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Hatta W, Koike T, Takahashi S, Shimada T, Hikichi T, Toya Y, Tanaka I, Onozato Y, Hamada K, Fukushi D, Watanabe K, Kayaba S, Ito H, Mikami T, Oikawa T, Takahashi Y, Kondo Y, Yoshimura T, Shiroki T, Nagino K, Hanabata N, Funakubo A, Hirasawa D, Ohira T, Nakamura J, Matsumoto T, Nakamura T, Nakaya N, Iijima K, Fukuda S, Masamune A. Risk of metastatic recurrence after endoscopic resection for esophageal squamous cell carcinoma invading into the muscularis mucosa or submucosa: a multicenter retrospective study. J Gastroenterol 2021; 56:620-632. [PMID: 33881632 DOI: 10.1007/s00535-021-01787-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND We aimed to elucidate the risk of metastatic recurrence after endoscopic resection (ER) without additional treatment for esophageal squamous cell carcinomas (ESCCs) with tumor invasion into the muscularis mucosa (pT1a-MM) or submucosa (T1b-SM). METHODS We retrospectively enrolled patients with pT1a-MM/pT1b-SM ESCC after ER at 21 institutions in Japan between 2006 and 2017. We compared metastatic recurrence between patients with and without additional treatment, stratified into category A (pT1a-MM with negative lymphovascular invasion [LVI] and vertical margin [VM]), B (tumor invasion into the submucosa ≤ 200 µm [pT1b-SM1] with negative LVI and VM), and C (others). Subsequently, using multivariate Cox analysis, we evaluated risk factors for metastatic recurrence after ER without additional treatment. RESULTS We enrolled 593 patients, and metastatic recurrence occurred in 38 patients. Metastatic recurrence after additional treatment was significantly lower than that after no additional treatment in category C (9.1% vs. 23.6% in 5 years, p = 0.001), whereas no significant difference was noted in categories A (0.0% vs. 2.6%) and B (0.0% vs. 4.3%). In patients without additional treatment after ER, risk factors for metastatic recurrence were lymphatic invasion (hazard ratio [HR], 5.61), positive VM (HR, 4.55), and tumor invasion into the submucosa > 200 μm (HR, 3.25), and, but near half of the patients with metastatic recurrence had no further recurrence after salvage treatment, resulting in excellent 5-year disease-specific survival in categories A (99.6%) and B (100.0%). CONCLUSIONS Closed follow-up with no additional treatment may be an acceptable option after ER in pT1a-MM/pT1b-SM1 ESCC with negative LVI and VM.
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Affiliation(s)
- Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - So Takahashi
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Tomohiro Shimada
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Yosuke Toya
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Ippei Tanaka
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Yusuke Onozato
- Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan.,Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Daisuke Fukushi
- Tohoku Medical and Pharmaceutical University School of Medicine, Sendai, Japan
| | - Ko Watanabe
- Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan
| | - Shoichi Kayaba
- Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Ohshu, Japan
| | - Hirotaka Ito
- Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan
| | - Tatsuya Mikami
- Division of Endoscopy, Hirosaki University Hospital, Hirosaki, Japan
| | - Tomoyuki Oikawa
- Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan
| | - Yasushi Takahashi
- Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Yutaka Kondo
- Department of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan
| | | | - Takeharu Shiroki
- Department of Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan
| | - Ko Nagino
- Department of Gastroenterology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Norihiro Hanabata
- Division of Endoscopy, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akira Funakubo
- Department of Gastroenterology, Fukushima Medical University Aizu Medical Center, Aizuwakamatsu, Japan
| | - Dai Hirasawa
- Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan
| | - Tetsuya Ohira
- Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan
| | - Jun Nakamura
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan
| | - Tomohiro Nakamura
- Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Naoki Nakaya
- Department of Health Sciences, Saitama Prefectural University, Koshigaya, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinsaku Fukuda
- National University Corporation Hirosaki University, Hirosaki, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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Ujiie D, Matsumoto T, Endo E, Okayama H, Fujita S, Kanke Y, Watanabe Y, Hanayama H, Hayase S, Saze Z, Ohki S, Kono K. Circulating tumor cells after neoadjuvant chemotherapy are related with recurrence in esophageal squamous cell carcinoma. Esophagus 2021; 18:566-573. [PMID: 33661456 DOI: 10.1007/s10388-021-00829-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Circulating tumor cells (CTCs) are known to be a systemic process of malignant progression of cancer cells and there is a possibility that analysis for CTCs as a liquid biopsy become predictive or prognostic tools for cancer patients. METHODS In the present study with the novel CTCs detection system (Celsee system®), we performed quantitative and qualitative analysis of CTCs in patients with esophageal squamous cell carcinoma (ESCC) receiving neoadjuvant chemotherapy (NAC) with 5FU + CDDP regimen. CTCs are defined as having both DAPI positive and CD45 negative. Vimentin-positive CTCs were defined as mesenchymal-type CTCs (M-CTCs), while epithelial-type CTCs (E-CTCs) were only positive for pan-cytokeratin. RESULTS At the baseline, there are detectable amounts of CTCs in all patients (n = 30) at all stages, and there were no significant differences of total CTCs, E-CTCs, or M-CTCs numbers between stages. Of importance, among total CTCs, M-CTCs are more dominant than E-CTCs in number. Also, there was no significant change of detectable amounts and phenotype of CTCs before and after NAC (n = 24). Of note, early recurrent group indicated that there was an elevated total CTCs number before NAC and an increased M-CTCs after NAC in comparison to those in non-recurrent group. CONCLUSIONS Quantitative and qualitative analysis of CTCs may provide useful complementary predictive and prognostic information in ESCC.
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Affiliation(s)
- Daisuke Ujiie
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takuro Matsumoto
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Eisei Endo
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hirokazu Okayama
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shotaro Fujita
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuyuki Kanke
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yohei Watanabe
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Hiroyuki Hanayama
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Suguru Hayase
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Zenichirou Saze
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Shinji Ohki
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koji Kono
- Department of Gastrointestinal Tract Surgery, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
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Visaggi P, Barberio B, Ghisa M, Ribolsi M, Savarino V, Fassan M, Valmasoni M, Marchi S, de Bortoli N, Savarino E. Modern Diagnosis of Early Esophageal Cancer: From Blood Biomarkers to Advanced Endoscopy and Artificial Intelligence. Cancers (Basel) 2021; 13:cancers13133162. [PMID: 34202763 PMCID: PMC8268190 DOI: 10.3390/cancers13133162] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Esophageal cancer (EC) has a poor prognosis when the diagnosis is delayed, but curative treatment is possible if the diagnosis is timely. The disease subtly progresses before symptoms prompt patients to seek medical attention. Effective pre-symptomatic screening strategies may improve the outcome of the disease. Recent evidence provided insights into early diagnosis of EC via blood tests, advanced endoscopic imaging, and artificial intelligence. Accordingly, we reviewed available strategies to diagnose early EC. Abstract Esophageal cancer (EC) is the seventh most common cancer and the sixth cause of cancer death worldwide. Histologically, esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) account for up to 90% and 20% of all ECs, respectively. Clinical symptoms such as dysphagia, odynophagia, and bolus impaction occur late in the natural history of the disease, and the diagnosis is often delayed. The prognosis of ESCC and EAC is poor in advanced stages, being survival rates less than 20% at five years. However, when the diagnosis is achieved early, curative treatment is possible, and survival exceeds 80%. For these reasons, mass screening strategies for EC are highly desirable, and several options are currently under investigation. Blood biomarkers offer an inexpensive, non-invasive screening strategy for cancers, and novel technologies have allowed the identification of candidate markers for EC. The esophagus is easily accessible via endoscopy, and endoscopic imaging represents the gold standard for cancer surveillance. However, lesion recognition during endoscopic procedures is hampered by interobserver variability. To fill this gap, artificial intelligence (AI) has recently been explored and provided encouraging results. In this review, we provide a summary of currently available options to achieve early diagnosis of EC, focusing on blood biomarkers, advanced endoscopy, and AI.
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Affiliation(s)
- Pierfrancesco Visaggi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy; (P.V.); (S.M.); (N.d.B.)
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (B.B.); (M.G.)
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (B.B.); (M.G.)
| | - Mentore Ribolsi
- Department of Digestive Diseases, Campus Bio Medico University of Rome, 00128 Roma, Italy;
| | - Vincenzo Savarino
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, 16143 Genoa, Italy;
| | - Matteo Fassan
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padua, 35121 Padua, Italy;
| | - Michele Valmasoni
- Department of Surgical, Oncological and Gastroenterological Sciences, Center for Esophageal Disease, University of Padova, 35124 Padova, Italy;
| | - Santino Marchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy; (P.V.); (S.M.); (N.d.B.)
| | - Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56124 Pisa, Italy; (P.V.); (S.M.); (N.d.B.)
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, 35121 Padua, Italy; (B.B.); (M.G.)
- Correspondence:
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204
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Matsuda S, Kawakubo H, Okamura A, Takahashi K, Toihata T, Takemura R, Mayanagi S, Takeuchi H, Watanabe M, Kitagawa Y. Prognostic Significance of Stratification Using Pathological Stage and Response to Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2021; 28:8438-8447. [PMID: 34142294 DOI: 10.1245/s10434-021-10221-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/10/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE Risk stratification to select appropriate candidates for adjuvant therapy is required for esophageal cancer patients based on adjuvant therapy advancement including immunotherapy. The current study aims to develop a novel staging system using pathological stage (pStage) and response to neoadjuvant chemotherapy (NAC) for esophageal squamous cell carcinoma (ESCC). METHODS ESCC patients who received NAC and underwent transthoracic esophagectomy at two Japanese high-volume esophageal centers were retrospectively reviewed. The prognostic value of NAC response was evaluated within the same pStage, and a novel risk stratification to predict cancer-specific survival (CSS) was developed. RESULTS The HR (95% CI) of pathological responders in pStage 0-I, II, III, and IV was 0.29 (0.07-1.17), 0.37 (0.12-1.10), 0.37 (0.15-0.92), and 0.24 (0.06-0.98), respectively. Responders in pStage 0-II were classified to be in the same class and those in pStage III/IV in another group, because the 5-year CSS (5y-CSS) rate of responders in pStage 0-I, II, III, and IV was 94%, 92%, 76%, and 71%, respectively. Combining nonresponders in pStage 0-II as the same group, all patients were subdivided into five groups. Intriguingly, the 5y-CSS in pStage III-IV responders was 75%, almost identical to that of nonresponders in pStage 0-II (78%). CONCLUSIONS The histological response influenced the long-term outcomes of patients who underwent esophagectomy after NAC, even within groups stratified by pathologic stage. The current risk stratification system will contribute to selecting appropriate candidates for adjuvant therapy.
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Affiliation(s)
- Satoru Matsuda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keita Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tasuku Toihata
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ryo Takemura
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Shuhei Mayanagi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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205
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Kawamoto T, Nakamura N, Saito T, Tonari A, Wada H, Harada H, Kubota H, Nagakura H, Heianna J, Miyazawa K, Yamada K, Tago M, Fushiki M, Nozaki M, Uchida N, Araki N, Sekii S, Kosugi T, Takahashi T, Shikama N. Palliative brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer: a nationwide survey in Japan. Jpn J Clin Oncol 2021; 51:950-955. [PMID: 33624768 DOI: 10.1093/jjco/hyab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/31/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND International guidelines recommend brachytherapy for patients with dysphagia from esophageal cancer, whereas brachytherapy is infrequently used to palliate dysphagia in some countries. To clarify the availability of palliative treatment for dysphagia from esophageal cancer and explain why brachytherapy is not routinely performed are unknown, this study investigated the use of brachytherapy and external beam radiotherapy for dysphagia from esophageal cancer. METHODS Japanese Radiation Oncology Study Group members completed a survey and selected the treatment that they would recommend for hypothetical cases of dysphagia from esophageal cancer. RESULTS Of the 136 invited facilities, 61 completed the survey (44.9%). Four (6.6%) facilities performed brachytherapy of the esophagus, whereas brachytherapy represented the first-line treatment at three (4.9%) facilities. Conversely, external beam radiotherapy alone and chemoradiotherapy were first-line treatments at 61 and 58 (95.1%) facilities, respectively. In facilities that performed brachytherapy, the main reason why brachytherapy of the esophagus was not performed was high invasiveness (30.2%). Definitive-dose chemoradiotherapy with (≥50 Gy) tended to be used in patients with expected long-term survival. CONCLUSIONS Few facilities routinely considered brachytherapy for the treatment of dysphagia from esophageal cancer in Japan. Conversely, most facilities routinely considered external beam radiotherapy. In the future, it will be necessary to optimize external beam radiotherapy.
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Affiliation(s)
- Terufumi Kawamoto
- Department of Radiation Oncology, Juntendo University Hospital, Tokyo, Japan
| | - Naoki Nakamura
- Department of Radiation Oncology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Tetsuo Saito
- Department of Radiation Oncology, Arao Municipal Hospital, Kumamoto, Japan
| | - Ayako Tonari
- Department of Radiation Oncology, Kyorin University Hospital, Mitaka, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Fukushima, Japan
| | - Hideyuki Harada
- Division of Radiation Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe University Hospital, Kobe, Japan
| | | | - Joichi Heianna
- Department of Radiation Oncology, Ryukyu University Hospital, Nishihara, Japan
| | | | - Kazunari Yamada
- Department of Radiation Oncology, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Masao Tago
- Department of Radiology, Teikyo University Hospital, Tokyo, Japan
| | - Masato Fushiki
- Department of Radiation Oncology, Nagahama City Hospital, Nagahama, Japan
| | - Miwako Nozaki
- Department of Radiation Oncology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Nobue Uchida
- Department of Radiation Oncology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Norio Araki
- Department of Radiation Oncology, Kyoto Medical Center, Kyoto, Japan
| | - Shuhei Sekii
- Department of Radiation Oncology, Kita-Harima Medical Center, Ono, Japan
| | - Takashi Kosugi
- Department of Radiation Oncology, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Juntendo University Hospital, Tokyo, Japan
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206
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Hayashi M, Abe M, Fujita T, Matsushita H. Assessing the Prognostic Value of Extranodal Extension in Esophageal Cancer from the Pathological Staging Perspective. J INVEST SURG 2021; 35:698-706. [PMID: 34096439 DOI: 10.1080/08941939.2021.1912221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Extranodal extension (ENE) is a prognostic factor for several types of malignant tumors, including esophageal cancer. Although the prognostic value of ENE has been investigated in esophageal cancer, its clinical utility warrants further investigation. MATERIALS AND METHODS This retrospective single-center study evaluated 105 patients who underwent esophagectomy and had histologically node-positive metastasis between January 2007 and June 2017. The abilities of ENE to predict overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan-Meier method and log-rank test, as well as Cox proportional hazard models. Subgroup analyses of ENE's prognostic value were performed according to each pathological tumor-node-metastasis category. RESULTS Significant differences according to ENE status were observed in the Kaplan-Meier analyses of OS (p = 0.001) and DFS (p = 0.001), as well as in the Cox proportional hazards models for OS (p = 0.009) and DFS (p = 0.012). Relative to patients without ENE, patients with ENE had significantly poorer OS if they also had pT3 status, pN1 status, or pathological stage III disease. However, no significant differences were observed in the subgroup analyses of pN3 status and pathological stage IV disease. CONCLUSIONS Among patients with esophageal cancer, ENE status can predict a poor prognosis and may be useful for patient stratification. However, the prognostic value of ENE status may be limited to patients with specific pathological factors.
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Affiliation(s)
- Masato Hayashi
- Department of Surgery, Tochigi Cancer Center Hospital, Utsunomiya, Tochigi, Japan
| | - Makoto Abe
- Department of Pathology, Tochigi Cancer Center Hospital, Utsunomiya, Tochigi, Japan
| | - Takeshi Fujita
- Department of Surgery, Tochigi Cancer Center Hospital, Utsunomiya, Tochigi, Japan
| | - Hisayuki Matsushita
- Department of Surgery, Tochigi Cancer Center Hospital, Utsunomiya, Tochigi, Japan
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Kanie Y, Okamura A, Asari T, Maruyama S, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Ishiyama A, Yoshio T, Tsuchida T, Chin K, Watanabe M. Additional Treatment Following Noncurative Endoscopic Resection for Esophageal Squamous Cell Carcinoma: A Comparison of Outcomes between Esophagectomy and Chemoradiotherapy. Ann Surg Oncol 2021; 28:8428-8435. [PMID: 34085140 DOI: 10.1245/s10434-021-10225-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Endoscopic resection (ER) has been widely implemented for cT1N0 esophageal squamous cell carcinoma (ESCC). Additional therapy, including esophagectomy and chemoradiotherapy (CRT), is sometimes required after noncurative ER. METHODS We retrospectively reviewed 108 patients who received any additional treatment following noncurative ER (positive vertical margins, lymphovascular invasion, or invasion depth of submucosa or more), and compared the short- and long-term outcomes between the two treatment modalities. RESULTS Of 108 patients, 56 underwent esophagectomy (E group), and 52 received CRT (CRT group). A positive vertical margin was observed in 17 (14.8%) patients and high risks of occult lymph node metastasis were observed in 91 (85.2%) patients, as well as lymphovascular invasion in 35 (32.4%) patients, invasion depth of the submucosa or more in 27 (25.0%) patients, and both in 29 (26.9%) patients. The E group patients were significantly younger (p = 0.046) and tended to present with larger tumors than those in the CRT group (p = 0.057). Lymphatic invasion was more frequent in the E group (p = 0.019), and, furthermore, one treatment-related death was observed in the E group. There were no significant differences between the groups in overall and disease-specific survival (p = 0.406 and 0.151, respectively), however, recurrence was only observed in the CRT group. CONCLUSION Both esophagectomy and CRT are safe and effective as additional treatments after noncurative ER in patients with ESCC. Esophagectomy is oncologically safe, whereas a risk of postoperative morbidity and mortality remains. Although the adverse events are acceptable, CRT has a certain degree of risk of disease recurrence.
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Affiliation(s)
- Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Takao Asari
- Department of Radiation Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kei Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiyoshi Ishiyama
- Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Tsuchida
- Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keisho Chin
- Department of Gastroenterological Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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Lampis A, Ratti M, Ghidini M, Mirchev MB, Okuducu AF, Valeri N, Hahne JC. Challenges and perspectives for immunotherapy in oesophageal cancer: A look to the future (Review). Int J Mol Med 2021; 47:97. [PMID: 33846775 PMCID: PMC8041478 DOI: 10.3892/ijmm.2021.4930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/25/2021] [Indexed: 12/16/2022] Open
Abstract
Oesophageal cancer is one of the most aggressive malignancies with limited treatment options, thus resulting in a high morbidity and mortality. With 5‑year survival rates of only 5‑10%, oesophageal cancer holds a dismal prognosis for patients. In order to improve overall survival, the early diagnosis and tools for patient stratification for personalized treatment are urgent needs. A minority of oesophageal cancers belong to the spectrum of Lynch syndrome‑associated cancers and are characterized by microsatellite instability (MSI). Microsatellite instability is a consequence of defective mismatch repair protein functions and it has been well characterized in other gastrointestinal tumours, such as colorectal and gastric cancer. In the latter, high levels of MSI are associated with a better prognosis and with an increased benefit to immune‑based therapies. Therefore, similar therapeutic approaches could offer an opportunity of treatment for oesophageal cancer patients with MSI. Apart from immune checkpoint inhibitors, other immunotherapies such as adoptive T‑cell transfer, peptide vaccine and oncolytic viruses are under investigation in oesophageal cancer patients. In the present review, the rationale and current knowledge about immunotherapies in oesophageal cancer are summarised.
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Affiliation(s)
- Andrea Lampis
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
| | - Margherita Ratti
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
- Medical Department, Division of Oncology, Hospital Trust of Cremona, I-26100 Cremona, Italy
| | - Michele Ghidini
- Division of Medical Oncology, Hospital Policlinic 'Fondazione IRCCS Ca' Granda Ospedale Maggiore', I-20122 Milan, Italy
| | - Milko B. Mirchev
- Clinic of Gastroenterology, Medical University, 9002 Varna, Bulgaria
| | | | - Nicola Valeri
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
- Department of Medicine, The Royal Marsden NHS Foundation Trust, Sutton SM25NG, UK
| | - Jens Claus Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton SM25NG, UK
- Centre for Evolution and Cancer, The Institute of Cancer Research, Sutton SM25NG, UK
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209
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Hamada K, Itoh T, Kawaura K, Kuno H, Kamai J, Kobayasi R, Azukisawa S, Kitakata H, Ishisaka T, Igarashi Y, Kodera K, Okuno T, Morita T, Himeno T, Yano H, Higashikawa T, Iritani O, Iwai K, Morimoto S, Matoba M, Okuro M. A Case of Refractory Esophageal Ulcer Caused by Radiotherapy for Hepatocellular Carcinoma. World J Oncol 2021; 12:67-72. [PMID: 34046101 PMCID: PMC8139740 DOI: 10.14740/wjon1370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
A 77-year-old man who underwent radiotherapy for hepatocellular carcinoma 6 months prior consulted for esophageal obstruction. Esophagogastroduodenoscopy revealed an esophageal ulcer caused by radiotherapy for hepatocellular carcinoma. He was treated with dietary counseling and vonoprazan. After 9 months, the ulcer improved but a moderate stenosis remained. Several factors such as high fraction size, history of chemotherapy, and stress associated with food intake might involve in the development of a radiation-associated ulcer. Opportunities to choose radiotherapy for hepatocellular carcinoma may increase, so we hypothesize that esophageal ulcers might be a complication that should be noted associated with this therapy.
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Affiliation(s)
- Kazu Hamada
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.,Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Tohru Itoh
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Ken Kawaura
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroaki Kuno
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Junji Kamai
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Rika Kobayasi
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Sadahumi Azukisawa
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Hidekazu Kitakata
- Department of Gastroenterological Endoscopy, Kanazawa Medical University, Ishikawa, Japan
| | - Taishi Ishisaka
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Yuta Igarashi
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Kumie Kodera
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Tazuo Okuno
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Takuro Morita
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Tarou Himeno
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Hiroshi Yano
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | | | - Osamu Iritani
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Kunimitsu Iwai
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Shigeto Morimoto
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Munetaka Matoba
- Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Masashi Okuro
- Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan
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210
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Li CC, Chen CY, Chou YH, Huang CJ, Ku HY, Chien CR. Optimal radiotherapy dose in cervical esophageal squamous cell carcinoma patients treated with definitive concurrent chemoradiotherapy: A population based study. Thorac Cancer 2021; 12:2065-2071. [PMID: 34028200 PMCID: PMC8287021 DOI: 10.1111/1759-7714.14009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The optimal radiotherapy dose for locally advanced cervical esophageal squamous cell carcinoma (C-ESqCC) treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. Here, we aimed to compare the survival of those treated with high dose versus standard dose via a population based approach. METHODS Eligible C-ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between high (60-70 Gy) and standard dose (50-50.4 Gy). We also evaluated the outcome in supplementary analyses via alternative approaches. RESULTS Our primary analysis consisted of 141 patients in whom covariates were well balanced after PS weighting. The HR of death when high dose was compared with standard dose was 0.65 (95% confidence interval [CI]: 0.4-1.03, p = 0.07). The HR of IECM was 0.74 (p = 0.45). The HR of OS remained similarly insignificant in supplementary analyses. CONCLUSIONS We observed a trend in favor of high radiotherapy dose versus standard dose for C-ESqCC treated with dCCRT in this population-based nonrandomized study. Further studies are needed to confirm the findings of the study.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Republic of China
| | - Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Republic of China.,Institute of Medicine, Chung Shan Medical University, Taichung, Republic of China
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Republic of China.,Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Republic of China
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Republic of China
| | - Hsiu-Ying Ku
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Republic of China.,Department of Healthcare Administration, Asia University, Taichung, Republic of China
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Republic of China.,School of Medicine, College of Medicine, China Medical University, Taichung, Republic of China.,Department of Radiation Oncology, China Medical University Hospital, Taichung, Republic of China
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211
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Kawashima K, Abe S, Koga M, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Hikichi T, Ohira H, Saito Y. Optimal selection of endoscopic resection in patients with esophageal squamous cell carcinoma: endoscopic mucosal resection versus endoscopic submucosal dissection according to lesion size. Dis Esophagus 2021; 34:5909779. [PMID: 32959874 DOI: 10.1093/dote/doaa096] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/21/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
En bloc resection is essential for accurate pathological evaluation in patients with superficial esophageal squamous cell carcinoma (SESCC). This retrospective study aimed to clarify optimal treatment selection of endoscopic resection according to lesion size. A total of 760 patients underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) between January 2011 and December 2015. Among them, this retrospective study included 196 solitary index SESCC lesions ≤20 mm, with the deepest invasion to the mucosa or superficial submucosa endoscopically. The lesions were classified according to size measured via endoscopy as follows; group A: lesions ≤10 mm, group B: lesions ≥11 mm but ≤15 mm, and group C: lesions ≥16 mm but ≤20 mm. The short- and long-term outcomes were investigated for EMR and ESD subgroups. In patients undergoing EMR and ESD, en bloc resection rates for group A and B were not different (98.8 vs. 100%, 93.3 vs. 100%, respectively). However, the en bloc resection rate was significantly lower in EMR than that in ESD for group C (64.3 vs. 100%, P < 0.001). Furthermore, the use of adjunctive ablative therapy rate was significantly higher in EMR than that in ESD in group C (35.7 vs. 0%, P < 0.001). The 5-year cumulative local recurrence rate of group C was significantly higher than that of group A + B after EMR (P < 0.01). EMR was an adequate treatment for SESCC lesions ≤15 mm. On the other hand, ESD could be necessary to achieve en bloc resection for lesions ≥16 mm to avoid local recurrence.
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Affiliation(s)
- Kazumasa Kawashima
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.,Department of Gastroenterology, Fukushima Medical University School Medicine, Fukushima, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masakazu Koga
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoru Nonaka
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhisa Suzuki
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takuto Hikichi
- Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School Medicine, Fukushima, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
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212
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Maruyama S, Okamura A, Kanie Y, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Watanabe M. Influence of Damaged Stomach on Anastomotic Leakage following Cervical Esophagogastrostomy in Patients with Esophageal Cancer. Ann Surg Oncol 2021; 28:7240-7246. [PMID: 33999347 DOI: 10.1245/s10434-021-10145-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) is one of the most common complications after esophagectomy. Although some patients have a history of peptic ulcers or other prior stomach diseases, the influence of a damaged stomach (DS) on AL incidence remains unclear. Therefore, we investigated the association between DS and incidence of AL in patients who underwent esophagectomy. PATIENTS AND METHODS Between 2015 and 2019, a total of 447 consecutive patients who underwent cervical esophagogastrostomy using gastric tube following esophagectomy were enrolled. DS was defined on the basis of endoscopic findings of ulcers or scars due to medical history or prior treatment. We compared the incidence of AL between patients with DS and those with a healthy stomach (HS). Univariate and multivariate logistic regression analyses were used to identify factors that could predict AL incidence. RESULTS Fifty-one patients (11.4%) had DS. Causes of DS included peptic ulcer (n = 36), endoscopic resection for early gastric cancer (n = 9), percutaneous endoscopic gastrostomies (n = 5), and post-chemotherapy scar for gastric malignant lymphoma (n = 1). Overall, AL occurred in 35 patients (7.8%). The incidence of AL in the DS group was significantly higher than in the HS group (15.7 vs. 6.8%, p = 0.03). DS was one of the independent predictive factors for AL (odds ratio, 2.75; 95% confidence interval, 1.10-6.92; p = 0.03) on multivariate analysis. Further, the diseases in the lower third of the conduit were associated with AL. CONCLUSIONS Presence of DS can predict AL in patients who underwent cervical esophagogastrostomy after esophagectomy.
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Affiliation(s)
- Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kei Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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213
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Fukuda S, Okajima K, Okada K, Fukuda K, Wakasa T, Tsujimoto T, Gakuhara A, Tomihara H, Ohta K, Kitani K, Hashimoto K, Ishikawa H, Hida JI, Yukawa M, Ohta Y, Inoue M. Postoperative solitary liver metastasis from esophageal squamous cell carcinoma achieving a clinical complete response to chemotherapy with cisplatin and 5-fluorouracil followed by stereotactic body radiotherapy: A case report. Mol Clin Oncol 2021; 15:130. [PMID: 34055345 PMCID: PMC8138851 DOI: 10.3892/mco.2021.2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
Treatment strategies for distant organ metastasis have changed markedly since the concept of oligometastasis was introduced. The perception that distant organ metastasis is a systemic disease and not eligible for local therapy is now a thing of the past. Therefore, the present report details a case of postoperative solitary liver metastasis from esophageal squamous cell carcinoma (ESCC), which achieved a clinical complete response to chemotherapy with cisplatin and 5-fluorouracil (5-FU) followed by stereotactic body radiotherapy (SBRT). A 76-year-old male patient underwent esophagectomy for lower thoracic ESCC. At 7 months after surgery, abdominal CT revealed a solitary hypovascular mass, 28 mm in size, in segment 7 of the liver. After three courses of chemotherapy with cisplatin and 5-FU, abdominal CT revealed that the liver mass had shrunk to 7 mm in size. SBRT was then administered with a 6 MV X-ray beam generated by a linear accelerator. A total dose of 50 Gy was given in 5 fractions of 10 Gy to the liver mass. At 1 month after SBRT, abdominal CT revealed that the liver mass had disappeared. The patient received no further adjuvant chemotherapy and had no recurrence at 18 months after diagnosis of liver metastasis and 13 months after SBRT.
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Affiliation(s)
- Shuichi Fukuda
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Kaoru Okajima
- Department of Radiology, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Kaoru Okada
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Kohei Fukuda
- Department of Radiology, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Tomoko Wakasa
- Department of Pathology, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Tomoyuki Tsujimoto
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Atsushi Gakuhara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Hideo Tomihara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Katsuya Ohta
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Kotaro Kitani
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Kazuhiko Hashimoto
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Hajime Ishikawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Jin-Ichi Hida
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Masao Yukawa
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Yoshio Ohta
- Department of Pathology, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
| | - Masatoshi Inoue
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, Ikoma, Nara 630-0293, Japan
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214
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Maruyama S, Okamura A, Ishizuka N, Kanie Y, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Watanabe M. Airflow Limitation Predicts Postoperative Pneumonia after Esophagectomy. World J Surg 2021; 45:2492-2500. [PMID: 33939012 DOI: 10.1007/s00268-021-06148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is known to be a risk factor of pneumonia after esophagectomy. In this study, we investigated the relationship of airflow limitation with the occurrence and the severity of pneumonia in esophageal cancer patients who underwent esophagectomy. METHODS We enrolled 844 patients who underwent curative esophagectomy between 2009 and 2018. The airflow limitation was evaluated using the percent-predicted forced expiratory volume at 1 s (%FEV1) with spirometry. RESULTS There were 597 (70.7%), 141 (16.7%), 68 (8.1%), and 38 patients (4.5%) with %FEV1 of ≥ 90%, 80-90%, 70-80%, and < 70% categories, respectively. One hundred and ninety-one patients (22.6%) occurred pneumonia, and the incidences of pneumonia in each category of patients were 18.8%, 28.4%, 29.4%, and 50.0%, respectively. In multivariate analysis, the categories of 80%-90%, 70-80%, and < 70% were significantly associated with a higher incidence of postoperative pneumonia (OR 1.57; 95% CI 1.02-2.43, OR 1.87; 95% CI 1.04-3.36, OR 3.34; 95% CI 1.66-6.71, respectively), with the %FEV1 category of ≥ 90% as reference. The incidence of severe pneumonia of Clavien-Dindo grade III or higher was also significantly associated with the %FEV1. In patients without COPD, the incidence of pneumonia was significantly higher in those with %FEV1 < 90% than in those with %FEV1 ≥ 90% (32.2% versus 17.5%, p < 0.001). CONCLUSIONS The airflow limitation can help predict the occurrence of pneumonia after esophagectomy in patients with and without COPD. Exclusive preventive measures should be considered in patients with reduced %FEV1 undergoing esophagectomy.
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Affiliation(s)
- Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan.
| | - Naoki Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Kei Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan
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215
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Kaida H, Kitajima K, Nakajo M, Ishibashi M, Matsunaga T, Minamimoto R, Hirata K, Nakatani K, Hung A, Hattori S, Yasuda T, Ishii K. Predicting tumor response and prognosis to neoadjuvant chemotherapy in esophageal squamous cell carcinoma patients using PERCIST: a multicenter study in Japan. Eur J Nucl Med Mol Imaging 2021; 48:3666-3682. [PMID: 33934168 DOI: 10.1007/s00259-021-05365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/11/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the usefulness of the positron emission tomography response criteria in solid tumors 1.0 (PERCIST1.0) for predicting tumor response to neoadjuvant chemotherapy and prognosis and determine whether PERCIST improvements are necessary for esophageal squamous cell carcinoma (ESCC) patients. PATIENTS AND METHODS We analyzed the cases of 177 ESCC patients and examined the association between PERCIST and their pathological responses. Associations of whole-PERCIST with progression-free survival (PFS) and overall survival (OS) were evaluated by a Kaplan-Meier analysis and Cox proportional hazards model. To investigate potential PERCIST improvements, we used the survival tree technique to understand patients' prognoses. RESULTS There were significant correlations between the pathologic response and PERCIST of primary tumor (p < 0.001). The optimal cutoff value of the primary tumors' SULpeak response to classify pathologic responses was -50.0%. The diagnostic accuracy of SULpeak response was 87.3% sensitivity, 54.1% specificity, 68.9% accuracy, positive predictive value 60.5%, and negative predictive value 84.1%. Whole-PERCIST was significantly associated with PFS and OS. The survival tree results indicated that a high reduction of the whole SULpeak response was significantly correlated with the patients' prognoses. The cutoff values for the separation of prognoses were - 52.5 for PFS and - 47.1% for OS. CONCLUSION PERCIST1.0 can help predict tumor responses and prognoses. However, 18F-FDG-PET/CT tends to underestimate residual tumors in histopathological response evaluations. Modified PERCIST, in which the partial metabolic response is further classified by the SULpeak response (-50%), might be more appropriate than PERCIST1.0 for evaluating tumor responses and stratifying high-risk patients for recurrence and poor prognosis.
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Affiliation(s)
- Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Kazuhiro Kitajima
- Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masatoyo Nakajo
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-5-31, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Mana Ishibashi
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University of Faculty of Medicine, 36-1, Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koya Nakatani
- Department of Diagnostic Radiology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Ao Hung
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, 2-2, Yamadagaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Hattori
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, 2-2, Yamadagaoka, Suita, Osaka, 565-0871, Japan.,Institute for Open and Transdisciplinary Research Initiative, Osaka University, 2-2, Yamadagaoka, Suita, Osaka, 565-0871, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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216
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Yura M, Koyanagi K, Hara A, Hayashi K, Tajima Y, Kaneko Y, Fujisaki H, Hirata A, Takano K, Hongo K, Yo K, Yoneyama K, Tamai Y, Dehari R, Nakagawa M. Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy: A case report. World J Clin Cases 2021; 9:2801-2810. [PMID: 33969062 PMCID: PMC8058665 DOI: 10.12998/wjcc.v9.i12.2801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/02/2021] [Accepted: 03/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Definitive chemoradiotherapy (dCRT) using cisplatin plus 5fluorouracil (CF) with radiation is considered the standard treatment for unresectable locally advanced T4 esophageal squamous cell carcinoma (ESCC). Recently, induction chemotherapy has received attention as an effective treatment strategy.
CASE SUMMARY We report a successful case of a 59-year-old female with unresectable locally advanced T4 ESCC treated by two additional courses of chemotherapy with CF after induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by dCRT. Initial esophagogastroduodenoscopy (EGD) detected a type 2 advanced lesion located on the middle part of the esophagus, with stenosis. Computed tomography detected the primary tumor with suspected invasion of the left bronchus and 90° of direct contact with the aorta, and upper mediastinal lymph node metastasis. Pathological findings from biopsy revealed squamous cell carcinoma. We initially performed induction chemotherapy using three courses of DCF, but the lesion was still evaluated unresectable after DCF chemotherapy. Therefore, we subsequently performed dCRT treatment (CF and radiation). After dCRT, prominent reduction of the primary tumor was recognized but a residual tumor with ulceration was detected by EGD. Since the patient had some surgical risk, we performed two additional courses of CF and achieved a clinically complete response. After 14 mo from last administration of CF chemotherapy, recurrence has not been detected by computed tomography and EGD, and biopsy from the scar formation has revealed no cancer cells.
CONCLUSION We report successful case with tumor remnants even after DCF and subsequent dCRT, for whom a complete response was finally achieved with two additional courses of CF chemotherapy. Additional CF chemotherapy could be one radical treatment option for residual ESCC after treatment with induction DCF followed by dCRT to avoid salvage surgery, especially for high-risk patients.
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Affiliation(s)
- Masahiro Yura
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kazuo Koyanagi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Japan
| | - Asuka Hara
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Keita Hayashi
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yuki Tajima
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yasushi Kaneko
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Hiroto Fujisaki
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Akira Hirata
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kiminori Takano
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kumiko Hongo
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kikuo Yo
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Kimiyasu Yoneyama
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Yoshifumi Tamai
- Department of Radiology, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Reiko Dehari
- Department of Surgical Pathology, Hiratsuka City Hospital, Kanagawa 2540065, Japan
| | - Motohito Nakagawa
- Department of Surgery, Hiratsuka City Hospital, Kanagawa 2540065, Japan
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Kanie Y, Okamura A, Maruyama S, Sakamoto K, Fujiwara D, Kanamori J, Imamura Y, Watanabe M. Clinical Significance of Serum Squamous Cell Carcinoma Antigen for Patients with Recurrent Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2021; 28:7990-7996. [PMID: 33839977 DOI: 10.1245/s10434-021-09945-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/17/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Squamous cell carcinoma antigen (SCC-Ag) is a widely used tumor marker of SCC. However, the clinical significance of serum SCC-Ag levels in recurrent esophageal SCC (ESCC) remains unclear. This study aimed to investigate the clinical relevance of serum SCC-Ag levels in patients with recurrent ESCC after surgery. METHODS This study retrospectively analyzed 208 patients who experienced recurrence after curative resection for ESCC. Serum SCC-Ag levels at the time of recurrence were collected from the patients' records. The patients were classified into tertiles based on the serum SCC-Ag values (low, middle, and high), and the clinical characteristics and outcomes were compared among the groups. RESULTS Significant differences in sex (p = 0.001), pathologic T (p = 0.034), and N stages of primary cancer (p = 0.015) were observed among the groups. Although the recurrence patterns did not differ significantly, a high SCC-Ag was significantly associated with multiple recurrences (p = 0.019). The high-SCC-Ag group patients demonstrated a shorter time to recurrence than the other groups (p = 0.044). The SCC-Ag levels were significantly associated with overall survival after recurrence (p = 0.036). Multivariate analysis showed that serum SCC-Ag value at recurrence was an independent poor prognosticator (p = 0.031). CONCLUSION Elevated serum SCC-Ag levels at recurrence were significantly associated with a reduced time to recurrence, multiple recurrences, and a poor prognosis after recurrence. An alternative to the current standard treatment is required to improve the outcome for patients with high serum SCC-Ag levels at recurrence.
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Affiliation(s)
- Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan.
| | - Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Kei Sakamoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, 135-8550, Japan
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A long-term follow-up study of minimally invasive Ivor Lewis esophagectomy with linear stapled anastomosis. Surg Endosc 2021; 36:1979-1988. [PMID: 33837477 DOI: 10.1007/s00464-021-08482-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 03/28/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is increasingly performed to expect lower complication rate compared to open esophagectomy. Studies of minimally invasive Ivor Lewis esophagectomy (MIILE) with circular staplers have reported better outcomes compared to MIE with cervical anastomosis, but frequent anastomotic complications have also been reported. MIILE with linear staplers is a promising alternative, but the long-term functional and oncological outcomes are uncertain. METHODS To evaluate the functional and oncological outcomes of MIILE with linear stapled anastomosis, a retrospective cohort study was performed in 104 patients who underwent MIILE with linear stapled anastomosis for esophageal malignant tumors. The primary endpoints were the overall complication and anastomotic leak rates. The secondary endpoints were late complications, overall and disease-free survival, and nutritional status at 6 and 12 months after MIILE. RESULTS Anastomotic leak occurred in 4 patients (3.8%). The short-term complication rate of grade IIIb or higher was 6.7%. During a median 57-month follow-up period, anastomotic stricture occurred in one patient, 7 required hiatal hernia repair, and 2 underwent conduit revision surgery. The 5-year overall survival and disease-free survival rates were 69.3% and 59.5%, respectively. Status of reflux esophagitis at the time of most recent evaluation was grade N/A/B/C/D in 52/10/10/13/8 among 93 patients who had follow-up endoscopy. The mean body weight loss at 6 and 12 months after MIILE was 11.3 and 11.8% with maintenance of the serum albumin level. CONCLUSIONS MIILE with linear stapled anastomosis is a safe procedure with a low anastomotic complication rate and favorable long-term functional and survival outcomes.
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Borgstein ABJ, Brunner S, Hayami M, Moons J, Fuchs H, Eshuis WJ, Gisbertz SS, Bruns CJ, Nafteux P, Nilsson M, Schröder W, van Berge Henegouwen MI. Safety of Esophageal Cancer Surgery During the First Wave of the COVID-19 Pandemic in Europe: A Multicenter Study. Ann Surg Oncol 2021; 28:4805-4813. [PMID: 33830357 PMCID: PMC8028574 DOI: 10.1245/s10434-021-09886-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/17/2021] [Indexed: 12/21/2022]
Abstract
Background Many hospitals postponed elective surgical care during the first wave of the coronavirus disease 2019 (COVID-19) pandemic. Some centers continued elective surgery, including esophageal cancer surgery, with the use of preoperative screening methods; however, there is no evidence supporting the safety of this strategy as postoperative outcomes after esophageal cancer surgery during the COVID-19 pandemic have not yet been investigated. Methods This multicenter study in four European tertiary esophageal cancer referral centers included consecutive adult patients undergoing elective esophageal cancer surgery from a prospectively maintained database in a COVID-19 pandemic cohort (1 March 2020–31 May 2020) and a control cohort (1 October 2019–29 February 2020). The primary outcome was the rate of respiratory failure requiring mechanical ventilation. Results The COVID-19 cohort consisted of 139 patients, versus 168 patients in the control cohort. There was no difference in the rate of respiratory failure requiring mechanical ventilation (13.7% vs. 8.3%, p = 0.127) and number of pulmonary complications (32.4% vs. 29.9%, p = 0.646) between the COVID-19 cohort and the control cohort. Overall, postoperative morbidity and mortality rates were comparable between both cohorts. History taking and reverse transcription polymerase chain reaction (RT-PCR) were used as preoperative screening methods to detect a possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in all centers. No patients were diagnosed with COVID-19 pre- or postoperatively. Conclusion Esophageal cancer surgery during the first wave of the COVID-19 pandemic was not associated with an increase in pulmonary complications as no patients were diagnosed with COVID-19. Esophageal cancer surgery can be performed safely with the use of adequate preoperative SARS-CoV-2 screening methods. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-09886-z.
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Affiliation(s)
- Alexander B J Borgstein
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Stefanie Brunner
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Masaru Hayami
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinskja Institutet, Solna, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Johnny Moons
- Department of Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Hans Fuchs
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Wietse J Eshuis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Suzanne S Gisbertz
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Christiane J Bruns
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Philippe Nafteux
- Department of Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinskja Institutet, Solna, Sweden.,Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Wolfgang Schröder
- Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital of Cologne, Cologne, Germany
| | - Mark I van Berge Henegouwen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Li CC, Chen CY, Chou YH, Huang CJ, Ku HY, Chien CR. Chemotherapy alone versus definitive concurrent chemoradiotherapy for cT4b esophageal squamous cell carcinoma: a population-based study. BMC Gastroenterol 2021; 21:153. [PMID: 33827451 PMCID: PMC8028221 DOI: 10.1186/s12876-021-01742-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background The role of radiotherapy for cT4bNanyM0 esophageal squamous cell carcinoma (ESqCC) is relatively unclear, with both chemotherapy (C/T) alone and definitive concurrent chemoradiotherapy (dCCRT) being treatment options in the current guidelines. We aimed to compare the survival of dCCRT versus C/T for these patients via a population-based approach. Methods Eligible cT4b ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance the observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between dCCRT and C/T. We also evaluated OS in subgroups of either low or standard radiotherapy doses. Results Our primary analysis consisted of 247 patients in whom covariates were well balanced after PS weighing. The HR for death when dCCRT was compared with C/T was 0.36 (95% confidence interval 0.24–0.53, P < 0.001). Similar results were found for IECM. Statistical significance was only observed in the standard RT dose but not in the low dose in subgroup analyses. Conclusions In this population-based nonrandomized study of cT4bNanyM0 ESqCC patients from Asia (Taiwan), we found that the use of radiotherapy with chemotherapy was associated with better overall survival than chemotherapy alone. Further studies (especially RCTs) are needed to confirm our findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01742-4.
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Affiliation(s)
- Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
| | - Chih-Yi Chen
- Division of Thoracic Surgery, Department of Surgery, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ying-Hsiang Chou
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan.,Department of Radiation Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Ying Ku
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan.,Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan. .,Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan. .,School of Medicine, College of Medicine, China Medical University, No. 91 Hsueh-Shih Road, North District, Taichung, 40402, Taiwan.
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Narusaka T, Ohara T, Noma K, Nishiwaki N, Katsura Y, Kato T, Sato H, Tomono Y, Kikuchi S, Tazawa H, Shirakawa Y, Matsukawa A, Fujiwara T. Nanog is a promising chemoresistant stemness marker and therapeutic target by iron chelators for esophageal cancer. Int J Cancer 2021; 149:347-357. [PMID: 33662150 DOI: 10.1002/ijc.33544] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
Esophageal cancer is a disease showing poor prognosis. Although combination chemotherapy using cisplatin (CDDP) and 5-fluorouracil is standard for unresectable esophageal cancer, the response rate is 35%. Cancer stem cells (CSCs) and inflammation are reportedly responsible for the poor prognosis of esophageal cancer. However, comprehensive analyses have not been conducted and proposals for progress remain lacking. Iron is known to be a key factor in the stemness of CSCs. Our study focused on the therapeutic potential of iron control using iron chelators for CSCs in esophageal cancer. Among 134 immunohistochemically analyzed cases, Nanog expression was high in 98 cases and low in 36 cases. High Nanog expression correlated with low overall and disease-free survivals. The iron chelators deferasirox (DFX) and SP10 suppressed the proliferation and expression of stemness markers in TE8 and OE33 cells. DFX and SP10 did not induce compensatory interleukin (IL)-6 secretion, although CDDP did result in high induction. Moreover, BBI608 and SSZ, as other CSC-targeting drugs, could not suppress the expression of stemness markers. Overall, Nanog expression appears related to poor prognosis in esophageal cancer patients, and inhibition of stemness and compensatory IL-6 secretion by iron chelators may offer a novel therapeutic strategy for esophageal cancer.
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Affiliation(s)
- Toru Narusaka
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiaki Ohara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Pathology and Experimental Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Noma
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noriyuki Nishiwaki
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Katsura
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuya Kato
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroaki Sato
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuko Tomono
- Division of Molecular Cell biology, Shigei Medical Research Institute, Okayama, Japan
| | - Satoru Kikuchi
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Tazawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Yasuhiro Shirakawa
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Akihiro Matsukawa
- Department of Pathology and Experimental Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyoshi Fujiwara
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Fujihata S, Ogawa R, Nakaya S, Hayakawa S, Okubo T, Sagawa H, Tanaka T, Takahashi H, Matsuo Y, Takiguchi S. The impact of skeletal muscle wasting during neoadjuvant chemotherapy on postoperative anastomotic leakage in patients with esophageal cancer. Esophagus 2021; 18:258-266. [PMID: 32889673 DOI: 10.1007/s10388-020-00774-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sarcopenia is defined by low muscle mass and low muscle strength and is a prognostic factor of unfavorable outcomes in various diseases. The purpose of this study is to examine the correlation between skeletal muscle wasting (SMW) during neoadjuvant chemotherapy (NAC) and postoperative complications in patients with esophageal cancer, particularly in relation to anastomotic leakage. METHODS The present study involved 99 patients with thoracic esophageal cancer and esophago-gastric junctional cancer who received NAC followed by radical esophagectomy between August 2008 to June 2019, and who were pStage 0-III. Patient demographics and clinical variables were retrospectively reviewed. For assessing the extent of SMW, the rate of change in skeletal muscle mass index (SMI) was measured from CT images at the level of the third lumbar vertebra. Factors associated with postoperative complications were also examined. RESULTS The median rate of change in total SMI in patients was - 1.87%. The decreased rates in SMI of the side abdominal muscles and rectus abdominis were significantly greater than that of the psoas major (side abdominal muscles: p = 0.0084, rectus abdominis: p = 0.036). Multivariate analysis showed a decreased rate in SMI, especially in the erector spinae muscle, and the Charlson comorbidity index (CCI) was significantly associated with Grade IIIa of higher anastomotic leakage (Grade ≥ IIIa) (SMI cutoff (favorable): ≤ - 7.84, p = 0.0040; CCI cutoff (favorable): ≥ 2, p = 0.0032). CONCLUSION In patients with esophageal cancer, SMI tend to decrease during NAC treatment. It is therefore important to prevent the additional impact that SMW during NAC has on postoperative anastomotic leakage.
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Affiliation(s)
- Shiro Fujihata
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan. shiro--
| | - Ryo Ogawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Seiichi Nakaya
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Shunsuke Hayakawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Tomotaka Okubo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Hiroyuki Sagawa
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Tatsuya Tanaka
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Hiroki Takahashi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
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Harada K, Hwang H, Wang X, Abdelhakeem A, Iwatsuki M, Blum Murphy MA, Maru DM, Weston B, Lee JH, Rogers JE, Thomas I, Shanbhag N, Zhao M, Bhutani MS, Nguyen QN, Swisher SG, Ikoma N, Badgwell BD, Hofstetter WL, Ajani JA. Frequency and Implications of Paratracheal Lymph Node Metastases in Resectable Esophageal or Gastroesophageal Junction Adenocarcinoma. Ann Surg 2021; 273:751-757. [PMID: 31188215 DOI: 10.1097/sla.0000000000003383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We aimed to evaluate the frequency of paratracheal lymph nodes (LN) metastases and their prognostic influence. SUMMARY BACKGROUND DATA Paratracheal LNs are considered regional nodes in the esophageal cancer classification, but their metastatic rate and influence on survival remain unclear. METHODS One thousand one hundred ninety-nine patients with resectable esophageal or gastroesophageal junction adenocarcinoma (EAC) (January 2002 and December 2016) in our Gastrointestinal Medical Oncology Database were analyzed. Paratracheal LNs were defined as1R, 1L, 2R, 2L, 4R, and 4L, according to the 8th American Joint Committee on Cancer classification. RESULTS Of 1199 patients, 73 (6.1%) had positive paratracheal LNs at diagnosis. The median overall survival (OS) of 73 patients with initial paratracheal LN involvement was 2.10 years (range 0.01-10.1, 5-yrs OS 24.2%). Of 1071 patients who were eligible for recurrence evaluation, 70 patients (6.5%) developed paratracheal LN metastases as the first recurrence. The median time to recurrence was 1.28 years (range 0.28-5.96 yrs) and the median OS following recurrence was only 0.95 year (range 0.03-7.88). OS in 35 patients who had only paratracheal LN recurrence was significantly longer than in patients who had other recurrences (median OS 2.26 vs 0.51 yrs, 5-yrs OS; 26.8% vs 0%, P < 0.0001). Higher T stage (T3/T4) was an independently risk factor for paratracheal LN recurrence (odds ratio 5.10, 95% confidence interval 1.46-17.89). We segregated patients in 3 groups based on the distance of tumor's proximal edge to esophagogastric junction (low; ≤2 cm, medium; 2.0-7.0 cm, and high; >7.0 cm). Paratracheal LN metastases were more frequent with the proximal tumors (low, 4.2%; medium, 12.0%; high, 30.3%; Cochran-Armitage Trend test, P < 0.001). CONCLUSION Paratracheal LN metastases were associated with a shorter survival in resectable EAC patients. Alternate approaches to prolong survival of this group of patients are warranted.
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Affiliation(s)
- Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Hyunsoo Hwang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xuemei Wang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ahmed Abdelhakeem
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Masaaki Iwatsuki
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Mariela A Blum Murphy
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dipen M Maru
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian Weston
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey H Lee
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane E Rogers
- Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Irene Thomas
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Namita Shanbhag
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Meina Zhao
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manoop S Bhutani
- Department of Gastroenterology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naruhiko Ikoma
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brian D Badgwell
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jaffer A Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Motoyama S, Sato Y, Wakita A, Nagaki Y, Fujita H, Sasamori R, Kemuriyama K, Takashima S, Imai K, Minamiya Y. Lower local recurrence rate after robot-assisted thoracoscopic esophagectomy than conventional thoracoscopic surgery for esophageal cancer. Sci Rep 2021; 11:6774. [PMID: 33762693 PMCID: PMC7990925 DOI: 10.1038/s41598-021-86420-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 03/16/2021] [Indexed: 01/01/2023] Open
Abstract
The oncological advantages of robot-assisted thoracoscopic esophagectomy (RATE) over conventional thoracoscopic esophagectomy (TE) for thoracic esophageal cancer have yet to be verified. In this study, we retrospectively analyzed clinical data to compare the incidences of recurrence within the surgical field after RATE and TE as an indicator of local oncological control. Among 121 consecutive patients with thoracic esophageal or esophagogastric junction cancers for which thoracoscopic surgery was indicated, 51 were treated with RATE while 70 received TE. The number of lymph nodes dissected from the mediastinum, duration of the thoracic portion of the surgery, and morbidity due to postoperative complications did not differ between the two groups. However, the rate of overall local recurrence within the surgical field was significantly (P = 0.039) higher in the TE (9%) than the RATE (0%) group. Lymph node recurrence within the surgical field occurred in left recurrent nerve, left tracheobronchial, left main bronchus and thoracic paraaortic lymph nodes, which were all difficult to approach to dissect. The other two local failures occurred around the anastomotic site. This study indicates that using RATE enabled the incidence of recurrence within the surgical field to be reduced, though there were some limitations.
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Affiliation(s)
- Satoru Motoyama
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
- Comprehensive Cancer Control, Akita University Graduate School of Medicine, Akita, Japan.
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Yusuke Sato
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Akiyuki Wakita
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yushi Nagaki
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiromu Fujita
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Ryohei Sasamori
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kohei Kemuriyama
- Esophageal Surgery, Akita University Hospital, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Shinogu Takashima
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kazuhiro Imai
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Yoshihiro Minamiya
- Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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225
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Saito R, Yoshimura K, Shoda K, Furuya S, Akaike H, Kawaguchi Y, Murata T, Ogata K, Iwano T, Takeda S, Ichikawa D. Diagnostic significance of plasma lipid markers and machine learning-based algorithm for gastric cancer. Oncol Lett 2021; 21:405. [PMID: 33841566 PMCID: PMC8020384 DOI: 10.3892/ol.2021.12666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/08/2021] [Indexed: 12/26/2022] Open
Abstract
Biomarkers may be of value for the early detection of gastric cancer (GC) and the preoperative identification of tumor characteristics to guide treatment strategies. The present study analyzed the expression levels of phospholipids in plasma from patients with GC using liquid chromatography/electrospray ionization-mass spectrometry (LC/ESI-MS) to detect reliable biomarkers for GC. Furthermore, combining the results with a machine learning strategy, the present study attempted to establish a diagnostic system for GC. A total of 20 plasma samples from preoperative patients with GC and 16 plasma samples from tumor-free patients (controls) were selected from our biobank named ‘SHINGEN (Yamanashi Biobank of Gastroenterological Cancers)’, which includes a total of 1,592 plasma samples, and were analyzed by LC/ESI-MS. The obtained data were discriminated using a machine learning-based diagnostic algorithm, whose discriminant ability was confirmed through leave-one-out cross-validation. Using LC/ESI-MS, the levels of 236 lipid molecules were determined. Biomarker analysis revealed that a few lipids that were downregulated in the GC group could discriminate between the GC and control groups. Whole lipid composition analysis using partial least squares regression revealed good discrimination ability between the GC and control groups. Integrative analysis of all molecules using the aforementioned machine learning method exhibited a diagnostic accuracy of 94.4% (specificity, 93.8%; sensitivity, 95.0%). In conclusion, the outcomes of the present study suggested the potential future application of the aforementioned system in clinical settings. By accumulating more reliable data, the present system will be able to detect early-stage cancer and will be capable of predicting the efficacy of each therapeutic strategy.
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Affiliation(s)
- Ryo Saito
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Kentaro Yoshimura
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Katsutoshi Shoda
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Tasuku Murata
- MS Business Unit, Life Science Business Department, Analytical and Measuring Instruments Division, Shimadzu Corporation, Kyoto 6048511, Japan
| | - Koretsugu Ogata
- MS Business Unit, Life Science Business Department, Analytical and Measuring Instruments Division, Shimadzu Corporation, Kyoto 6048511, Japan
| | - Tomohiko Iwano
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Sen Takeda
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Yamanashi 4093898, Japan
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226
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Kobayashi Y, Nishikawa K, Akasaka T, Kato S, Hamakawa T, Yamamoto K, Kobayashi N, Kitakaze M, Maeda S, Uemura M, Miyake M, Hama N, Miyamoto A, Kato T, Miyazaki M, Nakamori S, Mita E, Sekimoto M, Mano M, Hirao M. Retrograde endoscopic submucosal dissection for early thoracic esophageal carcinoma. Clin J Gastroenterol 2021; 14:434-438. [PMID: 33689125 DOI: 10.1007/s12328-021-01371-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/22/2021] [Indexed: 12/01/2022]
Abstract
Although the standard treatment for intramucosal esophageal cancer without lymph node metastasis is endoscopic submucosal dissection (ESD), we sometimes encounter patients who are not able to undergo a transoral endoscopic examination. Here, we report a surgical procedure consisting of transgastric retrograde ESD to treat early esophageal cancer (T1a-EP, N0, M0) because of a stricture after hypopharyngeal cancer surgery. This retrograde ESD procedure can be a safe and effective treatment option for early esophageal cancer. This is the first report of a surgical retrograde ESD method for esophageal cancer.
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Affiliation(s)
- Yuta Kobayashi
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Kazuhiro Nishikawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Tomofumi Akasaka
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Seiya Kato
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan.,Department of Gastroenterology and Hepatology, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Kei Yamamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Noboru Kobayashi
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Masatoshi Kitakaze
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Sakae Maeda
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Surgery, Sakai City Medical Center, 1-1-1, Ebaraji, Sakai, Osaka, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-1, Yamadaoka, Suita, Osaka, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Naoki Hama
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Digestive Surgery, Ikeda City Hospital, 3-1-18 Jonan, Ikeda, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Shoji Nakamori
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Eiji Mita
- Department of Gastroenterology and Hepatology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.,Department of Surgery, Kansai Medical University, 2-3-1, Shinmachi, Hirakata, Osaka, Japan
| | - Masayuki Mano
- Department of Central Laboratory and Surgical Pathology, National Hospital Organization, Osaka National Hospital, 2-1-14, Houenzaka, Chuo-ku, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
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227
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Yang L, Jin H, Xie XL, Cao YT, Liu ZH, Li N, Jin P, He YQ, Sheng JQ. Endoscopic resections for superficial esophageal squamous cell epithelial neoplasia: focus on histological discrepancies between biopsy and resected specimens. BMC Gastroenterol 2021; 21:114. [PMID: 33750308 PMCID: PMC7941920 DOI: 10.1186/s12876-021-01694-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 02/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endoscopic resection has been used for high-grade intraepithelial neoplasia (HGIN) and superficial esophageal squamous cell carcinoma (ESCC) with limited risk of lymph node metastasis. However, some of these lesions cannot be accurately diagnosed based on forceps biopsy prior to treatment. In this study we aimed to investigate how to solve this histological discrepancy and avoid over- and under-treatment. METHODS The medical records of patients with superficial esophageal squamous cell neoplasia who underwent endoscopic resection at our hospital from January 2012 to December 2019 were reviewed retrospectively. The histological discrepancy between the biopsy and resected specimens was calculated and its association with clinicopathological parameters was analyzed. RESULTS A total of 137 lesions from 129 patients were included. The discrepancy rate between forceps biopsy and resected specimens was 45.3% (62/137). Histological discrepancy was associated with the histological category of the biopsy (p < 0.001). In addition, 17 of the 30 (56.7%) biopsies that was diagnosed as indefinite/negative for neoplasia or low-grade intraepithelial neoplasia were upgraded to HGIN or ESCC after resection. The upgrade was due to lesion size ≥ 10 mm (p = 0.002) and type B intrapapillary capillary loops (p < 0.001). Moreover, 34 of the 83 biopsies that were diagnosed with HGIN were upgraded to ESCC after resection, which was related to lesion size (p = 0.001), location (p = 0.018), and pink color sign (p = 0.002). CONCLUSIONS Histological discrepancy between forceps biopsy and resected specimens is common in clinical practice. Recognizing the risk factors for each histological category of biopsy may reduce these discrepancies and improve clinical management.
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Affiliation(s)
- Lang Yang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Hua Jin
- Department of Pathology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xiao-Li Xie
- Department of Pathology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yang-Tian Cao
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Zhen-Hua Liu
- Department of Pathology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Na Li
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Peng Jin
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Yu-Qi He
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China
| | - Jian-Qiu Sheng
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, No. 5 Nanmencang, Dongcheng District, Beijing, 100700, China.
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228
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Haneda R, Booka E, Ishii K, Kikuchi H, Hiramatsu Y, Kamiya K, Ogawa H, Yasui H, Takeuchi H, Tsubosa Y. Evaluation of Definitive Chemoradiotherapy Versus Radical Esophagectomy in Clinical T1bN0M0 Esophageal Squamous Cell Carcinoma. World J Surg 2021; 45:1835-1844. [PMID: 33620541 DOI: 10.1007/s00268-021-06016-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The standard treatment for patients with clinical T1bN0M0 esophageal squamous cell carcinoma is radical esophagectomy. Definitive chemoradiotherapy is regarded as a treatment option, and recently, good clinical outcomes of this treatment have been reported. This study compared prognosis after definitive chemoradiotherapy with radical esophagectomy. METHODS From January 2011 to December 2019, 68 consecutive patients who were diagnosed clinical T1bN0M0 squamous cell carcinoma were enrolled and investigated retrospectively. Patients were classified into two groups whether treated by surgery or definitive chemoradiotherapy. Survival outcomes were compared, and subsequent therapies after recurrence were also investigated. RESULTS Among 68 patients, 39 patients underwent surgery and 29 patients received definitive chemoradiotherapy. No significant difference was noted in overall survival between the two groups. However, the rate of 5-year recurrence-free survival was significantly lower in definitive chemoradiotherapy group than that of surgery group (91.1 vs. 62.7%, hazard ratio 3.976, 95% confidence interval 1.076-14.696, p = 0.039). Patients who had local recurrence after definitive chemoradiotherapy received endoscopic submucosal dissection or photodynamic therapy as salvage therapies, which resulted in no disease progression and a good prognosis. CONCLUSIONS Definitive chemoradiotherapy may become a promising alternative therapy comparable with radical esophagectomy in patients with clinical T1bN0M0 esophageal squamous cell carcinoma. Early detection of recurrence by frequent follow-up after definitive chemoradiotherapy is important to control disease within local recurrence, and salvage therapy for local lesions could contribute to long-term survival.
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Affiliation(s)
- Ryoma Haneda
- Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.,Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Eisuke Booka
- Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
| | - Kenjiro Ishii
- Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yoshihiro Hiramatsu
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kinji Kamiya
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Yasui
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
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229
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Sauri FM, Zakarneh EA, Alessa MY, Sakr AH, Chung YS, Kim HS, Kim NK. Triple synchronous primary neoplasms in the gastrointestinal tract. Chin Med J (Engl) 2021; 134:1233-1235. [PMID: 33538507 PMCID: PMC8143777 DOI: 10.1097/cm9.0000000000001389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Fozan Mohammed Sauri
- Department of Surgery, Colorectal Division, Yonsei University College of Medicine, Seoul, 120-752, South Korea
| | - Eman Adnan Zakarneh
- Department of Surgery, Colorectal Division, Yonsei University College of Medicine, Seoul, 120-752, South Korea
| | - Mohammed Yousef Alessa
- Department of Surgery, Colorectal Division, Yonsei University College of Medicine, Seoul, 120-752, South Korea
- Department of General Surgery, King Faisal University, Alahsa 31982, Saudi Arabia
| | - Ahmad Hammad Sakr
- Department of Surgery, Colorectal Division, Yonsei University College of Medicine, Seoul, 120-752, South Korea
- Colorectal Surgery Unit, Department of General Surgery, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura 35511, Egypt
| | - Yeon Seung Chung
- Department of Pathology, Yonsei University College of Medicine, Seoul 120-752, South Korea
| | - Ho Seung Kim
- Department of Surgery, Colorectal Division, Yonsei University College of Medicine, Seoul, 120-752, South Korea
| | - Nam Kyu Kim
- Department of Surgery, Colorectal Division, Yonsei University College of Medicine, Seoul, 120-752, South Korea
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230
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Hirose W, Taniyama Y, Fujishima F, Sato C, Unno M, Kamei T. Salvage esophagectomy for local recurrent esophageal cancer after definitive chemoradiotherapy followed by photodynamic therapy: A case report. Int J Surg Case Rep 2021; 80:105617. [PMID: 33592421 PMCID: PMC7893415 DOI: 10.1016/j.ijscr.2021.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
We report a case of esophageal cancer treated with PDT followed by esophagectomy. We assessed the PDT effect on adjacent tissues based on surgery and pathology. PDT can cause intense inflammation in tissues adjacent to the tumor. The location should be considered when performing salvage esophagectomy after PDT.
Introduction Photodynamic therapy (PDT) is performed as a salvage treatment for patients with residual or recurrent esophageal cancer after chemoradiotherapy (CRT). Although PDT is considered less invasive than salvage surgery, it is unclear how deep its effects are and whether it causes damage to adjacent tissues. Herein, we report a case of esophageal cancer treated with PDT followed by esophagectomy. In this case, we evaluated the effect of PDT on adjacent tissues based on surgical and pathological examination. Presentation of case A 58-year-old man with dysphagia was diagnosed with esophageal squamous cell carcinoma (SqCC; T1N0M0, Stage I) in the upper thoracic esophagus. He underwent definitive CRT with two courses of 5-fluorouracil and cisplatin every 4 weeks with 60 Gy of radiation. Twelve months after CRT, endoscopic examination revealed local recurrence, and PDT using talaporfin sodium was performed. The tumor recurred again 6 months after PDT, and robot-assisted thoracoscopic esophagectomy was performed as a definitive treatment. Tissues around the left side of the esophagus and thoracic duct were tightly adherent with severe fibrosis and were successfully removed by extended resection. Histopathological examinations showed that the esophageal wall and peri-esophageal tissue were replaced by fibrous tissue and this extended even beyond the tumor. Discussion The primary tumor was limited to the submucosal layer, and the target for irradiation had some longitudinal margins. Therefore, PDT can cause intense inflammation in tissues adjacent to the tumor. Conclusions It is necessary to consider the location when performing salvage esophagectomy after PDT.
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Affiliation(s)
- Wataru Hirose
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yusuke Taniyama
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Fumiyoshi Fujishima
- Department of Pathology, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Chiaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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231
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Tu DH, Qu R, Wang Q, Fu X. After-hours esophagectomy may pose additional risk to patients with esophageal cancer. J Thorac Dis 2021; 13:1118-1129. [PMID: 33717585 PMCID: PMC7947526 DOI: 10.21037/jtd-20-3141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The increase in the incidence of esophageal cancers (ECs) combined with fewer surgeons working at large centers will increase the likelihood of surgery for ECs being performed during later hours. This study aimed to compare esophagectomies’ operative outcomes for EC performed at different surgical starting times. Methods This was a single-center, retrospective study. Risk-adjusted cumulative sum curve analysis and Cox regression analysis were used to identify the potential change-point of surgical starting times. The participants were then divided into 2 groups according to the change-point time. Propensity score matching was used to control confounding factors between the 2 groups. We compared the short- and long-term outcomes in both groups. Results A total of 702 patients who underwent potentially radical esophagectomy from 7 May 2014 to 31 December 2017 in our institute were included. The 3-year all-cause mortality showed a significant change-point at 16:42, with an increment from 56.5% to 76.9% (P=0.043). Esophagectomy that commenced between 17:00–18:59 was associated with significantly lower overall survival (OS) [multivariate hazard ratio (HR): 2.47; 95% confidence interval (CI): 1.25 to 4.90; P=0.010] and disease-free survival (DFS) (multivariate HR: 2.14; 95% CI: 1.08 to 4.21; P=0.028). The participants were allocated to the during-hours group and the after-hours group according to the change-point of 17:00. A total of 84 participants in the during-hours group were matched to 33 participants in the after-hours group. The median operative time was shorter in the after-hours group [309 (during-hours) vs. 239 (after-hours) minutes, P=0.014); the after-hours group had a greater incidence of respiratory complications (22.63% vs. 45.45%, P=0.023) and 90-day mortality (0 vs. 9.09%, P=0.021). The 5-year OS (P=0.042) and DFS (P=0.030) were significantly higher in the during-hours group. Conclusions Esophagectomies started during after-hours are correlated with poorer surgical outcomes. It is recommended to cancel selective esophagectomies due to commence after 17:00.
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Affiliation(s)
- De-Hao Tu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rirong Qu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qi Wang
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Kim GH, Na HK, Ahn JY, Lee JH, Jung KW, Kim DH, Kim HR, Choi KD, Song HJ, Kim YH, Lee GH, Jung HY, Park SI. Long-term Outcomes and Factors Affecting the Survival of Patients with Mucosal Esophageal Squamous Cell Carcinoma. Gut Liver 2021; 15:705-712. [PMID: 33462160 PMCID: PMC8444104 DOI: 10.5009/gnl20254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background/Aims Data regarding the prognosis of early esophageal cancer are lacking. This study investigated the long-term outcomes and factors affecting the survival of patients with mucosal esophageal squamous cell carcinoma (T1aESCC). Methods We analyzed the clinical and tumor-specific parameters of 263 patients who received surgical resection (SR; n=63) or endoscopic resection (ER; n=200) for T1aESCC. Underlying comorbidities were scored using the Charlson Comorbidity Index (CCI). Overall survival (OS) was the primary outcome, and multivariate regression analysis was performed to predict factors for OS. Results Of the study patients (age, 64.5±8.0 years), the CCI was 1.0±1.4 in the ER group and 0.6±0.9 in the SR group (p=0.107). The 5-year OS rate during follow-up (54.4±20.4 months) was 85.7% (ER group, 86.8%; SR group, 82.4%; p=0.631). The cumulative 5-year incidence of esophageal cancer recurrence was 10.5% in the ER group (vs 0% in the SR group). The overall mortality rate was 12.9% (12.0% in the ER group and 15.9% in the SR group; p=0.399). The most common cause of mortality was second primary cancers in the ER group (75%) and organ dysfunction or postoperative complications in the SR group (70%). According to multivariate analysis, only CCI was significantly associated with OS (p<0.001). The 5-year OS rate in patients with a CCI >2 and in those with a CCI ≤2 was 60.2% and 88.2%, respectively (p<0.001). The treatment method (ER vs SR) was not a significant affecting factor (p=0.238). Conclusions The long-term prognosis of patients with T1aESCC was significantly associated with underlying comorbidities.
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Affiliation(s)
- Ga Hee Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Kyong Na
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Hoon Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Don Choi
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho June Song
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gin Hyug Lee
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwoon-Yong Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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233
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Maruyama S, Okamura A, Imamura Y, Kanamori J, Kanie Y, Takahashi K, Fujiwara D, Watanabe M. Comparison of Outcomes Between Additional Esophagectomy After Noncurative Endoscopic Resection and Upfront Esophagectomy for T1N0 Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2021; 28:4859-4866. [PMID: 33420566 DOI: 10.1245/s10434-020-09498-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/28/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Esophagectomy with lymph node dissection is a choice of additional treatment after noncurative endoscopic resection (ER) of T1N0 esophageal squamous cell carcinoma (ESCC). The efficacy and safety of esophagectomy in this situation remain unclear when compared with upfront esophagectomy. METHODS We investigated the short- and long-term outcomes of 321 patients with clinical T1N0M0 ESCC who underwent curative esophagectomy, and compared the status of lymph node metastasis, surgical results, and the prognosis between the ER and non-ER groups. RESULTS The ER group consisted of 57 patients (17.8%), while the non-ER group consisted of 264 patients (82.2%). The incidence of lymph node metastasis was not significantly different between the ER (24.6%) and non-ER groups (30.7%), and there was no significant difference in surgical outcomes between the groups. The distribution of metastatic lymph nodes was very similar between the groups. However, 13 of 14 patients (93%) with lymph node metastasis in the ER group and 63 of 82 patients (77%) with lymph node metastasis in the non-ER group had pN1 disease, while the remaining 18 patients (23%) with lymph node metastasis in the non-ER group had pN2 or N3 disease. Overall and relapse-free survival rates were significantly better in the ER group than in the non-ER group (p < 0.05 and p < 0.01, respectively). To date, no patients in the ER group experienced disease recurrence. CONCLUSIONS Additional esophagectomy is a safe and effective treatment modality for patients after noncurative ER.
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Affiliation(s)
- Suguru Maruyama
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yasukazu Kanie
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Keita Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Daisuke Fujiwara
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
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234
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Tsunoda S, Obama K, Hisamori S, Hashimoto K, Nishigori T, Sakai Y. Simple technique of azygos arch division and retraction for minimally invasive esophagectomy. Esophagus 2021; 18:169-172. [PMID: 32613326 DOI: 10.1007/s10388-020-00760-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/24/2020] [Indexed: 02/03/2023]
Abstract
The azygos arch is usually divided during esophagectomy. To achieve thorough lymphadenectomy up to upper mediastinum, many surgeons prefer to retract the distal stump of the azygos arch by pulling out the thread which ligates the stump to the skin through the dorsal side of the intercostal space. However, the access to the dorsal chest wall near vertebrae for percutaneous puncture is difficult during robot-assisted minimally invasive esophagectomy in the prone position. This paper reports a new simple method of azygos arch division and retraction using a polymer locking ligation system Hem-o-lok (Teleflex, Morrisville, NC, USA) and a barbed suture device. This technique can be easily performed completely as a robotic procedure without extra puncture, and it is also applicable for conventional thoracoscopic procedures with the potential benefits of less trauma and bleeding.
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Affiliation(s)
- Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kyoichi Hashimoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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235
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Repeated talaporfin sodium photodynamic therapy for esophageal cancer: safety and efficacy. Esophagus 2021; 18:817-824. [PMID: 34106353 PMCID: PMC8387249 DOI: 10.1007/s10388-021-00853-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/22/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Talaporfin sodium photodynamic therapy (tPDT) is an effective salvage treatment for local failure after chemoradiotherapy for esophageal cancer. Repeated tPDT could also be indicated for local recurrence or residue after the first salvage tPDT. However, the safety and efficacy of repeated tPDT have not been elucidated. METHODS We reviewed 52 patients with esophageal cancer who were treated with the first tPDT at Kyoto University Hospital between October 2015 and April 2020. RESULTS Among 52 patients, repeated tPDT after the first tPDT was indicated for 13 patients (25%), of which six had residual tumor, four had local recurrence after complete response (CR) after the first tPDT at the primary site, and six had metachronous lesion. The total session of repeated tPDT was 25; 16 were for primary sites and nine were for metachronous sites. Among them, six patients (46.2%) achieved local (L)-CR and nine lesions (56.3%) achieved lesion L-CR. By session, 10 sessions (40%) achieved L-CR. There were no severe adverse events except for one patient; this patient showed grade 3 esophageal stenosis and perforation after the third tPDT on the same lesion that was previously treated with porfimer sodium photodynamic therapy four times. CONCLUSION Repeated tPDT could be an effective and safe treatment for local failure even after salvage tPDT for esophageal cancer.
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236
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Ogata Y, Hatta W, Koike T, Saito M, Jin X, Nakagawa K, Kanno T, Uno K, Asano N, Imatani A, Nakamura T, Nakaya N, Masamune A. Predictors of Early and Late Mortality after Endoscopic Resection for Esophageal Squamous Cell Carcinoma. TOHOKU J EXP MED 2021; 253:29-39. [PMID: 33441512 DOI: 10.1620/tjem.253.29] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Yohei Ogata
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Waku Hatta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tomoyuki Koike
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Masahiro Saito
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Xiaoyi Jin
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kenichiro Nakagawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Takeshi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kaname Uno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Naoki Asano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Akira Imatani
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tomohiro Nakamura
- Department of Health Record Informatics, Tohoku Medical Megabank Organization, Tohoku University
| | - Naoki Nakaya
- Department of Health Sciences, Saitama Prefectural University
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
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237
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Takahashi M, Kato K, Okada M, Chin K, Kadowaki S, Hamamoto Y, Doki Y, Kubota Y, Kawakami H, Ogata T, Hara H, Muto M, Nakashima Y, Ishihara R, Tsuda M, Motoyama S, Kodani M, Kitagawa Y. Nivolumab versus chemotherapy in Japanese patients with advanced esophageal squamous cell carcinoma: a subgroup analysis of a multicenter, randomized, open-label, phase 3 trial (ATTRACTION-3). Esophagus 2021; 18:90-99. [PMID: 33170461 PMCID: PMC7794205 DOI: 10.1007/s10388-020-00794-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The efficacy and safety of nivolumab versus chemotherapy was evaluated in the Japanese subpopulation from the overall intent-to-treat (ITT) population of the ATTRACTION-3 trial conducted in patients with advanced esophageal squamous cell carcinoma (ESCC) as second-line treatment. METHODS Data from Japanese patients enrolled in the multicenter, randomized, open-label, phase 3 ATTRACTION-3 trial were analyzed. The primary endpoint was overall survival (OS). Secondary endpoints included duration of response (DOR), objective response rate (ORR), disease control rate (DCR), and safety. Exploratory subgroup analyses evaluated the association between OS and stratification factors/baseline variables. RESULTS Overall, 274 (nivolumab, 136; chemotherapy, 138) of the 419 patients in ATTRACTION-3 were enrolled from Japan: response-evaluable population (107; 108) and safety population (135; 138). OS tended to be longer in the nivolumab group versus the chemotherapy group (median: 13.4 months vs. 9.4 months; HR, 0.77; 95% CI 0.59-1.01). Median DOR was longer in the nivolumab group (7.6 months) versus the chemotherapy group (3.6 months). ORRs were similar between the nivolumab [22.4% of patients (24/107)] and chemotherapy groups [22.2% (24/108); odds ratio, 0.98; 95% CI 0.52-1.87]. DCR was lower in the nivolumab group [41.1% (44/107)] versus the chemotherapy group [66.7% (72/108)]. OS in the exploratory analysis consistently favored the nivolumab group versus the chemotherapy group. Overall, nivolumab demonstrated favorable efficacy and safety versus chemotherapy in the Japanese subpopulation, and the trend was similar to that observed in the overall ATTRACTION-3 ITT population. CONCLUSION Nivolumab represents a new standard second-line treatment option for Japanese patients with advanced ESCC.
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Affiliation(s)
- Masanobu Takahashi
- grid.412757.20000 0004 0641 778XDepartment of Medical Oncology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai-shi, Miyagi, 980-8574 Japan
| | - Ken Kato
- grid.272242.30000 0001 2168 5385Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Morihito Okada
- grid.257022.00000 0000 8711 3200Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Keisho Chin
- grid.410807.a0000 0001 0037 4131Department of Gastroenterological Chemotherapy, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shigenori Kadowaki
- grid.410800.d0000 0001 0722 8444Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasuo Hamamoto
- grid.26091.3c0000 0004 1936 9959Keio Cancer Center, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Doki
- grid.412398.50000 0004 0403 4283Department of Surgery, Osaka University Hospital, Osaka, Japan
| | - Yutaro Kubota
- grid.410714.70000 0000 8864 3422Department of Medicine, Division of Medical Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Hisato Kawakami
- grid.258622.90000 0004 1936 9967Department of Medical Oncology, Kindai University Faculty of Medicine, Osakasayama, Osaka Japan
| | - Takashi Ogata
- grid.414944.80000 0004 0629 2905Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroki Hara
- grid.416695.90000 0000 8855 274XDepartment of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Manabu Muto
- grid.411217.00000 0004 0531 2775Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Yuichiro Nakashima
- grid.177174.30000 0001 2242 4849Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ryu Ishihara
- grid.489169.bDepartment of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiro Tsuda
- grid.417755.50000 0004 0378 375XDepartment of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan
| | - Satoru Motoyama
- grid.251924.90000 0001 0725 8504Department of Thoracic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Mamoru Kodani
- grid.459873.40000 0004 0376 2510Department of Oncology, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Yuko Kitagawa
- grid.26091.3c0000 0004 1936 9959Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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238
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Long-term outcomes of endoscopic versus surgical resection for MM-SM1 esophageal squamous cell carcinoma using propensity score analysis. Esophagus 2021; 18:72-80. [PMID: 32876825 DOI: 10.1007/s10388-020-00775-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) confined to the muscularis mucosae (MM) or up to 200 µm of the submucosa (SM1) confers the risk for lymph node metastasis, and is defined as relative indication for endoscopic submucosal dissection (ESD) by the Japan Esophageal Society guidelines. Although additional surgical treatment after ESD is recommended, long-term outcomes of ESD compared with those of surgery have not been clarified. This study aimed to evaluate the long-term outcomes of ESD and surgery for cN0M0 relative indication lesions of ESCC. METHODS Between 2006 and 2016, patients with relative indication lesions of ESCC who underwent ESD or surgery at nine participating hospitals were examined retrospectively. Using propensity score matching, we evaluated survival curves for and hazard ratios associated with endoscopic submucosal dissection and surgery. RESULTS In total, 155 lesions in the ESD group and 106 lesions in the surgery group met the pathological criteria of relative indication for endoscopic resection. After matching, 50 matched pairs of patients who underwent ESD or surgery were selected. The 5-year overall survival rates were 84.5% [95% confidence interval (CI) 68-93] in the ESD group and 79% [95% CI 60-90] in the surgery group. The hazard ratio of mortality for ESD compared with that for surgery estimated by Cox regression analysis was 0.79 (95% CI 0.3-2.06, p = 0.63). CONCLUSIONS Compared with surgery, ESD does not compromise long-term outcomes. ESD alone or ESD with chemotherapy and/or radiotherapy may be an option for the treatment of MM and SM1 ESCC.
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239
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Booka E, Tsubosa Y, Yokota T, Mayanagi S, Ishii K, Urakami K, Ohshima K, Ohnami S, Nagashima T, Yamaguchi K. Whole exome sequencing and deep sequencing of esophageal squamous cell carcinoma and adenocarcinoma in Japanese patients using the Japanese version of the Genome Atlas, JCGA. Esophagus 2021; 18:743-752. [PMID: 33826001 PMCID: PMC8387260 DOI: 10.1007/s10388-021-00835-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Recent comprehensive mutation analyses have revealed a relatively small number of driver mutations in esophageal cancer, implicating a limited number of molecular targets, most of which are also implicated in squamous cell carcinoma. METHODS In this study, we investigated genetic alterations in 44 esophageal squamous cell carcinomas (ESCC) and 8 adenocarcinomas (EAC) from Japanese patients as potential molecular targets, based on data from the Japanese version of The Genome Atlas (JCGA). RESULTS Esophageal cancer was characterized by TP53 somatic mutations in ESCC (39/44, 88.6%) and EAC (5/8, 62.5%). In addition to TP53 mutations, somatic mutations in NFE2L2 (16/44, 36.4%), CDKN2A (7/44, 15.9%), and KMT2D (7/44, 15.9%) were more frequently detected in ESCC than in EAC. WRN-truncated type mutations that lead to genomic instability correlate with EAC, but not ESCC. ESCC samples were enriched in ALDH2-associated mutational signature 16 as well as the APOBEC signature. Patients with FAT2 mutations had significantly poorer overall survival compared with those with wild-type status at FAT2 (p < 0.05). Patients with EP300 or PTPRD mutations also had poor progression-free survival compared with respective wild-types (p < 0.05 or p < 0.001). CONCLUSIONS These findings may facilitate future precision medicine approaches based on genomic profiling in ESCC and EAC.
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Affiliation(s)
- Eisuke Booka
- grid.415797.90000 0004 1774 9501Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
| | - Yasuhiro Tsubosa
- grid.415797.90000 0004 1774 9501Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
| | - Tomoya Yokota
- grid.415797.90000 0004 1774 9501Division of Gastrointestinal Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Shuhei Mayanagi
- grid.415797.90000 0004 1774 9501Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
| | - Kenjiro Ishii
- grid.415797.90000 0004 1774 9501Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
| | - Kenichi Urakami
- grid.415797.90000 0004 1774 9501Cancer Diagnostic Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Keiichi Ohshima
- grid.415797.90000 0004 1774 9501Medical Genetics Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Shumpei Ohnami
- grid.415797.90000 0004 1774 9501Cancer Diagnostic Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan
| | - Takeshi Nagashima
- grid.415797.90000 0004 1774 9501Cancer Diagnostic Research Division, Shizuoka Cancer Center Research Institute, Shizuoka, Japan ,grid.410830.eSRL, Tokyo, Japan
| | - Ken Yamaguchi
- grid.415797.90000 0004 1774 9501Shizuoka Cancer Center, Shizuoka, Japan
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240
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Multimodality approaches to control esophageal cancer: development of chemoradiotherapy, chemotherapy, and immunotherapy. Esophagus 2021; 18:25-32. [PMID: 32964312 DOI: 10.1007/s10388-020-00782-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/15/2020] [Indexed: 02/03/2023]
Abstract
Esophageal cancer has a poor prognosis despite the fact that surgical techniques have been advanced and optimized, and systemic multimodality approaches have progressed recently. Adding chemotherapy, radiotherapy, and immunotherapy to the basic surgical approach have been shown to have therapeutic benefit for esophageal cancer. This review describes the latest development of chemoradiotherapy, chemotherapy, and immunotherapy, which have contributed to the reduction in esophageal cancer growth and improved the survival of patients. Chemoradiation is a treatment option for resectable esophageal cancer to preserve the esophagus for patients who cannot tolerate surgery. Moreover, a combination of chemoradiotherapy and salvage surgery could extend the survival of patients. The effects of a triplet chemotherapy regimen are currently being verified in some Phase III studies for unresectable advanced/recurrent esophageal cancer. In addition, with the great promise of immune checkpoint inhibitors, strategies that incorporate the use of immunotherapy may shift from the metastatic setting to the neoadjuvant/adjuvant setting as a result of clinical trials. More precise comprehension of the molecular biology of esophageal cancer is expected to further control disease progression using multimodality treatments in the future.
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241
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Toh Y, Inoue Y, Hayakawa M, Yamaki C, Takeuchi H, Ohira M, Matsubara H, Doki Y, Wakao F, Takayama T. Creation and provision of a question and answer resource for esophageal cancer based on medical professionals' reports of patients' and families' views and preferences. Esophagus 2021; 18:872-879. [PMID: 34169363 PMCID: PMC8387257 DOI: 10.1007/s10388-021-00857-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND In the rapidly-progressing healthcare environment, it is essential to improve treatment quality through continuous clarification of the needs and concerns of esophageal cancer patients and their families. Effective collaboration between information providers and academic associations could help make such clarified information available. METHODS We analyzed esophageal cancer patients' views and preferences (PVPs) using data that were previously obtained from medical staff in Japan. Based on these PVPs, we created a question and answer (Q&A) resource through collaboration with the Cancer Information Service in Japan (CISJ) and the Japan Esophageal Society (JES). RESULTS Regarding esophageal cancer, "diet and eating behavior" was the most frequent PVP mentioned by patients and their families, followed by "treatment-related symptoms and adverse effects" and "daily life, recuperation, and survivorship." These PVPs were noted by a wide variety of medical specialties. By analyzing the PVPs, the CISJ developed 11 proposed questions and sent them to the JES, which then created answers based on evidence and clinical-practice-associated consensus. The resultant Q&A resource was uploaded to the CISJ website with mutual linkage to the JES website. CONCLUSIONS This study showed the usefulness of collecting esophageal-cancer-related PVPs from medical staff and fostering successful collaboration between a cancer-information provider and an academic association. This arrangement may represent a model case for developing a sustainable system that can satisfactorily respond to PVPs regarding other cancers and/or issues.
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Affiliation(s)
- Yasushi Toh
- The Japan Esophageal Society, Tokyo, Japan ,Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yoji Inoue
- Division of Cancer Information Services, Center for Cancer Control and Information Service, National Cancer Center, Tokyo, Japan
| | - Masayo Hayakawa
- Division of Cancer Information Services, Center for Cancer Control and Information Service, National Cancer Center, Tokyo, Japan
| | - Chikako Yamaki
- Division of Cancer Information Services, Center for Cancer Control and Information Service, National Cancer Center, Tokyo, Japan
| | - Hiroya Takeuchi
- The Japan Esophageal Society, Tokyo, Japan ,Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka Japan
| | - Masaichi Ohira
- The Japan Esophageal Society, Tokyo, Japan ,Department of Gastroenterological Surgery, Osaka City University School of Medicine, Osaka, Japan
| | - Hisahiro Matsubara
- The Japan Esophageal Society, Tokyo, Japan ,Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yuichiro Doki
- The Japan Esophageal Society, Tokyo, Japan ,Division of Gastroenterological Surgery, Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fumihiko Wakao
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Tomoko Takayama
- Division of Cancer Information Services, Center for Cancer Control and Information Service, National Cancer Center, Tokyo, Japan
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Motoyama S, Maeda E, Iijima K, Sato Y, Koizumi S, Wakita A, Nagaki Y, Fujita H, Yoneya T, Imai K, Terata K, Minamiya Y, Higashi T. Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5,066 Patients in the National Database of Hospital-Based Cancer Registries in Japan. Ann Surg 2020; 276:e16-e23. [DOI: 10.1097/sla.0000000000004437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shiozaki A, Kudou M, Fujiwara H, Konishi H, Shimizu H, Arita T, Kosuga T, Yamamoto Y, Morimura R, Ikoma H, Kuriu Y, Kubota T, Okamoto K, Otsuji E. Clinical safety and efficacy of neoadjuvant combination chemotherapy of tranilast in advanced esophageal squamous cell carcinoma: Phase I/II study (TNAC). Medicine (Baltimore) 2020; 99:e23633. [PMID: 33327342 PMCID: PMC7738016 DOI: 10.1097/md.0000000000023633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Transient receptor potential vanilloid 2 (TRPV2) was previously shown to play an important role in the maintenance of cancer stem cells, and its specific inhibitor, tranilast, also has potential as a targeted therapeutic agent for esophageal squamous cell carcinoma (ESCC). The present study is being conducted to confirm the safety and efficacy of the additional use of tranilast with conventional preoperative adjuvant chemotherapy for patients with advanced ESCC. PATIENTS AND METHODS Between 56 and 59 patients aged between 20 and 74 years with clinically diagnosed Stage II or Stage III ESCC will be enrolled. Eligible patients will receive preoperative adjuvant chemotherapy, 2 cycles of combination therapy with cisplatin, 5-fluorouracil, and tranilast. Recruitment started in November 2019, with the final follow-up being planned for March 2029. One subject has been enrolled since October 21, 2020. The pathological therapeutic effect is the primary endpoint. The objective response rate, safety of preoperative adjuvant chemotherapy, recurrence-free survival (RFS), and overall survival (OS) are the secondary endpoints. RFS and OS will be calculated as the time from surgery to first recurrence and all-cause death, respectively. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Boards of Kyoto Prefectural University of Medicine and all participating hospitals in August 30, 2019 (Number: CRB5180001). Written informed consent will be obtained from all patients before their registration, which is in accordance with the Declaration of Helsinki. The results of the present study will be disseminated via publication in peer-reviewed journals. TRIAL REGISTRATION Trial registration number jRCTs051190076.
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Comment on "Clinical Importance of Mean Corpuscular Volume as a Prognostic Marker After Esophagectomy for Esophageal Cancer: A Retrospective Study". Ann Surg 2020; 274:e751-e752. [PMID: 33278163 DOI: 10.1097/sla.0000000000004158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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245
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Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement. Cancers (Basel) 2020; 12:cancers12123598. [PMID: 33276430 PMCID: PMC7761405 DOI: 10.3390/cancers12123598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Virtually all early (T1) esophageal cancers can be resected endoscopically. However, the presence of histologic criteria on the resection specimen (deep submucosal invasion, lymphovascular involvement, poor tumor differentiation) are believed to be associated with a high risk (> 10%) of lymph node involvement. Therefore, the presence of such histoprognostic criteria currently require an esophagectomy. However, some patients are unfit for surgery or decline surgery, and undergo close follow-up or chemoradiotherapy. We analyzed the outcomes of these patients. We included 41 patients, of which thirteen (32%) were closely monitored, and 28 (68%) were treated by chemoradiotherapy or radiotherapy alone. After a mean follow-up of 19 and 28 months, cancer specific survival was 100% and 96%, respectively. Our study shows that close follow-up may be an alternative to esophagectomy after endoscopic resection of an early esophageal cancer with a predicted high risk of lymph node involvement. Abstract Background: Esophagectomy is recommended after endoscopic resection of an early esophageal cancer when pejorative histoprognostic criteria indicate a high risk of lymph node involvement. Our aim was to analyze the clinical outcomes of a non-surgical, organ preserving management in this clinical setting. Patients and Methods: This retrospective study was performed in two tertiary centers from 2015 to 2020. Patients were included if they had histologically complete resection of an early esophageal cancer, with poor differentiation, lymphovascular invasion or deep submucosal invasion. Endoscopic resection was followed by chemoradiotherapy or follow-up in case of surgical contraindications or patient refusal. Outcome measures were disease-free survival (DFS), overall survival (OS), cancer specific survival (CSS) and toxicity of chemoradiotherapy. Results: Forty-one patients (36 with squamous cell carcinoma and 5 with adenocarcinomas) were included. The estimated high risk of lymph node involvement was based on poor differentiation (10/41; 24%), lympho-vascular invasion (11/41; 27%), muscularis mucosa invasion or deep sub-mucosal invasion (38/41; 93%). Thirteen patients (13/41; 32%) were closely monitored, and 28 (28/41; 68%) were treated by chemoradiotherapy or radiotherapy alone. In the close follow-up group, DFS, OS and CSS were 92%, 92% and 100%, respectively vs. 75%, 79% and 96%, respectively in the chemoradiotherapy group at the end of the follow-up. Serious adverse events related to chemoradiotherapy occurred in 10% of the patients. There were no treatment-related deaths. Conclusions: Our study shows that close follow-up may be an alternative to systematic esophagectomy after endoscopic resection of early esophageal cancer with a predicted high risk of lymph node involvement.
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Zhang W, Zhao J, Han W, Zhang H, Wang X, Li C, Chen J, Wang X, Zhao Y, Qiao X, Zhou Z, Han C, Zhu S, Shen W, Wang L, Ge X, Sun X, Zhang K, Hu M, Li L, Hao C, Li G, Xu Y, Wang Y, Lu N, Liu M, Qian S, Xiao Z, Wang P, Pang Q. Dose escalation of 3D radiotherapy is effective for esophageal squamous cell carcinoma: a multicenter retrospective analysis (3JECROG R-03). ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1140. [PMID: 33240989 PMCID: PMC7576038 DOI: 10.21037/atm-20-4672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background To evaluate the impact of radiation dose escalation on overall survival (OS) in patients with non-metastatic esophageal squamous cell carcinoma (ESCC) treated with radical radiotherapy. Methods The clinical data of ESCC patients treated with three-dimensional (3D) radiotherapy alone or chemoradiotherapy were collected from multiple institutes and retrospectively analyzed. Patients who received radiation dose ≥40 Gy were included. Radiation dose as a continuous variable was entered into the Cox regression model by using penalized spline regression to allow for a nonlinear relationship between radiation dose and OS to be identified. Patients were stratified into five groups according to EQD2. The Kaplan-Meier method was used to assess the OS in different dose groups. Univariate and multivariate analyses were performed to evaluate the factors associated with OS. Results A total of 2,469 patients were included from 10 institutes across China. The median follow-up time was 58.3 months [95% confidence interval (CI): 56.4–60.2 months]. The median OS and PFS time were 24.3 months (95% CI: 22.5–26.2 months) and 18.0 months (95% CI: 16.4–19.6 months), respectively. The risk of death decreased sharply with a dose up to 60 to 62 Gy, before increasing slightly after the dose was elevated beyond 62 Gy. Multivariate analysis indicated that the chance of death was significantly decreased in patients who received radiotherapy doses of 60–62 Gy [P=0.028, hazard ratio (HR) 0.85, 95% CI: 0.73–0.98)], compared with those who received radiotherapy doses of 40–60 Gy. Conclusions Our results reveal radiation dose is a significant prognostic factor of survival for ESCC patients. Higher radiation dose contributes to much more favorable survival outcomes for ESCC patients receiving radical radiotherapy by modern techniques, and 60 Gy or above might be the most optimal radiation dose.
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Affiliation(s)
- Wencheng Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Jingjing Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Weiming Han
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hualei Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Xin Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junqiang Chen
- Department of Radiation Oncology, Fujian Cancer Hospital/Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Xiaomin Wang
- Department 4th of Radiation Oncology, Anyang Cancer Hospital, Anyang, China
| | - Yidian Zhao
- Department 4th of Radiation Oncology, Anyang Cancer Hospital, Anyang, China
| | - Xueying Qiao
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhiguo Zhou
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chun Han
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuchai Zhu
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenbin Shen
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lan Wang
- Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaolin Ge
- Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xinchen Sun
- Department of Radiation Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kaixian Zhang
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Miaomiao Hu
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Ling Li
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Chongli Hao
- Department of Oncology, Tengzhou Central People's Hospital, Tengzhou, China
| | - Gaofeng Li
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yonggang Xu
- Department of Radiation Oncology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yadi Wang
- Department of Radiation Oncology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Na Lu
- Department of Radiation Oncology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Miaoling Liu
- Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Shuai Qian
- Department of Radiation Oncology, Affiliated Hospital of Hebei University, Baoding, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Wang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Qingsong Pang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, China
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Mahawongkajit P, Boochangkool N. Comparison of Preoperative CT Colonography and Colonoscopy for Esophageal Reconstruction with Colonic Interposition. Surg Res Pract 2020; 2020:6585762. [PMID: 33283041 PMCID: PMC7685867 DOI: 10.1155/2020/6585762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/03/2020] [Accepted: 11/07/2020] [Indexed: 12/24/2022] Open
Abstract
Colonic evaluation is an essential step before proceeding with esophagectomy to reconstruct by colonic interposition. Colonoscopy is the standard practice for colorectal cancer screening, but it has a chance of failing cecal intubation and carries a risk of horrific adverse events by colonic perforation. CT colonography is a less invasive alternative method reported as useful for colonoscopic screening in cases of average risk of colorectal cancer. This study set out to report our clinical experience and to evaluate CT colonography in the preoperative process for colonic interposition of esophagectomy patients. Data for esophagectomy with colonic interposition patients were retrospectively analyzed and compared the colonoscopy group with the CT colonography group. During eight years, 31 patients, 12 patients in the colonoscopy group and 19 patients in the CT colonography group, included in this study. In both groups, the patient demographic data, procedures, and outcomes were not different. After colonic interposition, endoscopy was performed, and no lesions of conduits were detected. CT colonography is a minimally invasive and reliable option for colonic evaluation method for the patient of average colorectal cancer risk who has undergone esophagectomy with colonic interposition.
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Affiliation(s)
- Prasit Mahawongkajit
- Department of Surgery, Faculty of Medicine, Thammasat University, Bangkok, Pathumthani, Thailand
| | - Nuttorn Boochangkool
- Department of Surgery, Faculty of Medicine, Thammasat University, Bangkok, Pathumthani, Thailand
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Liu Q, Zhu Z, Chen Y, Deng J, Ai D, Liu Q, Wang S, Wu S, Chen J, Zhao K. Phase 2 Study of Stereotactic Body Radiation Therapy for Patients with Oligometastatic Esophageal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2020; 108:707-715. [DOI: 10.1016/j.ijrobp.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/28/2020] [Accepted: 05/03/2020] [Indexed: 01/26/2023]
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Nishizawa T, Suzuki H. Long-Term Outcomes of Endoscopic Submucosal Dissection for Superficial Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12102849. [PMID: 33023117 PMCID: PMC7601175 DOI: 10.3390/cancers12102849] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
In this review, we summarize up-to-date reports with 5-year survival after endoscopic submucosal dissection (ESD) for superficial esophageal squamous cell carcinoma. In ESD for the depth of the epithelium (m1) or lamina propria (m2), the 5-year cause-specific survival and 5-year overall survival rates were reported to be 98-100%, and 85-95%, respectively. In cases with submucosal invasion or vascular involvement, additional prophylactic treatment such as chemoradiotherapy or surgery was recommended, and the 5-year cause-specific survival and 5-year overall survival rates were reported to be 85-100%, and 56-84%, respectively. Additional treatment might be too invasive for the elderly or patients with severe comorbidities. The risk of additional therapy should be balanced against the risk of lymph node metastasis, considering the life expectancy of such patients.
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Affiliation(s)
- Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan;
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara 259-1193, Japan
- Correspondence: ; Tel.: +81-463-93-1121
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Harada K, Rogers JE, Iwatsuki M, Yamashita K, Baba H, Ajani JA. Recent advances in treating oesophageal cancer. F1000Res 2020; 9:F1000 Faculty Rev-1189. [PMID: 33042518 PMCID: PMC7531047 DOI: 10.12688/f1000research.22926.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/14/2022] Open
Abstract
Esophageal cancer (EC) is an aggressive malignancy with an increasing incidence and a poor prognosis. EC is histologically divided into two major categories: adenocarcinoma (EAC) and squamous cell carcinoma (ESCC). EAC and ESCC are molecularly different and therefore treatments should reflect the respective histological subtype. Combined modality therapy is needed for localized EC. When EC is advanced (stage 4), systemic therapy is the mainstay treatment for palliation. For localized EC, several strategies are considered standard, and more trials are necessary to determine a unified and more effective approach. The management for advanced EC is slowly evolving as immunotherapy is showing some promise for ESCC, but more data from ongoing studies are anticipated. Treatment advances will be based on high-definition genomic investigation of individual tumors. Herein, we review the contemporary trends in diagnosing and treating EAC and ESCC.
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Affiliation(s)
- Kazuto Harada
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Jane E. Rogers
- Department of Pharmacy Clinical Program, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Masaaki Iwatsuki
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Kohei Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Jaffer A. Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
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