in relieving dysphagia and improving dysphagia-related life indices.

Survival predictors associated with signet ring cell carcinoma of the esophagus (SRCCE): A population-based retrospective cohort study

Purpose

Signet ring cell carcinoma of the esophagus (SRCCE) is an uncommon tumor associated with significant morbidity and mortality. There is still no consensus regarding cut-off values for tumor size, age and optimal treatment for SRCCE. Thus, we elucidated the current survival outcomes of patients with SRCCE and analyzed factors associated with prognosis.

Methods

A retrospective cohort study based on the SEER (The Surveillance, Epidemiology, and End Results) program database was conducted. We identified 537 patients (461 men and 76 women) newly diagnosed with SRCCE between January 2004 and December 2014. A multivariate Cox proportional hazards model was utilized to measure the mortality-associated risk factors in patients with SRCCE after adjusting for various variables.

Results

The 1-, 2- and 5-year disease-specific mortalities (DSM) were 51.6%, 67.6%, and 78.4%, respectively, and the median survival time was 12.0 months. The factors correlated with mortality hazard were marital status (unmarried versus married, Hazard Ratio (HR) = 1.443), tumor size (≥ 5 cm versus < 5 cm, HR = 1.444), tumor grade (high grade versus low grade, HR = 3.001), condition of primary tumor (T4 versus T1, HR = 2.178), regional lymph node metastasis (N1 versus N0, HR = 1.739), further metastasis (M1 versus M0, HR = 1.951) and chemotherapy (receiving chemotherapy versus no chemotherapy, HR = 0.464).

Conclusions

The contemporary 5-year DSM was 78.4%. Being unmarried, having a tumor size ≥ 5 cm, a high tumor grade, a score of T4 for tumor invasion of adjacent organs, a score of N1 for regional lymph node metastasis, a score of M1 for distant metastasis and no chemotherapy were independent predictors of high DSM.