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Loew A, Schneider C, Pflüger M, Mantke R, Weylandt KH, Gretschel S. [Treatment reality of esophageal cancer in the Federal State of Brandenburg : Comparison between squamous cell carcinoma and adenocarcinoma]. CHIRURGIE (HEIDELBERG, GERMANY) 2024:10.1007/s00104-024-02110-0. [PMID: 38861172 DOI: 10.1007/s00104-024-02110-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Clinical cancer registries are intended to reflect the reality of care through differentiated data analysis and, if necessary, to offer approaches for improving care. METHODS For the years 2000-2018, the data of the Clinical Epidemiological Cancer Registry Brandenburg-Berlin were examined separately for adenocarcinoma and squamous cell carcinoma with respect to epidemiology and health care reality. RESULTS Between 2000 and 2018 a total of 3207 esophageal cancers were documented in the cancer registry, of which 2182 were squamous cell carcinomas (ESCC), 843 adenocarcinomas (EAC) and 182 various others or missing histology. During the observation period there was a clear dominance of ESCC but with a significant increase in EAC in both sexes. Overall, the rate of new cases was 5 times higher for men than for women. The relative 5‑year survival probability of all esophageal cancers was 17.4% in men and 22.5% in women. Patients with EAC survived significantly longer than those with ESCC. Radiotherapy and chemotherapy, individually or in combination, were mainly used as treatment methods. Surgery was performed on 19% of ESCC and 42% of EAC. CONCLUSION The proportion of ESCC in Brandenburg is still significantly higher than EAC, with a significant increase for the latter, especially in men. Although locally advanced tumors have been significantly more common, modern neoadjuvant concepts have rarely been documented, and although the quality of the surgery is comparable to the international standard, surgery is carried out in relatively few patients.
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Affiliation(s)
- Andreas Loew
- Medizinische Klinik B, Universitätsklinikum Ruppin-Brandenburg (ukrb), Medizinische Hochschule Brandenburg, 16816, Neuruppin, Deutschland.
| | - Constanze Schneider
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin (KKRBB), 03044, Cottbus, Deutschland
| | - Maren Pflüger
- Klinisch-epidemiologisches Krebsregister Brandenburg-Berlin (KKRBB), 03044, Cottbus, Deutschland
| | - René Mantke
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Brandenburg, Medizinische Hochschule Brandenburg, 14770, Brandenburg an der Havel, Deutschland
- Fakultät für Gesundheitswissenschaften, gemeinsame Fakultät der Brandenburgischen Technischen Universität Cottbus-Senftenberg, der Brandenburgischen Medizinischen Hochschule Theodor Fontane und der Universität Potsdam, Potsdam, Deutschland
| | - Karsten H Weylandt
- Medizinische Klinik B, Universitätsklinikum Ruppin-Brandenburg (ukrb), Medizinische Hochschule Brandenburg, 16816, Neuruppin, Deutschland
- Fakultät für Gesundheitswissenschaften, gemeinsame Fakultät der Brandenburgischen Technischen Universität Cottbus-Senftenberg, der Brandenburgischen Medizinischen Hochschule Theodor Fontane und der Universität Potsdam, Potsdam, Deutschland
| | - Stephan Gretschel
- Fakultät für Gesundheitswissenschaften, gemeinsame Fakultät der Brandenburgischen Technischen Universität Cottbus-Senftenberg, der Brandenburgischen Medizinischen Hochschule Theodor Fontane und der Universität Potsdam, Potsdam, Deutschland
- Klinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Ruppin-Brandenburg (ukrb), Medizinische Hochschule Brandenburg, 16816, Neuruppin, Deutschland
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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Wang Q, Ge JT, Wu H, Zhong S, Wu QQ. Impacts of neoadjuvant therapy on the number of dissected lymph nodes in esophagogastric junction cancer patients. BMC Gastroenterol 2023; 23:64. [PMID: 36894903 PMCID: PMC9999651 DOI: 10.1186/s12876-023-02705-7] [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: 06/29/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Neoadjuvant therapy favors the prognosis of various cancers, including esophagogastric junction cancer (EGC). However, the impacts of neoadjuvant therapy on the number of dissected lymph nodes (LNs) have not yet been evaluated in EGC. METHODS We selected EGC patients from the Surveillance, Epidemiology, and End Results (SEER) database (2006-2017). The optimal number of resected LNs was determined using X-tile software. Overall survival (OS) curves were plotted with the Kaplan-Meier method. Prognostic factors were evaluated using univariate and multivariate COX regression analyses. RESULTS Neoadjuvant radiotherapy significantly decreased the mean number of LN examination compared to the mean number of patients without neoadjuvant therapy (12.2 vs. 17.5, P = 0.003). The mean LN number of patients with neoadjuvant chemoradiotherapy was 16.3, which was also statistically lower than 17.5 (P = 0.001). In contrast, neoadjuvant chemotherapy caused a significant increase in the number of dissected LNs (21.0, P < 0.001). For patients with neoadjuvant chemotherapy, the optimal cutoff value was 19. Patients with > 19 LNs had a better prognosis than those with 1-19 LNs (P < 0.05). For patients with neoadjuvant chemoradiotherapy, the optimal cutoff value was 9. Patients with > 9 LNs had a better prognosis than those with 1-9 LNs (P < 0.05). CONCLUSIONS Neoadjuvant radiotherapy and chemoradiotherapy decreased the number of dissected LNs, while neoadjuvant chemotherapy increased it in EGC patients. Hence, at least 10 LNs should be dissected for neoadjuvant chemoradiotherapy and 20 for neoadjuvant chemotherapy, which could be applied in clinical practice.
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Affiliation(s)
- Qi Wang
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Jin-Tong Ge
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Hua Wu
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Sheng Zhong
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China
| | - Qing-Quan Wu
- Department of Thoracic Surgery, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huaian, 223300, Jiangsu, China.
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Li R, He Y, Sun X, Wang N, Zhang M, Wei K, Li H, Dong P, Du L, Chen W. The long-term survival of esophageal cancer in elderly patients: A multi-center, retrospective study from China. Cancer Med 2023; 12:4852-4863. [PMID: 36210795 PMCID: PMC9972158 DOI: 10.1002/cam4.5307] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Esophageal cancer (EC) often occurs in the elderly, and approximately 40% of patients are 70 years or older. To investigate the long-term survival of EC in elderly patients, to provide a theoretical direction for better management and predicting survival of EC based on the hospital-based multi-center study in China. METHODS The study was conducted in 18 hospitals including 6 provincial hospitals, 8 municipal hospitals, and 4 county hospitals. We extracted information from medical record homepage, records of admission and discharge, and pathological diagnosis reports from the medical record department of the elderly patients at 70-84 years old to obtain the 3-year and 5-year overall survival (OS), and main associated factors, and to analyze the current therapeutic effect of different treatment options for elderly patients. RESULTS The 3-year and 5-year OS rate of the 1013 elderly patients was 44.8% and 32.8%, respectively. Their median survival was 28.00 months. The median survival of patients with squamous cell carcinoma was longer than that of other pathological type (squamous vs. other types: 31.00 vs. 20.00 months, p = 0.018). The median survival of patients with surgery only or combined therapy was longer than that of radiotherapy, chemotherapy, and no therapy (surgery only vs. combined therapy vs. radiotherapy vs. chemotherapy vs. no therapy: 56.00 vs. 33.00 vs. 26.00 vs.18.00 vs. 16.00 months, p < 0.001). The 5-year OS rate of patients with highly differentiated cancer was higher than that of medium differentiated and poor differentiation/undifferentiated. In multivariate analysis, the older ages, pathological stage, were independent prognostic risk factors for poor EC survival. Treatment method was independent protective factors predictive of a good EC OS. CONCLUSIONS The survival rate of the elderly EC patients was still low in China. Age, therapy method, and pathological stage were mainly associated with the survival rate of EC in elderly patients.
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Affiliation(s)
- Runhua Li
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University/The Tumor Hospital of Hebei Province, Shijiazhuang, Hebei, China
| | - Xibin Sun
- Henan Cancer Hospital, Zhengzhou, Henan, China
| | - Ning Wang
- Peking University Cancer Hospital (Beijing Cancer Hospital), Beijing, China
| | - Min Zhang
- Hubei Cancer Hospital, Wuhan, Hubei, China
| | - Kuangrong Wei
- Cancer Institute, Zhongshan City People's Hospital, Zhongshan, Guangdong, China
| | - Huizhang Li
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Peng Dong
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Lingbin Du
- Department of Cancer Prevention/Zhejiang Key Laboratory of Diagnosis and Treatment Technology on Thoracic Oncology (Lung and Esophagus), The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, P.R. China
| | - Wanqing Chen
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, P.R. China
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Ma K, Wang H, Fang C, Jiang X, Ma J. Development and validation of the novel subclassification of pN3 for patients with esophageal cancer. Front Oncol 2023; 13:1113711. [PMID: 37205185 PMCID: PMC10187992 DOI: 10.3389/fonc.2023.1113711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background Patients with stage pN3 esophageal cancer (EC) have a large number of metastatic lymph nodes (mLNs) and have poor prognosis. This study was to elucidate whether subclassification of pN3 according to the number of mLNs could improve the discrimination ability of EC patients. Methods This study retrospectively analyzed patients with pN3 EC from the Surveillance, Epidemiology, and End Results (SEER) database as a training cohort and SEER validation cohort. Patients with pN3 esophageal cancer from the Affiliated Cancer Hospital of Harbin Medical University were used as the validation cohort. The optimal cutoff value of mLNs was identified using the X-tile software, and group pN3 into pN3-I and pN3-II based on mLNs. Kaplan-Meier method and log-rank test were used to analyze the disease-specific survival (DSS). The Cox proportional hazards regression analysis was used to identify the independent prognostic factors. Results For the training cohort, patients with 7 to 9 mLNs were categorized as pN3-I, while those with more than 9 mLNs were categorized as pN3-II. There were 183 (53.8%) pN3-I and 157 (46.2%) pN3-II. The 5-year DSS rates of pN3-I and pN3-II in the training cohort were 11.7% and 5.2% (P=0.033), and the pN3 subclassification was an independent risk factor associated with patient prognosis. More RLNs may not improve patient prognosis, but the use of mLNs/RLNs is effective in predicting patient prognosis. Furthermore, the pN3 subclassification was well validated in the validation cohort. Conclusion Subclassification of pN3 can better distinguish survival differences in EC patients.
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Affiliation(s)
- Keru Ma
- Department of Thoracic Surgery, Esophagus and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hao Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Chengyuan Fang
- Department of Thoracic Surgery, Esophagus and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xiangyu Jiang
- Department of Thoracic Surgery, Esophagus and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jianqun Ma
- Department of Thoracic Surgery, Esophagus and Mediastinum, Harbin Medical University Cancer Hospital, Harbin, China
- *Correspondence: Jianqun Ma,
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Yang T, Huang S, Chen B, Chen Y, Liang W. A modified survival model for patients with esophageal squamous cell carcinoma based on lymph nodes: A study based on SEER database and external validation. Front Surg 2022; 9:989408. [PMID: 36157416 PMCID: PMC9489949 DOI: 10.3389/fsurg.2022.989408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background The counts of examined lymph nodes (ELNs) in predicting the prognosis of patients with esophageal squamous cell carcinoma (ESCC) is a controversial issue. We conducted a retrospective study to develop an ELNs-based model to individualize ESCC prognosis. Methods Patients with ESCC from the SEER database and our center were strictly screened. The optimal threshold value was determine by the X-tile software. A prognostic model for ESCC patients was developed and validated with R. The model’s efficacy was evaluated by C-index, ROC curve, and decision curve analysis (DCA). Results 3,629 cases and 286 cases were screened from the SEER database and our center, respectively. The optimal cut-off value of ELNs was 10. Based on this, we constructed a model with a favorable C-index (training group: 0.708; external group 1: 0.687; external group 2: 0.652). The model performance evaluated with ROC curve is still reliable among the groups. 1-year AUC for nomogram in three groups (i.e., 0.753, 0.761, and 0.686) were superior to that of the TNM stage (P < 0.05). Similarly, the 3-year AUC and the 5-year AUC results for the model were also higher than that of the 8th TNM stage. By contrast, DCA showed the benefit of this model was better in the same follow-up period. Conclusion More than 10 ELNs are helpful to evaluate the survival of ESCC patients. Based on this, an improved model for predicting the prognosis of ESCC patients was proposed.
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Affiliation(s)
- Tianbao Yang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Shijie Huang
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Boyang Chen
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Putian University, Putian, China
| | - Yahua Chen
- Department of Gastroenterology, The Affiliated Hospital of Putian University, Putian, China
- Correspondence: Wei Liang Yahua Chen
| | - Wei Liang
- Department of GastrointestinalEndoscopy, Fujian Provincial Hospital, Teaching Hospital of Fujian Medical University, Fuzhou, China
- Correspondence: Wei Liang Yahua Chen
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Sun Z, Xu X, Zhao X, Ma X, Ye Q. Impact of postoperative lymph node status on the prognosis of esophageal squamous cell carcinoma after esophagectomy following neoadjuvant chemoradiotherapy: a retrospective study. J Gastrointest Oncol 2021; 12:2685-2695. [PMID: 35070398 PMCID: PMC8748053 DOI: 10.21037/jgo-21-807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/20/2021] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (nCRT) and surgery are widely used treatments for locally advanced esophageal squamous cell carcinoma (ESCC). Thus, it is critically important to investigate risk factors that affect patient prognosis after preoperative chemoradiotherapy and surgery. METHODS We conducted a retrospective analysis of 77 patients with ESCC who received nCRT and underwent surgery at our center from January 2015 to December 2019. We analyzed the primary clinical data, postoperative pathological results, recurrence, and death results. RESULTS Among the 77 ESCC patients who received nCRT and surgery, 19 achieved a postoperative pathologic complete response (pCR), and the overall pCR rate was 24.68%. The univariate analysis indicated that postoperative post-neoadjuvant treatment N stage (ypN) metastasis [hazards ratio (HR): 2.908; 95% confidence interval (CI): 0.874-9.676; P=0.082], a high lymph-node ratio [(LNR) >0.1] (HR: 7.149, 95% CI: 1.740-29.369; P=0.006), post-neoadjuvant treatment T3-4 (ypT3-4) (HR: 3.626, 95% CI: 0.824-15.956; P=0.088) affected disease-specific survival (DSS). The multivariate analysis indicated that a high LNR (>0.1) (HR: 6.170; 95% CI: 1.472-25.856; P=0.013) was a significant independent predictor of DSS. The univariate analysis indicated that postoperative ypN metastasis (HR: 2.283; 95% CI: 1.047-4.979; P=0.038) and a high LNR (>0.1) (HR: 4.210; 95% CI: 1.547-11.458; P=0.005) were associated with recurrence-free survival (RFS). The multivariate survival analysis showed that a high LNR (>0.1) (HR: 4.289; 95% CI: 1.538-11.965; P=0.005) was also a significant independent predictor of RFS. In this study, 57 positive lymph nodes were found in 30 of the 77 patients, including 16 left gastric lymph nodes, 9 pericardial lymph nodes, and 7 left supraclavicular lymph nodes. CONCLUSIONS A high LNR (>0.1) in ESCC patients after nCRT is a risk factor of DSS and RFS. ypN metastasis is also an independent predictor of RFS. Left gastric-arterial lymph nodes, para-cardiac lymph nodes, and left supraclavicular lymph nodes are the most common sites of metastasis in ESCC after nCRT.
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Affiliation(s)
- Zhiyong Sun
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Xu
- Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaojing Zhao
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiumei Ma
- Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Ye
- Department of Thoracic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Duprée A, Ehlken H, Rösch T, Lüken M, Reeh M, Werner YB, de Heer J, Schachschal G, Clauditz TS, Mann O, Izbicki JR, Groth S. Laparoscopic lymph node sampling: a new concept for patients with high-risk early esophagogastric junction cancer resected endoscopically. Gastrointest Endosc 2021; 94:282-290. [PMID: 33639136 DOI: 10.1016/j.gie.2021.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/13/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Endoscopic resection is considered a curative treatment for early upper GI cancers under certain histologic (low-risk) criteria. In tumors not completely fulfilling these criteria but resected R0 endoscopically, esophagectomy is still advised because of an increased risk of lymph node (LN) metastases (LNM). However, the benefit-risk ratio, especially in elderly patients at higher risk for radical surgery, can be debated. We now present the outcome of our case series of laparoscopic LN sampling (LLS) in patients with T1 esophagogastric junction tumors, which had been completely resected by endoscopy but did not fulfill the low-risk criteria (G1/2, m, L0, V0). METHODS Retrospective review was done of all patients with T1 cancer undergoing LLS with at least 1 high-risk parameter after endoscopic resection during an 8-year period. Repeated endoscopy with biopsy and abdominothoracic CT had been performed before. The patients were divided into 2 periods: before (n = 8) and after (n = 12) the introduction of an extended LLS protocol (additional resection of the left gastric artery). In cases of positive LN, patients underwent conventional oncologic surgery; if negative, follow-up was performed. The main outcome was the number of harvested LNs by means of LLS and the percentage of positive LNs found. RESULTS Twenty patients with cardia (n = 1) and distal esophageal/Barrett's cancer (n = 19) were included. The LN rate with use of the extended LLS technique increased by 12% (period 1: median 12 [range, 5-19; 95% CI, 3.4-15.4] vs period 2: median 17.5 [range, 12-40; 95% CI, 12.8-22.2]; P = .013). There were 2 adverse events: 1 inadvertent chest tube removal and 1 postoperative pneumonia. In 15% of cases, patients had positive LNs. and in 2 cases there was local recurrence at the endoscopic resection site, all necessitating surgery. CONCLUSIONS An extended technique of laparoscopic LN sampling appears to provide adequate LN numbers and is a safe approach with short hospital stay only. Only long-term follow-up of larger patient numbers will allow conclusions about miss rate as well as oncologic adequacy of this concept.
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Affiliation(s)
- Anna Duprée
- Departments of General and Abdominal Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hanno Ehlken
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Rösch
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marina Lüken
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Reeh
- Departments of General and Abdominal Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Yuki B Werner
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jocelyn de Heer
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Schachschal
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Till S Clauditz
- Institute of Pathology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Mann
- Departments of General and Abdominal Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob R Izbicki
- Departments of General and Abdominal Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Groth
- Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Fan N, Wang Z, Huang Y, Tan Z, Yang H, Lin P. A Retrospective Study of 52 Patients With Primary Small Cell Carcinoma of the Esophagus Treated With Radical Surgery. Cancer Control 2021; 28:10732748211027147. [PMID: 34155924 PMCID: PMC8226382 DOI: 10.1177/10732748211027147] [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] [Indexed: 11/17/2022] Open
Abstract
Background: Primary small cell carcinoma of the esophagus (SCCE) is a rare and extremely
fatal disease. We aim to evaluate the efficacy of radical surgery for
resectable SCCE and to explore potential prognostic factors. Methods: We retrospectively reviewed 52 consecutive SCCE patients who underwent
radical surgery from February 1993 to November 2014 at a single institution.
The Kaplan-Meier estimator with log-rank test was used to assess overall
survival (OS), disease-free survival (DFS) and median survival time.
Univariate and multivariable analyses were used to evaluate prognostic
factors through Cox proportional hazard regression model. Results: Twenty-five (48.1%) patients were treated with surgery alone, whereas 27
(51.9%) patients underwent adjuvant therapy after surgery. The median OS
time was 17.4 months (95% CI: 13.5-21.3). The median DFS time was 13.4
months (95% CI: 7.7-19.0). Patients whose tumors were located in the lower
part of thoracic esophagus and the esophagogastric junction showed
significantly better OS (27.0 vs. 13.2 months, P = 0.016)
and DFS (27.0 vs. 11.3 months, P = 0.017) than those
located in the upper and middle parts. Patients with N0 status experienced
significantly better OS (21.4 vs. 11.6 months, P = 0.012)
and DFS (21.4 vs. 8.6 months, P = 0.012) than those with N+
status. Patients whose tumor lengths were shorter than 5 cm had a better OS
(17.4 vs. 5.7 months, P = 0.035) than those longer than 5
cm. Patients who underwent chemotherapy experienced a significantly improved
OS (21.0 vs. 14.1 months, P = 0.032) compared to surgery
alone. Multivariable analysis showed that lower tumor location, shorter
tumor length, pN0 status and chemotherapy independently predicted better OS;
lower tumor location and pN0 status independently predicted better DFS. Conclusions: Radical surgery in combination with chemotherapy has better outcomes than
surgery alone for resectable SCCE. Higher tumor location, longer tumor
length, lymph node metastasis and not undergoing chemotherapy independently
predict worse prognoses.
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Affiliation(s)
- Ningbo Fan
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 71067Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,Department of General, Visceral, Cancer and Transplantation Surgery, 27182University Hospital Cologne, Cologne, Germany
| | - Zhen Wang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 71067Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Yuanheng Huang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 71067Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Zihui Tan
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 71067Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Han Yang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 71067Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Peng Lin
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 71067Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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11
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Guo X, Zhang H, Xu L, Zhou S, Zhou J, Liu Y, Ji S. Value of Nomogram Incorporated Preoperative Tumor Volume and the Number of Postoperative Pathologically Lymph Node Metastasis Regions on Predicting the Prognosis of Thoracic Esophageal Squamous Cell Carcinoma. Cancer Manag Res 2021; 13:4619-4631. [PMID: 34140808 PMCID: PMC8203278 DOI: 10.2147/cmar.s307764] [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: 02/21/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study was to explore the influence of preoperative tumor volume, length, maximum diameter and the number of postoperative pathologically lymph node metastasis (LNM) regions on survival prognosis of esophageal squamous cell carcinoma (ESCC) patients. Methods A total of 296 patients with ESCC treated by standard curative esophagectomy were retrospectively analyzed. These patients were grouped for further analysis according to the optimal threshold of preoperative tumor volume, length, maximum diameter and the number of postoperative pathologically LNM regions. Kaplan–Meier method was used to calculate survival rate and survival comparison was performed by Log rank test. The Cox proportional hazards model was used to carry out univariate and multivariate analyses. Nomogram model was established by integrating statistically significant clinicopathological parameters, and the predictive value was further verified by calibration curve, concordance index (C-index) and decision curve. Results The univariate and multivariate Cox regression analysis all showed that differentiation grade, TNM stage, adjuvant therapy, preoperative tumor volume and the number of post operative pathologically LNM regions were independent prognostic factors for PFS and OS (all P<0.05). The C-indexes of PFS and OS by nomograms were predicted to be 0.747 (95% CI: 0.717–0.777) and 0.732 (95% CI: 0.697–0.767), respectively, which were significantly higher than the 7th AJCC TNM stage, the C-indexes 0.612 (95% CI: 0.574–0.650) and 0.633 (95% CI: 0.595–0.671), separately. In addition, the calibration curves of nomogram models were highly consistent with actual observation for the five-year PFS and OS rate, and the decision curve analysis also showed that nomogram models had higher clinical application potentials than TNM staging model in predicting survival prognosis of thoracic ESCC after surgery. Conclusion The nomograms incorporated preoperative tumor volume and the number of postoperative pathologically LNM areas are of great value in predicting survival prognosis of patients with thoracic ESCC.
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Affiliation(s)
- Xinwei Guo
- Department of Radiation Oncology, Affiliated Taixing People's Hospital of Yangzhou University, Taixing, People's Republic of China
| | - Han Zhang
- School of Mathematical Science and Application, Nanjing Normal University, Taizhou College, Taizhou, People's Republic of China
| | - Liben Xu
- Department of Radiotherapy, Jiangsu University Affiliated People's Hospital, Zhenjiang, People's Republic of China
| | - Shaobing Zhou
- Department of Radiation Oncology, Affiliated Taixing People's Hospital of Yangzhou University, Taixing, People's Republic of China
| | - Juying Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Yangchen Liu
- Department of Radiation Oncology, Affiliated Taixing People's Hospital of Yangzhou University, Taixing, People's Republic of China
| | - Shengjun Ji
- Department of Radiotherapy and Oncology, The Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, Suzhou, People's Republic of China
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12
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Li Z, Cheng J, Zhang Y, Wen S, LV H, Xu Y, Zhu Y, Zhang Z, Mu D, Tian Z. Comparison of Up-Front Minimally Invasive Esophagectomy versus Open Esophagectomy on Quality of Life for Esophageal Squamous Cell Cancer. ACTA ACUST UNITED AC 2021; 28:693-701. [PMID: 33503901 PMCID: PMC7924373 DOI: 10.3390/curroncol28010068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/02/2020] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
This study investigates whether minimally invasive esophagectomy (MIE) is a safe and effective way for patients with resectable esophageal cancer by comparing the short-term quality of life (QOL) after minimally invasive esophagectomy and open esophagectomy (OE). A total number of 104 patients who underwent esophagectomy from January 2013 to March 2014 were enrolled in this study. These patients were divided into two groups (MIE and OE group). Three scoring scales of quality of life were used to evaluate QOL before the operation and at the first, third, sixth and twelfth months after MIE or OE, which consist of Karnofshy performance scale (KPS), the European Organization for Research and Treatment questionnaire QLQC-30 (EORTC QLQC-30) and esophageal cancer supplement scale (OES-18). The MIE group was higher than the OE group in one-year survival rate (92.54% vs. 72.00%). Significant differences between the two groups were observed in intraoperative bleeding volume (158.53 ± 91.07 mL vs. 228.97 ± 109.33 mL, p = 0.001), and the incidence of postoperative pneumonia (33.33% vs. 58.62%, p = 0.018). The KPS of MIE group was significantly higher than the OE group at the first (80 vs. 70, p = 0.004 < 0.05), third (90 vs. 80, p = 0.006 < 0.05), sixth (90 vs. 80, p = 0.007 < 0.05) and twelfth months (90 vs. 80, p = 0.004 < 0.05) after surgery. The QLQC-30 score of MIE group was better than OE group at first and twelfth months after the operation. The OES-18 score of MIE group was significantly better than OE group at first, sixth and twelfth months after surgery. The short-term quality of life in MIE group was better than OE group.
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Affiliation(s)
- Zhenhua Li
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Jingge Cheng
- Department of Orthopedics, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China;
| | - Yuefeng Zhang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Shiwang Wen
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Huilai LV
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Yanzhao Xu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Yonggang Zhu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Zhen Zhang
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Donghui Mu
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
| | - Ziqiang Tian
- Department of Thoracic Surgery, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050011, China; (Z.L.); (Y.Z.); (S.W.); (H.L.); (Y.X.); (Y.Z.); (Z.Z.); (D.M.)
- Correspondence: ; Tel.: +86-18531118000
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13
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Jang JY, Yu J, Song KJ, Jo YY, Yoo YJ, Kim SB, Park SR, Kim YH, Kim HR, Kim JH. Prognostic significance of lymph node ratio after neoadjuvant chemoradiation therapy for esophageal squamous cell carcinoma. Radiat Oncol J 2020; 38:244-252. [PMID: 33233030 PMCID: PMC7785840 DOI: 10.3857/roj.2020.00850] [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: 10/16/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose We retrospectively evaluated the prognostic significance of lymph node ratio (LNR) in patients with esophageal squamous cell carcinoma who underwent neoadjuvant concurrent chemoradiation therapy (NCRT) followed by surgery. Materials and Methods In total, 270 patients who underwent NCRT followed by surgery between August 2005 and December 2015 were included. They were divided into three groups: LNR 0 (n = 196), LNR low (0 < LNR ≤ 0.1; n = 63), and LNR high (>0.1; n = 11). The primary endpoint was overall survival (OS), and the secondary endpoints were freedom from local recurrence (FFLR), distant metastasis-free survival (DMFS), and disease-free survival (DFS). Results The median number of retrieved lymph nodes per patient was 33. Pathologically, 74 patients had positive lymph nodes. The median follow-up duration was 36.1 months, and the median survival period was 68.4 months. There was a significant correlation between LNR and the number of positive lymph nodes (correlation coefficient = 0.763, p < 0.001). There was a substantial difference in the OS among the LNR groups, with 2-year survival rates of 79.0%, 54.0%, and 9.1% in the LNR 0, LNR low, and LNR high groups, respectively (p < 0.001). A marked decrease in FFLP, DMFS, and DFS was observed with the increasing LNR. In subgroup analysis, the survival results of patients with clinically positive lymph node were similar from those of entire cohort. Conclusion LNR is a significant prognostic factor in patients with esophageal squamous cell carcinoma who underwent NCRT followed by surgery. Additional treatment and closer follow-up would be necessary for patients with a high LNR.
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Affiliation(s)
- Jeong Yun Jang
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jesang Yu
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kye Jin Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Young Jo
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ye Jin Yoo
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sook Ryun Park
- Department of Medical Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, 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
| | - Jong Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Zheng YZ, Li XQ, Wang JY, Yang H, Wen J, Zhai WY, Yuan LX, Fu SS, Liao HY, Fu JH. Impact of Examined Lymph Node Count for Esophageal Squamous Cell Carcinoma in Patients who Underwent Right Transthoracic Esophagectomy. Ann Surg Oncol 2020; 28:3025-3033. [PMID: 33073346 DOI: 10.1245/s10434-020-09217-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 09/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The impact of the number of examined lymph nodes (ELNs) on stage correction and prognostication in patients with esophageal squamous cell carcinoma (ESCC) who underwent right transthoracic esophagectomy is still unclear. METHODS Patients with ESCC who underwent right transthoracic esophagectomy at Sun Yat-sen University Cancer Center between January 1997 and December 2013 were retrospectively enrolled. The Cox proportional hazards regression model was used to determine the effect of ELN count on overall survival. The impact of ELN count on stage correction was evaluated using the hypergeometric distribution and Bayes theorem and β-binomial distribution estimation, respectively. The threshold of ELNs was determined using the LOWESS smoother and piecewise linear regression. RESULTS Among the 875 included patients, greater ELNs were associated with a higher rate of nodal metastasis. Significant association between staging bias and the number of ELNs is only observed through the Bayes method. The ELN count did not impact 90-day mortality but significantly impacted long-term survival (adjusted hazard ratio [aHR] 0.986), especially in those patients with node-negative disease (aHR 0.972). In patients with node-negative disease, cut-point analysis showed a threshold ELN count of 21. CONCLUSIONS A greater number of ELNs is associated with more accurate node staging and better long-term survival in resected ESCC patients. We recommended harvesting at least 21 LNs to acquire accurate staging and long-term survival information for patients with declared node-negative disease using the right thoracic approach.
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Affiliation(s)
- Yu-Zhen Zheng
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.,Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun-Ye Wang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Hong Yang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Jing Wen
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Wen-Yu Zhai
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliation Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hong-Ying Liao
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Jian-Hua Fu
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation, Sun Yat-sen University Cancer Center, No.651, Dongfeng Road East, Guangzhou, 510060, Guangdong, China.
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15
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Nusrath S, Saxena AR, Raju KVVN, Patnaik S, Subramanyeshwar Rao T, Bollineni N. The Value of Lymphadenectomy Post-Neoadjuvant Therapy in Carcinoma Esophagus: a Review. Indian J Surg Oncol 2020; 11:538-548. [PMID: 33013140 DOI: 10.1007/s13193-020-01156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022] Open
Abstract
Lymph nodal metastasis is one of the most important prognostic factors determining survival in patients with carcinoma esophagus. Radical esophagectomy, with the resection of surrounding lymph nodes, is considered the prime treatment of carcinoma esophagus. An extensive lymphadenectomy improves the accuracy of staging and betters locoregional control, but its effect on survival is still not apparent and carries the disadvantage of increased morbidity. The extent of lymphadenectomy during esophagectomy also remains debatable, with many studies revealing contradictory results, especially in the era of neoadjuvant therapy. The pattern of distribution and the number of nodal metastasis are modified by neoadjuvant therapy. The paper reviews the existing evidence to determine whether increased lymph node yield improves oncological outcomes in patients undergoing esophagectomy with particular attention to those patients receiving neoadjuvant therapy.
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Affiliation(s)
- Syed Nusrath
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Ajesh Raj Saxena
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - K V V N Raju
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Sujith Patnaik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
| | - Naren Bollineni
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, India
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16
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Askari A, Munster AB, Jambulingam P, Riaz A. Critical number of lymph node involvement in esophageal and gastric cancer and its impact on long-term survival-A single-center 8-year study. J Surg Oncol 2020; 122:1364-1372. [PMID: 32803769 DOI: 10.1002/jso.26145] [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: 07/16/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nodal disease in esophageal and gastric cancer is associated with poor survival. OBJECTIVES To determine the critical level of lymph node involvement where survival becomes significantly compromised. METHODS Survival analyses using multivariable Cox regression and receiver operator characteristics (ROC) were undertaken to determine what number of positive lymph nodes were most sensitive and specific in predicting survival. RESULTS A total of 317 patients underwent esophagectomy (n = 190, 59.9%) and gastrectomy (n = 127, 40.1%) for adenocarcinoma. At multivariable analyses, four nodes positivity (irrespective of T-category) was associated with nearly a fivefold increased risk of mortality when compared to node-negative patients (hazard ratio [HR], 4.9; interquartile range 2.0-11.5; P < .001). A positive ratio of up to 50.0% was not associated with worse survival than having four nodes positive (HR, 4.6; 95% confidence interval, 2.6-8.1; P < .001). ROC analysis demonstrated four lymph nodes positive to have a sensitivity of 80.5%, a specificity of 60.1%, and an accuracy of 77.8 (P < .001). CONCLUSION The absolute number of nodes positive for cancer is more important than the proportion of positive nodes in predicting survival in esophageal/gastric cancer. Four positive lymph nodes are associated with a fivefold increase in mortality. Beyond this, increasing numbers of positive lymph nodes make no appreciable difference to survival.
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Affiliation(s)
- Alan Askari
- Department of Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | - Alex B Munster
- Department of Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK
| | | | - Amjid Riaz
- Department of Surgery, West Hertfordshire Hospitals NHS Trust, Watford, UK
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17
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Zheng YZ, Li XQ, Wang JY, Yang H, Wen J, Zhai WY, Yuan LX, Fu SS, Liao HY, Fu JH. Impact of examined lymph node count for oesophageal squamous cell carcinoma in patients who underwent left transthoracic oesophagectomy. Eur J Surg Oncol 2020; 46:1956-1962. [PMID: 32439262 DOI: 10.1016/j.ejso.2020.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/22/2020] [Accepted: 04/25/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The impact of the number of examined lymph nodes (ELNs) on stage correction and prognostication in patients with oesophageal squamous cell carcinoma (ESCC) who underwent left transthoracic oesophagectomy is still unclear. METHODS Patients with ESCC who underwent left transthoracic oesophagectomy at Sun Yat-sen University Cancer Center between January 1997 and December 2013 were retrospectively enrolled. The Cox proportional hazards regression model was used to determine the effect of ELN count on overall survival (OS). The association between ELN count and nodal status was investigated through scatter plot and binary logistic regression analyses. The impact of ELN count on stage correction was evaluated using the hypergeometric distribution and Bayes theorem. The threshold of ELNs was determined using the LOWESS smoother and piecewise linear regression. RESULTS Among the 1826 included patients, greater ELNs were associated with a higher rate of nodal metastasis (adjusted OR = 1.018). When the ELN count increased, the omission rate of positive lymph nodes (LNs) decreased. The ELN count did not impact 90-day mortality but significantly impacted long-term survival (adjusted HR = 0.983), especially in those with node-negative disease (adjust HR = 0.972). In patients with node-negative disease, cut point analysis showed a threshold ELN count of 18. CONCLUSIONS A greater number of ELNs is associated with more accurate node staging and better long-term survival in resected ESCC patients. We recommended harvesting at least 18 LNs to acquire accurate staging and long-term survival information for patients with declared node-negative disease in the left thoracic approach.
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Affiliation(s)
- Yu-Zhen Zheng
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China; Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Qiang Li
- Department of Thoracic Surgery, Peking University Shenzhen Hospital, Shenzhen, China
| | - Jun-Ye Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Hong Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jing Wen
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Wen-Yu Zhai
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Lian-Xiong Yuan
- Office of Research Service, Third Affiliation Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shen-Shen Fu
- Department of Ultrasonography, Guangzhou First People's Hospital, the Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Hong-Ying Liao
- Department of Thoracic Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Esophageal Cancer Institute, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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18
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Mo J, Chen D, Li C, Chen M. The Significance of Negative Lymph Nodes in Esophageal Cancer After Curative Resection: A Retrospective Cohort Study. Cancer Manag Res 2020; 12:1269-1279. [PMID: 32110101 PMCID: PMC7039082 DOI: 10.2147/cmar.s232856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objective The impact of negative lymph nodes (NLNs) count on prognosis in esophageal cancer (EC) was analyzed using two institutions surgical database. Methods We conducted a retrospective study of 768 EC patients treated by surgical resection between January 2010 and December 2012. The effects of the NLNs count on prognosis was analyzed. Cox regression model was conducted to determine the significant prognostic elements. Results The number of NLNs was studied as a categorical variable based on the quartiles (Q1: ≤15, Q2: 16–21, Q3: 22–30, Q4: ≥31). And a better overall survival (OS) was observed with increasing number of NLNs (HR= 0.762; 95% CI, 0.596–0.974 for Q2, HR= 0.666; 95% CI, 0.516–0.860 for Q3 and HR= 0.588; 95% CI, 0.450–0.768 for Q4) (all P<0.05). Multivariate regression analysis revealed that the NLNs count was an independent prognostic factor. Besides, for patients in T2 or T3 stage, a high number of NLNs was found to be significantly associated with a favorable OS (log rank P<0.001). Conclusion A higher number of NLNs is independently related to the better OS in EC patients after surgical resection.
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Affiliation(s)
- Junxian Mo
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, People's Republic of China.,Department of Cardio-Thoracic Surgery, The Seventh Affiliated Hospital of Guangxi Medical University, Wuzhou, Guangxi 543000, People's Republic of China
| | - Dongni Chen
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, People's Republic of China
| | - Changbo Li
- Department of Cardio-Thoracic Surgery, The Seventh Affiliated Hospital of Guangxi Medical University, Wuzhou, Guangxi 543000, People's Republic of China
| | - Mingwu Chen
- Department of Cardio-Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021, People's Republic of China
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19
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Vadhwana B, Zosimas D, Lykoudis PM, Phen HM, Martinou M, Khoo D. Tumour length as an independent prognostic factor in resectable oesophageal carcinoma. Ann R Coll Surg Engl 2019; 102:185-190. [PMID: 31755735 DOI: 10.1308/rcsann.2019.0147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Oesophageal longitudinal tumour length has been investigated as a prognostic indicator for disease recurrence and overall survival in resectable oesophageal carcinoma. However, there is conflicting evidence regarding its use in clinical practice. This study aims to assess the prognostic significance of histological tumour length in potentially curative oesophageal resections for cancer. MATERIALS AND METHODS Patients with locally advanced oesophageal carcinoma (squamous or adenocarcinoma) were identified in a single centre between July 2000 and December 2016. Patient demographics, tumour characteristics and survival outcomes were assimilated. Unifactorial and multifactorial analysis was performed to assess tumour length correlation with oncological outcomes. RESULTS A total of 281 patients were included; 226 (80.4%) male and 55 (19.6%) female, with a median age of 66 years; 39 patients (13.9%) developed local recurrence and 104 (37%) distant metastases. Disease progression rate was 44.8% with a median progression-free survival of 21 months and median overall survival of 30 months. Median tumour length was 3cm (interquartile range 2-4.5cm). Multivariate analysis demonstrated longer tumours to be significantly associated with a higher rate of local recurrence (p=0.028), metastases (p=0.016), disease progression (p=0.001) and shorter progression-free survival (p=0.001). DISCUSSION This study demonstrates histological tumour length as an independent prognostic factor for local recurrence, metastases, disease progression and progression-free survival. Further larger multicentre studies are required to define the role of longitudinal tumour length as a marker to identify patients who are at higher risk of poor oncological outcomes following surgery.
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Affiliation(s)
| | | | | | | | | | - D Khoo
- Queens Hospital, Romford, UK
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20
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Yeung JC, Bains MS, Barbetta A, Nobel T, DeMeester SR, Louie BE, Orringer MB, Martin LW, Reddy RM, Schlottmann F, Molena D. How Many Nodes Need to be Removed to Make Esophagectomy an Adequate Cancer Operation, and Does the Number Change When a Patient has Chemoradiotherapy Before Surgery? Ann Surg Oncol 2019; 27:1227-1232. [PMID: 31605332 DOI: 10.1245/s10434-019-07870-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND DESIGN Node dissection during esophagectomy is an important aspect of esophageal cancer staging. Controversy remains as to how many nodes need to be resected in order to properly stage a patient and whether the removal of more nodes carries a stage-independent survival benefit. A review of the literature performed by a group of experts in the subject may help define a minimum accepted number of lymph nodes to be resected in both primary surgery and post-induction therapy scenarios. RESULTS AND CONCLUSIONS The existing evidence generally supports the goal of obtaining a minimum of 15 lymph nodes for pathological examination in both primary surgery and post-induction therapy scenarios.
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Affiliation(s)
- Jonathan C Yeung
- Division of Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Arianna Barbetta
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Tamar Nobel
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Steven R DeMeester
- Foregut and Thoracic Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, The Oregon Clinic, Portland, OR, USA
| | - Brian E Louie
- Division of Thoracic Surgery, Swedish Cancer Institute, Seattle, WA, USA
| | - Mark B Orringer
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Linda W Martin
- Division of Thoracic Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Rishindra M Reddy
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Francisco Schlottmann
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniela Molena
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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21
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Xu H, Wu S, Luo H, Chen C, Lin L, Huang H, Xue R. Prognostic value of tumor length and diameter for esophageal squamous cell cancer patients treated with definitive (chemo)radiotherapy: Potential indicators for nonsurgical T staging. Cancer Med 2019; 8:6326-6334. [PMID: 31486278 PMCID: PMC6797578 DOI: 10.1002/cam4.2532] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The aim of this work was to evaluate the prognostic value of tumor length and diameter for patients with esophageal squamous cell cancer (ESCC) treated with definitive (chemo)radiotherapy to identify potential indicators for separate nonsurgical T staging, which are needed in clinical practice. MATERIALS AND METHODS A total of 682 patients with ESCC who underwent definitive (chemo)radiotherapy between 2009 and 2015 were reviewed. Esophageal tumor length and diameter were determined by barium esophagography and computed tomography before treatment. Univariate and multivariate analyses were used to assess the impact of tumor length and diameter on long-term overall survival (OS) and progression-free survival (PFS). Propensity score matching (PSM) analysis was also used to control intergroup heterogeneity. RESULTS The median OS and PFS were 22.2 months and 15.4 months, respectively, in the tumor length ≤ 6 cm group, which were significantly longer than those in the tumor length > 6 cm group (13.4 and 8.5 months, respectively). The median OS and PFS were 23.3 months and 15.9 months, respectively, in the tumor diameter ≤ 3.5 cm group, which were also significantly longer than those in the tumor diameter > 3.5 cm group (13.3 and 8.8 months, respectively). Similar results were found after PSM. Univariate and multivariate analyses showed that tumor length and diameter were both independent predictors of long-term survival. CONCLUSION Tumor length and diameter are both independent prognostic factors for ESCC patients treated with definitive (chemo)radiotherapy. These two imaging parameters have the potential for development and use in nonsurgical T staging.
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Affiliation(s)
- Hongyao Xu
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Shengxi Wu
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Hesan Luo
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Chuyun Chen
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Lianxing Lin
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Hecheng Huang
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Renliang Xue
- Department of Radiation Oncology, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
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Zhao Z, Zhang Y, Wang P, Wang X, Li M. The impact of the nodal status on the overall survival of non-surgical patients with esophageal squamous cell carcinoma. Radiat Oncol 2019; 14:161. [PMID: 31481064 PMCID: PMC6724275 DOI: 10.1186/s13014-019-1365-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognosis of N categories for patients with non-surgical esophageal carcinoma based on the number of metastatic lymph nodes is controversial. The present study analyzes prognostic implications of the number, extent, and size of metastatic lymph nodes for patients with esophageal squamous cell carcinoma (ESCC) treated with definitive (chemo-)radiotherapy to provide more information on treatment strategy. METHODS We reviewed 357 ESCC patients treated with definitive radiotherapy between January 2013 and March 2016 retrospectively. We assessed potential associations between the involved extent (N0, 1 region, 2 regions, and 3 regions), number (N0, 1-2, 3-6, and ≥ 7), and size (N0, ≤2 cm, and > 2 cm) of metastatic lymph nodes and overall survival. Multivariate analyses of the clinicopathological factors were performed using the Cox proportional hazard model. RESULTS 5-year survival rates were 43.6% for patients in the N0 group and 29.3% in the N+ group (p = 0.001). Kaplan-Meier analyses for all cases revealed that there were significant differences in survival based on the extent (the OS rates at 3 years were 53.3% for patients in the N0 group, 45.7% in the 1 region-involved group, 28.0% in the 2 regions-involved group, and 13.3% in the 3 regions-involved group, P < 0.001), number (the OS rates at 3 years were 49.0% for patients in the 1-2 LNs group, 27.8% in the 3-6 LNs group, 0 in the ≥7LNs group, P < 0.001), and size (the OS rates at 3 years were 41.6% for patients in the LNs ≤2 cm group and 20.7% in the LNs > 2 cm group, P = 0.001) of metastatic LNs. One hundred seventy-two patients (48.2%) had experienced GTV failure, 157 (43.1%) had distant failure, 49 (13.7%) had out-of-GTV nodal failure, and 70 patients (19.6%) had no evidence of disease at the last follow-up. Nodal status correlated statistically with GTV failure. Patients with LN metastases in the abdominal region had worse survival rates than those with metastases in the other regions. The extent and number of metastatic LNs, T category, Primary tumor location, and chemotherapy were independent prognostic factors of OS in multivariate analyses. CONCLUSIONS For patients with ESCC who received definitive (chemo-)radiotherapy, the number, extent, and size of metastatic LNs were prognostic factors, particularly of the T2/3 disease. Patients with LN metastases in the abdominal region had worse survival.
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Affiliation(s)
- Zongxing Zhao
- School of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.,Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Yanan Zhang
- Department of Health Care, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Peiliang Wang
- School of Medicine, Shandong University, Jinan, Shandong, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China
| | - Xin Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.,Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, Shandong, China.
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23
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Feng Y, Wu N, Yan S, Wang X, Yang Y. Comparison of Ivor Lewis esophagectomy and Sweet esophagectomy for the treatment of middle-lower esophageal squamous cell carcinoma. J Thorac Dis 2019; 11:3584-3592. [PMID: 31559065 DOI: 10.21037/jtd.2019.07.68] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background For cancer of the middle and/or lower segment of thoracic esophagus, the Ivor Lewis esophagectomy is the mainstream standard surgery, whereas the Sweet procedure is widely used in China. As no consensus has been reached about the choice of different thoracic approaches, we designed this retrospective study to investigate and compare oncological benefits of the two surgical approaches. Methods After propensity score matching, 150 patients who underwent the Sweet or Ivor Lewis esophagectomy from August 2003 to December 2009 in the Beijing Cancer Hospital were reviewed. We compared the postoperative recovery, nutritional parameters, and survival of the two different surgical approaches. Results The 5-year overall survival (OS) rate for the whole group was 48.5%, and the 10-year OS rate was 35.6%. The Ivor Lewis group had a longer operation time, longer duration of chest tube drainage, and a larger volume of total thoracic drainage. No significant differences were found between the two groups in terms of the duration of systemic inflammatory response syndrome (SIRS), length of postoperative hospital stay, duration of postoperative nasogastric tube use, incidence of major complications, and nutritional status after the esophagectomy. The OS rates were similar in both groups. Conclusions The Sweet and Ivor Lewis esophagectomy are both safe and effective. A change of the surgical incision may not be the best way to increase survival, and the choice of surgical procedure should depend on the preference of the thoracic surgeon to secure the safety of the operation.
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Affiliation(s)
- Yuan Feng
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Nan Wu
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Shi Yan
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Xing Wang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
| | - Yue Yang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing 100142, China
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Proposed revision of the 8th edition AJCC clinical staging system for esophageal squamous cell cancer treated with definitive chemo-IMRT based on CT imaging. Radiat Oncol 2019; 14:54. [PMID: 30922343 PMCID: PMC6437982 DOI: 10.1186/s13014-019-1258-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/20/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To validate and propose revision of the 8th edition American Joint Committee on Cancer (AJCC) clinical staging system for esophageal squamous cell cancer (ESCC) patients treated with definitive intensity-modulated radiation therapy combined with concurrent chemotherapy (Chemo-IMRT) based on computed tomography (CT) imaging. Methods The clinical data of patients with ESCC treated with Chemo-IMRT were collected and retrospectively reviewed. All CT images were independently reevaluated and restaged according to the 8th edition AJCC staging system. The overall survival (OS) rates were analyzed statistically. ROC curves of the various parameters of the primary tumor and metastatic lymph nodes were generated in order to identify the cutoff values correlated to patient survival using the area under curve. Results The gross tumor volume of the primary tumor (GTV-prT) and the clinical N stage (cN) were independent factors that influenced OS. The 5-year OS rate of patients with GTV-prT ≤28 cm3, GTV-prT > 28 and ≤ 56 cm3, and GTV-prT > 56 cm3 were 54.6, 31.1 and 18.6%, respectively. The 5-year OS rate of patients with cN0, cN1 SLNM (−), cN2 SLNM (−), cN3 SLNM (−) and SLNM (+) were 62.8 (P < 0.001), 34.0 (P = 0.16), 20.0 (P = 0.785), 0 (P < 0.001) and 26.9%, respectively. After restaging the SLNM as regional MLNs, the 5-year OS rates of the patients with cN0, 1, 2 and 3 were 62.8, 36.3, 23.7 and 7.8%, respectively. Various GTV-prT were combined with the cN to establish a new clinical TNM staging system: I, GTV-prT1 and cN0; II, GTV-prT2 or 3 and cN0, GTV-prT1 and cN1; III, GTV-prT1 and cN2, GTV-prT2 and cN1,2; Iva, GTV-prT3 and cN1,2; IVb, GTV-prTany and cN3; IVc, TanyNanyM1. Subsequently, the OS differed significantly between the adjacent GTV-prT cN categories, except those of stage I vs. II. Conclusion The SLNM should be dealt with as a regional rather than a distant disease in patients with ESCC when treated with CRT. The proposed nonsurgical staging system based on the GTV-prT and N appears to be a simple and accurate prognosis predictor for patients with ESCC who have undergone definitive Chemo-IMRT.
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Chen D, Wang W, Chen Y, Hu J, Yang M, Mo J, Wen Z. Recurrence and prognostic model for identifying patients at risk for esophageal cancer after surgery. Cancer Manag Res 2018; 10:6109-6120. [PMID: 30538559 PMCID: PMC6252785 DOI: 10.2147/cmar.s186194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of this study was to construct a risk model to assess overall survival (OS) and disease-free survival (DFS) in patients with esophageal cancer (EC) after surgery. Patients and methods A total of 872 consecutive EC patients who had undergone surgery between February 2009 and October 2012 were retrospectively analyzed. The cutoff for risk value (RV) was inferred by receiver operating characteristic curves and the Youden index. A log-rank test was used to compare the survival curves, and a Cox regression analysis was performed to clarify the significant prognostic factors. Results The area under the curve was 0.688 for OS and 0.645 for DFS. The survival rates were 69.4% (259/373) and 39.1% (195/499), and the rates of recurrence were 19.2% (70/364) and 27.6% (132/479), respectively, for RV<0.218 and RV≥0.218 (c2=78.83, P<0.001; c2=9.07, P=0.003; respectively). A multivariate Cox regression analysis identified cases suffering from higher overall mortalities with RV≥0.218 compared to RV<0.218 (HR=1.45; 95% CI, 1.21–2.02; P=0.015); similar results were also found for DFS (HR=1.38; 95% CI, 1.03–1.86; P=0.033). Kaplan–Meier survival curves showed that cases with RV<0.218 had better OS and DFS than cases with RV≥0.218 (log rank = 75.80, P<0.001; log rank = 24.78, P<0.001). Conclusion This model could be applied to an integrated assessment of recurrence and prognostic risk after the surgical treatment of EC.
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Affiliation(s)
- Dongni Chen
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China,
| | - Weidong Wang
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China,
| | - Youfang Chen
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China,
| | - Jia Hu
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China,
| | - Men Yang
- Department of Cardio-Thoracic Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, Guangdong 518000, China
| | - Junxian Mo
- Department of Cardio-Thoracic Surgery, The Seventh Affiliated Hospital of Guangxi Medical University, Wuzhou, Guangxi 543000, China
| | - Zhesheng Wen
- Department of Thoracic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China,
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A comparative study of quantitative assessment with fluorine-18-fluorodeoxyglucose positron-emission tomography and endoscopic ultrasound in oesophageal cancer. Nucl Med Commun 2018; 39:628-635. [PMID: 29672466 DOI: 10.1097/mnm.0000000000000844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study aims to assess the correlation between PET/CT and endoscopic ultrasound (EUS) parameters in patients with oesophageal cancer. PATIENTS AND METHODS All patients who had complete PET/CT and EUS staging performed for oesophageal cancer at our centre between 2010 and 2016 were included. Images were retrieved and analysed for a range of parameters including tumour length, volume and position relative to the aortic arch. RESULTS Seventy patients were included in the main analysis. A strong correlation was found between EUS and PET/CT in the tumour length, the volume and the position of the tumour relative to the aortic arch. Regression modelling showed a reasonable predictive value for PET/CT in calculating EUS parameters, with r higher than 0.585 in some cases. CONCLUSION Given the strong correlation between EUS and PET parameters, fluorine-18 fluorodeoxyglucose (F-FDG) PET can provide accurate information on the length and the volume of tumour in patients who either cannot tolerate EUS or have impassable strictures.
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Zhang X, Wang Y, Qu P, Liu-Helmersson J, Zhao L, Zhang L, Sang S. Prognostic Value of Tumor Length for Cause-Specific Death in Resectable Esophageal Cancer. Ann Thorac Surg 2018; 106:1038-1046. [PMID: 29883640 DOI: 10.1016/j.athoracsur.2018.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/03/2018] [Accepted: 05/14/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The current esophageal cancer American Joint Committee on Cancer TNM staging system may not capture the full prognostic implications of the primary tumor. A study is needed to explore the prognostic value of tumor size on esophageal cancer-specific death. METHODS Patients who underwent surgical resection for non-metastatic esophageal cancer were selected from the Surveillance, Epidemiology and End Results Program database (United States, 1988 to 2014). With the use of statistics methods, maximally selected rank and two hazard models (Cox model and Fine-Gray model), the optimum cutoff point for tumor length in each T classification was estimated and the prognostic value of tumor size on esophageal cancer-specific death was analyzed. RESULTS A total of 4,447 patients were identified. The median tumor size was significantly correlated with T classification, with the correlation coefficient of 0.43 (p < 0.001). Patients in the T1 to T3 classifications who had larger tumor size showed a larger probability of cancer-specific death. The multivariate Cox model showed that tumor size was significantly associated with an increase in cancer-specific death in T1 (2.15, 95% confidence interval [CI]: 1.72 to 2.69) and T2 (1.31, 95% CI: 1.06 to 1.62) but was marginally significantly associated in T3 (1.12, 95% CI: 1.00 to 1.27) and insignificantly associated in T4 classification (p > 0.1). Similar results were found by using the multivariate Fine-Gray model. CONCLUSIONS We have found that combining T classification with tumor size can increase the precision in identifying the high-risk groups in T1 to T2 classifications. On the basis of esophageal cancer-specific death our study explores the prognostic cutoff point of tumor size by T classification.
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Affiliation(s)
- Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yang Wang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Pengfei Qu
- Shandong Primary Chemical Industry Quality-Monitoring and Inspection Station, Chemical Technology Academy of Shandong Province, Jinan, China
| | - Jing Liu-Helmersson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University, Umea, Sweden
| | - Linping Zhao
- Department of Thoracic Surgery, Shouguang People's Hospital, Shouguang, China
| | - Lin Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Shaowei Sang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, China.
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Yu S, Zhang W, Ni W, Xiao Z, Wang X, Zhou Z, Feng Q, Chen D, Liang J, Fang D, Mao Y, Gao S, Li Y, He J. Nomogram and recursive partitioning analysis to predict overall survival in patients with stage IIB-III thoracic esophageal squamous cell carcinoma after esophagectomy. Oncotarget 2018; 7:55211-55221. [PMID: 27487146 PMCID: PMC5342412 DOI: 10.18632/oncotarget.10904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/10/2016] [Indexed: 12/20/2022] Open
Abstract
We have developed statistical models for predicting survival in patients with stage IIB-III thoracic esophageal squamous cell carcinoma (ESCC) and assessing the efficacy of adjuvant treatment. From a retrospective review of 3,636 patients, we created a database of 1,004 patients with stage IIB-III thoracic ESCC who underwent esophagectomy with or without postoperative radiation. Using a multivariate Cox regression model, we assessed the prognostic impact of clinical and histological factors on overall survival (OS). Logistic analysis was performed to identify factors to include in a recursive partitioning analysis (RPA) to predict 5-year OS. The nomogram was evaluated internally based on the concordance index (C-index) and a calibration plot. The median survival time in the training dataset was 30.9 months, and the 5-year survival rate was 33.9%. T stage, differentiated grade, adjuvant treatment, tumor location, lymph node metastatic ratio (LNMR), and the presence of vascular carcinomatous thrombi were statistically significant predictors of 5-year OS. The C-index of the nomogram was 0.70 (95% CI 0.67-0.73). RPA resulted in a three-class stratification: class 1, LNMR ≤ 0.15 with adjuvant treatment; class 2, LNMR ≤ 0.15 without adjuvant treatment and LNMR > 0.15 with adjuvant treatment; and class 3, LNMR > 0.15 without adjuvant treatment. The three classes were statistically significant for OS (P < 0.001). Thus, the nomogram and RPA models predicted the prognosis of stage IIB-III ESCC patients and could be used in decision-making and clinical trials.
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Affiliation(s)
- Shufei Yu
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wencheng Zhang
- Department of Radiation Oncology, Tianjing Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin 300000, China
| | - Wenjie Ni
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zefen Xiao
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xin Wang
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zongmei Zhou
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qinfu Feng
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dongfu Chen
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jun Liang
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dekang Fang
- Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Yousheng Mao
- Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
| | - Yexiong Li
- Department of Radiation Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jie He
- Department of Thoracic Surgery, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
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Zhang H, Tang P, Miao X, Gao Y, Shang X, Gong L, Ma Z, Yang M, Jiang H, Zhan Z, Meng B, Yu Z. Does tumor size improve the accuracy of prognostic prediction in patients with esophageal squamous cell carcinoma after surgical resection? Oncotarget 2018; 7:66623-66634. [PMID: 27579613 PMCID: PMC5341825 DOI: 10.18632/oncotarget.11286] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 08/09/2016] [Indexed: 01/22/2023] Open
Abstract
This study aimed to investigate whether the inclusion of tumor size could improve the prognostic accuracy in patients with esophageal squamous cell cancer (ESCC). A total of 387 patients with ESCC who underwent curative resection were enrolled in this analysis. The patients were categorized into small-sized tumors (SSTs) and large-sized tumors (LSTs) using an appropriate cut-off point for tumor size. Kaplan–Meier survival curve and log–rank test were used to evaluate the prognostic value of tumor size. A Cox regression model was adopted for multivariate analysis. Their accuracy was compared based on the presence or absence of tumor size. Using 3.5 cm as the optimal cut-off point, 228 and 159 patients presented with LSTs (≥ 3.5 cm) and SSTs (< 3.5 cm), respectively. The patients with LSTs had significantly worse prognoses than patients with SSTs (23.9% vs. 43.2%, P < 0.001). Multivariate analysis revealed that tumor size, histological type, invasion depth, and lymph node metastasis were independent predictors of overall survival. The addition of tumor size to the AJCC TNM staging improved the predictive accuracy of the 5-year survival rate by 3.9%. Further study showed that tumor size and T stage were independent predictors of the prognosis of node-negative patients, and the combination of tumor size and T stage improved the predictive accuracy by 3.7%. In conclusion, tumor size is indeed a simple and practical prognostic factor in patients with ESCC. It can be used to improve the prognostic accuracy of the current TNM staging, especially for patients with node-negative disease.
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Affiliation(s)
- Hongdian Zhang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Peng Tang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Xiaohui Miao
- Department of Thoracic Surgery, Tianjin Haihe Hospital, Tianjin 300350, China
| | - Yongyin Gao
- Department of Cardiopulmonary Function, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Xiaobin Shang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Zhao Ma
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Mingjian Yang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Hongjing Jiang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Zhongli Zhan
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Bin Meng
- Department of Pathology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, Tianjin 300060, China
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A Dendritic Cell Vaccine Combined With Radiotherapy Activates the Specific Immune Response in Patients With Esophageal Cancer. J Immunother 2018; 40:71-76. [PMID: 28125513 DOI: 10.1097/cji.0000000000000155] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dendritic cells (DC) are highly efficient antigen-presenting cells. DC may be used to create DC vaccines against cancer, but the optimal strategies remain to be elucidated. This study aimed to examine the benefits and adverse effects of using esophageal cancer cell antigens to stimulate DC to trigger the specific immune response in patients with esophageal cancer undergoing radiotherapy. This was an observational cohort study performed at Lianshui County People's Hospital between September 2010 and June 2012. Forty patients with esophageal cancer planned to receive radiotherapy were selected, and 28 received the DC vaccine. DC were isolated, loaded with antigens, and intradermally injected after being cultured for 1 week. One week after injection, the patients underwent a delayed-type hypersensitivity test. Serum Th1 cytokines [interleukin (IL)-2, IL-12, and interferon (IFN)-γ] and antigen-specific IFN-γCD8 T cells were tested before and after vaccination. Patients were followed up for 2 years. Adverse events were monitored. Patients in the vaccine group tolerated the DC vaccine. Levels of serum IL-2 (+92.4%), IL-12 (+70.9%), and IFN-γ (+214.3%) as well as the proportion of IFN-γCD8 T cells (3.0-16.4-fold) were significantly increased compared with baseline and the control group (all P<0.05). The 1- (82.1% vs. 50.0%, P=0.04) and 2-year survival (67.8% vs. 33.3%, P=0.04) was improved by vaccination. Only 2 patients showed mild fever. In conclusion, the DC vaccine triggered the specific immune response and induced the secretion of Th1 cytokines. The vaccine may lead to better survival, but this have to be confirmed. Adverse events were rare and mild.
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Cai W, Lu JJ, Xu R, Xin P, Xin J, Chen Y, Gao B, Chen J, Yang X. Survival based radiographic-grouping for esophageal squamous cell carcinoma may impact clinical T stage. Oncotarget 2018; 9:9512-9530. [PMID: 29507707 PMCID: PMC5823661 DOI: 10.18632/oncotarget.24056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 01/02/2018] [Indexed: 12/26/2022] Open
Abstract
Most patients diagnosed with thoracic esophageal squamous cell carcinoma (ESCC) have progressed beyond surgical resection as a therapeutic option. Difficulties in the proper assessment of tumor invasion depth before treatment complicate determination of the type and extent of therapy. Therefore, accurate tumor clinical staging is a necessity for identifying treatment options and aiding in patient prognosis. We investigated radiographic factors as prognostic indicators for survival in ESCC. Between July 2006 - July 2010, 324 thoracic ESCC patients who underwent surgery were selected. All patients received contrast enhanced preoperative chest CT scans and esophageal barium swallow examinations. Measurement of maximal lesion cross-sectional area, the largest long diameter, largest short diameter, CT-indicated lesion length, barium-indicated lesion length and the length of pericardial fat reduction were performed. Relationships between these indicators and post-surgical survival time and the cutoff values of related factors were analyzed. Maximum long diameter, maximum lesion area and lesion length, as measured by CT imaging, were correlated with survival. Survival effects were clearly associated with group intervals, calculated by a genetic algorithm, and tumor stages. Risk-stratification intervals of esophageal lesions from radiographic imaging included: maximum long diameter < 28.7, 28.7-34.6mm, 34.6-41.4mm and >41.4mm; maximum lesion area < 355.8mm2, 355.8-568.0mm2, 568.0-907.3mm2 and >907.3mm2; and CT-indicated lesion length <30.9mm, 30.9-57.3mm, 57.3-70.6mm and > 70.6mm. The reasonable stratification of maximum esophageal lesion area, largest long diameter and lesion length measured in CT is valuable for clinical T staging of ESCC. Radiographic parameters may have prognostic clinical value in the staging of esophageal carcinoma.
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Affiliation(s)
- Wenjie Cai
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Jiade J Lu
- Shanghai Proton and Heavy Ion Center, Shanghai 201315, P. R. China
| | - Rongyu Xu
- Department of Surgical Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Peiling Xin
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Jun Xin
- Department of Surgery, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Yayun Chen
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Bingzhong Gao
- Department of Radiation Oncology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Jieyun Chen
- Department of Radiology, First Hospital of Quanzhou Affiliated to Fujian Medical University, Quanzhou 362000, P. R. China
| | - Xiyang Yang
- Key Laboratory of Intelligent Computing and Information Processing, Quanzhou Normal University, Quanzhou 362000, P. R. China
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Jomrich G, Hollenstein M, John M, Baierl A, Paireder M, Kristo I, Ilhan-Mutlu A, Asari R, Preusser M, Schoppmann SF. The modified glasgow prognostic score is an independent prognostic indicator in neoadjuvantly treated adenocarcinoma of the esophagogastric junction. Oncotarget 2018; 9:6968-6976. [PMID: 29467943 PMCID: PMC5805529 DOI: 10.18632/oncotarget.24087] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022] Open
Abstract
The modified Glasgow Prognostic Score (mGPS) combines the indicators of decreased plasma albumin and elevated CRP. In a number of malignancies, elevated mGPS is associated with poor survival. Aim of this study was to investigate the prognostic role of mGPS in patients with neoadjuvantly treated adenocarcinomas of the esophagogastric junction 256 patients from a prospective database undergoing surgical resection after neoadjuvant treatment between 2003 and 2014 were evaluated. mGPS was scored as 0, 1, or 2 based on CRP (>1.0 mg/dl) and albumin (<35 g/L) from blood samples taken prior (preNT-mGPS) and after (postNT-mGPS) neoadjuvant therapy. Scores were correlated with clinicopathological patients’ characteristics. From 155 Patients, sufficient data was available. Median follow-up was 63.8 months (33.3–89.5 months). In univariate analysis, Cox proportional hazard model shows significant shorter patients OS (p = 0.04) and DFS (p = 0.02) for increased postNT-mGPS, preNT-hypoalbuminemia (OS: p = 0.003; DFS: p = 0.002) and post-NT-CRP (OS: p = 0.03; DFS: p = 0.04). Elevated postNT-mGPS and preNT-hypoalbuminemia remained significant prognostic factors in multivariate analysis for OS (p = 0.02; p = 0.005,) and DFS (p = 0.02, p = 0.004) with tumor differentiation and tumor staging as significant covariates. PostNT-mGPS and preNT-hypoalbuminemia are independent prognostic indicators in patients with neoadjuvantly treated adenocarcinomas of the esophagogastric junction and significantly associated with diminished OS and DFS.
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Affiliation(s)
- Gerd Jomrich
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Marlene Hollenstein
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Maximilian John
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Andreas Baierl
- Department of Statistics and Operations Research, University of Vienna, 1090 Vienna, Austria
| | - Matthias Paireder
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Ivan Kristo
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine 1, Medical University of Vienna, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Reza Asari
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Matthias Preusser
- Department of Medicine 1, Medical University of Vienna, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
| | - Sebastian F Schoppmann
- Department of Surgery, Medical University of Vienna, and Gastroesophageal Tumor Unit, Comprehensive Cancer Center (CCC), 1090 Vienna, Austria
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Shen WB, Gao HM, Zhu SC, Li YM, Li SG, Xu JR. Analysis of the causes of failure after radical surgery in patients with PT 3N 0M 0 thoracic esophageal squamous cell carcinoma and consideration of postoperative radiotherapy. World J Surg Oncol 2017; 15:192. [PMID: 29070049 PMCID: PMC5657067 DOI: 10.1186/s12957-017-1259-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/15/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Five-year overall survival rate of TESCC after surgery is low (approximately 30% to 60%), so it is meaningful to discuss the significance of PORT. METHODS We retrospectively collected the data of 227 patients with PT3N0M0 esophageal cancer (EC). The failure pattern after surgery was analyzed. Difference of adjuvant PORT in patients with PT3N0M0 TESCC and the appropriate population were explored based on the relevant studies. RESULTS There were 58 cases with intrathoracic locoregional recurrence (LRR) after radical surgery and 27 cases with distant metastasis, including 10 cases of recurrence. The recurrence rate of mediastinal lymph nodes in the thoracic cavity was 50.0%. Univariate analysis revealed that compared with patients with middle and lower thoracic EC, the 3/5-year survival rate of patients with upper thoracic EC was significantly lower, accompanied with remarkably higher thoracic LRR. Compared with those with moderately- and well-differentiated TESCC, the 3/5-year survival rate of patients with poorly differentiated TESCC was significantly lower, whereas the distant metastasis rate was notably higher. Multivariate analysis revealed that different lesion locations and different pathologic differentiation were the independent prognostic factors. The lesion location and degree of differentiation were the independent influencing factors for thoracic LRR and distant metastasis, respectively. CONCLUSION The intrathoracic LRR is the major failure pattern for patients with PT3N0M0 TESCC after conventional two-field lymphadenectomy. In addition, recurrence rate of PT3N0M0 TESCC was significantly higher in upper thoracic EC than in middle and lower thoracic EC. PORT is recommended to patients with PT3N0M0 upper TESCC.
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Affiliation(s)
- Wen-Bin Shen
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhaung, 050011, China
| | - Hong-Mei Gao
- Department of Radiation, The First Hospital of Shijiazhaung, Shijiazhaung, 050011, China
| | - Shu-Chai Zhu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhaung, 050011, China.
| | - You-Mei Li
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhaung, 050011, China
| | - Shu-Guang Li
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhaung, 050011, China
| | - Jin-Rui Xu
- Department of Radiation Oncology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankan Road, Chang'an District, Shijiazhaung, 050011, China
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Lin CS, Liu CY, Cheng CT, Tsai YC, Chiou LW, Lee MY, Liu CC, Shih CH. Prognostic role of initial pan-endoscopic tumor length at diagnosis in operable esophageal squamous cell carcinoma undergoing esophagectomy with or without neoadjuvant concurrent chemoradiotherapy. J Thorac Dis 2017; 9:3193-3207. [PMID: 29221296 DOI: 10.21037/jtd.2017.08.108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The objective of this study was to appraise the prognostic role of initial pan-endoscopic tumor length at diagnosis within or between operable esophageal squamous cell carcinoma (ESCC) undergoing upfront esophagectomy or neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by esophagectomy. Methods Between Jan 2001 and Dec 2013 in Koo-Foundation Sun Yat-sen Cancer Center in Taiwan, 101 ESCC patients who underwent upfront esophagectomy (surgery group) and 128 nCCRT followed by esophagectomy (nCCRT-surgery group) were retrospectively collected. Prognostic variables, including initial pan-endoscopic tumor length at diagnosis (sub-grouped ≤3, 3-5 and >5 cm), status of circumferential resection margin (CRM), and pathological T/N/M-status and cancer stage, were appraised within or between surgery and nCCRT-surgery groups. Results Within surgery group, longer initial pan-endoscopic tumor length at diagnosis (≤3, 3-5 and >5 cm; HR =1.000, 1.688 and 4.165; P=0.007) was an independent prognostic factor that correlated with advanced T/N/M-status, late cancer stage, and CRM invasion (all's P<0.001). Based on the initial pan-endoscopic tumor length at diagnosis ≤3, 3-5 and >5 cm, nCCRT-surgery group had a poorer (P=0.039), similar (P=0.447) and better (P<0.001) survivals than did surgery group, respectively. For those with initial pan-endoscopic tumor length at diagnosis >5 cm, nCCRT-surgery group had more percentage of T0/N0-status and stage 0 (all's P<0.05), and fewer rate of CRM invasion (P=0.036) than did surgery group. Conclusions Initial pan-endoscopic tumor length at diagnosis could be a criterion to select proper ESCC cases for nCCRT followed by esophagectomy to improve survival and reduce CRM invasion.
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Affiliation(s)
- Chen-Sung Lin
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Feng-Yuan Hospital, Ministry of Health and Welfare, Taichung City, Taiwan.,Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Chao-Yu Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan.,Division of Thoracic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chih-Tao Cheng
- National Defense University, Taipei, Taiwan.,Psychiatry Division, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Yu-Chen Tsai
- Department of Radiation Oncology, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Lun-Wei Chiou
- Department of Hematology and Medical Oncology, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Ming-Yuan Lee
- Department of Pathology, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Chia-Chuan Liu
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
| | - Chih-Hsun Shih
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Thoracic Surgery, Koo-Foundation Sun Yat-sen Cancer Center, Taipei, Taiwan
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Abstract
This article outlines a structure for assessing thoracic surgical quality and provides an overview of evidence-based quality metrics for surgical care in both lung cancer and esophageal cancer, with a focus on process and outcome measures in the preoperative, intraoperative, and postoperative setting.
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Affiliation(s)
- Jessica Hudson
- Department of Cardiothoracic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St Louis, MO 63110, USA
| | - Tara Semenkovich
- Department of Cardiothoracic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, St Louis, MO 63110, USA
| | - Varun Puri
- Department of Cardiothoracic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8234, St Louis, MO 63110, USA.
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Comparison of Inflammation-Based Prognostic Scores in a Cohort of Patients with Resectable Esophageal Cancer. Gastroenterol Res Pract 2017; 2017:1678584. [PMID: 28740506 PMCID: PMC5504944 DOI: 10.1155/2017/1678584] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/03/2017] [Indexed: 12/19/2022] Open
Abstract
Background A number of studies have revealed that inflammation-based prognostic scores, such as Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), and C-reactive protein and albumin ratio (C/A ratio), are associated with poor outcome in cancer patients. However, until now, no study has investigated the role of these prognostic scores in a cohort of neoadjuvant-treated esophageal adenocarcinomas (nEAC) and squamous cell carcinomas (nESCC). Methods Patients had laboratory measurements within three days before resection. GPS, mGPS, and C/A ratio were tested together with established clinicopathological factors in simple and multiple Cox regression analysis of overall survival (OS) and disease-free survival (DFS). Results A total of 283 patients (201 EAC and 82 ESCC) with locally advanced esophageal cancer were enrolled. 167 patients received neoadjuvant treatment (59.0%). Simple analysis revealed that there were significant differences in cancer-specific survival in relation to elevated C-reactive protein (p = 0.011), lymph node status (p < 0.001), UICC stage (p < 0.001), and nEAC (p = 0.005). mGPS (p = 0.024) showed statistical significance in simple analysis. No statistical significance could be found for GPS (p = 0.29), mGPS (p = 0.16), and C/A ratio (p = 0.76) in multiple analysis. Conclusion The investigated prognostic scores should be used and interpreted carefully, and established factors like histology, including tumor size and differentiation, lymph node involvement, and status of resection margin remain the only reliable prognostic factors for patients suffering from resectable EC.
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Abstract
OBJECTIVES To identify the associations of lymph node metastases (pN+), number of positive nodes, and pN subclassification with cancer, treatment, patient, geographic, and institutional variables, and to recommend extent of lymphadenectomy needed to accurately detect pN+ for esophageal cancer. SUMMARY BACKGROUND DATA Limited data and traditional analytic techniques have precluded identifying intricate associations of pN+ with other cancer, treatment, and patient characteristics. METHODS Data on 5806 esophagectomy patients from the Worldwide Esophageal Cancer Collaboration were analyzed by Random Forest machine learning techniques. RESULTS pN+, number of positive nodes, and pN subclassification were associated with increasing depth of cancer invasion (pT), increasing cancer length, decreasing cancer differentiation (G), and more regional lymph nodes resected. Lymphadenectomy necessary to accurately detect pN+ is 60 for shorter, well-differentiated cancers (<2.5 cm) and 20 for longer, poorly differentiated ones. CONCLUSIONS In esophageal cancer, pN+, increasing number of positive nodes, and increasing pN classification are associated with deeper invading, longer, and poorly differentiated cancers. Consequently, if the goal of lymphadenectomy is to accurately define pN+ status of such cancers, few nodes need to be removed. Conversely, superficial, shorter, and well-differentiated cancers require a more extensive lymphadenectomy to accurately define pN+ status.
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Zhang X, Wang Y, Li C, Helmersson J, Jiang Y, Ma G, Wang G, Dong W, Sang S, Du J. The prognostic value of tumor length to resectable esophageal squamous cell carcinoma: a retrospective study. PeerJ 2017; 5:e2943. [PMID: 28168111 PMCID: PMC5289103 DOI: 10.7717/peerj.2943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background The current TNM classification system does not consider tumor length for patients with esophageal carcinoma (EC). This study explored the effect of tumor length, in addition to tumor depth and lymph node involvement, on survival in patients with esophageal squamous cell carcinoma (ESCC). Methods A total of 498 ESCC patients who underwent surgical resection as the primary treatment were selected in the retrospective study. Pathological details were collected, which included tumor type, TNM stage, differentiation. Other collected information were: the types of esophageal resection, ABO blood group, family history and demographic and lifestyle factors. A time-dependent receiver operating characteristic (ROC) curve and a regression tree for survival were used to identify the cut-off point of tumor length, which was 3 cm. Univariate and multivariate Cox proportional hazard regression models were used to identify the prognostic factors to ESCC. Results & Discussion The 1-, 3-, 5-year overall survival rates were found to be 82.5%, 55.6%, and 35.1%, respectively. Patients who had larger tumor length (>3 cm) had a higher risk for death than the rest patients. From the univariate Cox proportional hazards regression model, the overall survival rate was significantly influenced by the depth of the tumor and lymph node involvement (either as dummy or continuous variables), Sex, and tumor length. Using these four variables in the multivariate Cox proportional hazard regression model, we found that the overall survival was significantly influenced by all variables except Sex. Therefore, in addition to the depth of the tumor and lymph node involvement (as either dummy or continuous variables), the tumor length is also an independent prognostic factor for ESCC. The overall survival rate was higher in a group with smaller tumor length (≤3 cm) than those patients with larger tumor length (>3 cm), no matter what the tumor stage was. Conclusion The tumor length was found to be an important prognostic factor for ESCC patients without receiving neoadjuvant therapy. The modification of EC staging system may consider tumor length to better predict ESCC survival and identify higher risk patients for postoperative therapy.
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Affiliation(s)
- Xiangwei Zhang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
| | - Yang Wang
- Department of Medical Imaging, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
| | - Cheng Li
- President's Office, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan , China
| | - Jing Helmersson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umea University , Umea , Sweden
| | - Yuanzhu Jiang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
| | - Guoyuan Ma
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
| | - Guanghui Wang
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
| | - Wei Dong
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
| | - Shaowei Sang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University , Jinan , China
| | - Jiajun Du
- Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University , Jinan , China
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Longitudinal, observational study on associations between postoperative nutritional vitamin D supplementation and clinical outcomes in esophageal cancer patients undergoing esophagectomy. Sci Rep 2016; 6:38962. [PMID: 27958342 PMCID: PMC5154179 DOI: 10.1038/srep38962] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/15/2016] [Indexed: 12/14/2022] Open
Abstract
Vitamin D can exert anticancer effect beyond bone and calcium metabolism. We aimed to investigate whether postoperative vitamin D supplementation affects quality of life (QOL) and survival in esophageal cancer (EC) patients. We utilized the widely used EORTC QLQ-C30 and QLQ-OES18 to assess QOL at EC diagnosis and 24 months after surgery. Generalized estimating equations (GEEs) were used to analysis the association of vitamin D supplement use with QOL. Kaplan-Meier method and Cox regression model were used to evaluate the prognostic value of vitamin D supplementation. The notably improved QOL were found among vitamin D supplementation users compared with non-users (p < 0.05). Kaplan-Meier analysis revealed that vitamin D supplement use was significantly associated with improved disease-free survival (DFS) (p = 0.030), but not related to overall survival (OS) (p = 0.303). The multivariable analysis further demonstrated vitamin D supplement use as an independent prognostic factor for DFS (p = 0.040; HR 0.610; 95% CI 0.381-0.978). In conclusion, these results showed that vitamin D supplement use could serve as a promising intervention to enhancing QOL and prolonging DFS in EC.
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Wu J, Chen QX. Prognostic and predictive significance of tumor length in patients with esophageal squamous cell carcinoma undergoing radical resection. BMC Cancer 2016; 16:394. [PMID: 27387460 PMCID: PMC4936257 DOI: 10.1186/s12885-016-2417-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/27/2016] [Indexed: 11/11/2022] Open
Abstract
Background The objective of this study was to investigate the prognostic and predictive significance of tumor length in patients with esophageal squamous cell carcinoma undergoing radical resection. Methods Tumor length and other clinicopathological variables were retrospectively evaluated in 1435 patients with squamous cell carcinoma treated with radical resection between 2003 and 2010. Tumor length was analyzed as categorical and continuous variable. Associations with overall survival were assessed with Cox proportional hazards models. Model-based nomograms were constructed. Predictive accuracy was measured with C-index. Decision curve analysis was used to evaluate clinical usefulness of prediction models. Results Both categorically and continuously coded tumor length were independent prognostic factors in multivariable analysis. Adding categorically and continuously coded tumor length to TNM staging model increased predictive accuracy by 0.2 and 0.4 % respectively. Decision curve analysis revealed that the models built by the addition of categorically or continuously coded tumor length did not perform better than TNM staging model. Conclusions Tumor length is an independent prognostic factor in patients with esophageal squamous cell carcinoma treated with radical resection. It increases predictive accuracy of TNM staging system for overall survival in these patients. But it does not increase clinical usefulness of TNM staging system as a prediction model. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2417-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Wu
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, 1 East Banshan Road, Hangzhou, 310022, Zhejiang Province, China.
| | - Qi-Xun Chen
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, 1 East Banshan Road, Hangzhou, 310022, Zhejiang Province, China
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Yamashita H, Takenaka R, Okuma K, Ootomo K, Nakagawa K. Prognostic factors in patients after definitive chemoradiation using involved-field radiotherapy for esophageal cancer in a phase II study. Thorac Cancer 2016; 7:564-569. [PMID: 27766787 PMCID: PMC5129562 DOI: 10.1111/1759-7714.12369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/01/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A prospective study was performed on the use of chemoradiotherapy (CRT) for esophageal cancer (EC) with involved-field radiation therapy (IFRT), based on 18-fluorodeoxyglucose positron-emission tomography. Prognostic factors for overall survival (OS) were analyzed. METHODS Eligible patients included 63 adults with newly diagnosed, untreated, inoperable stage I-IV EC with lymph node metastases. Patients received 80 mg/m2 nedaplatin per day on day 1, 800 mg/m2 5-fluorouracil on days 1-4 intravenously repeated every 28 days for two to four cycles, and combined IFRT. Irradiation was applied only to the primary tumor and positive lymph nodes. RESULTS Three-year progression-free survival and OS rates were 44.9% and 47.5%, respectively. The median survival time was 31.5 months. In univariate analyses for OS, Karnofsy Performance Scale <90% (P = 0.027), initial stage (P = 0.0087), T stage (P = 0.066), N stage (P = 0.000086), M stage of M1 (P = 0.0042), dysphagia score (P = 0.00017), tumor marker squamous cell carcinoma antigen >1.5 ng/mL (P = 0.0054), gross tumor volume (GTV) > 60 cc (P = 0.00011), and relative dose intensity (RDI) of chemotherapy ≤50% (P = 0.063) were found to be associated with significantly or marginally worse OS. In multivariate analyses for OS, GTV ≥ 60 cc (P = 0.00040), RDI < 50% (P = 0.00034), and cN2-3 (P = 0.0020) were associated with significantly worse OS. CONCLUSION GTV, RDI and N grading, were associated with OS after definitive CRT using IFRT for EC.
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Affiliation(s)
| | | | - Kae Okuma
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Kuni Ootomo
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
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Proposed Modification of Nodal Staging as an Alternative to the Seventh Edition of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System Improves the Prognostic Prediction in the Resected Esophageal Squamous-Cell Carcinoma. J Thorac Oncol 2016; 10:1091-8. [PMID: 26134226 DOI: 10.1097/jto.0000000000000580] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The 7th American Joint Committee on Cancer (AJCC) tumor-node-metastasis staging system for esophageal cancer defined N classification based on the number of metastatic lymph nodes (LNs). However, this classification might neglect the extent of LNs metastasis. This study aimed to revise N classification based on the extent of LNs metastasis and propose a modification to the current AJCC staging system for better representing the prognostic characteristics of Chinese esophageal squamous-cell carcinoma (ESCC). METHODS We retrospectively reviewed 1993 ESCC patients who underwent curative resection. The proposed N categories based on the number of LNs metastasis stations were compared with the current staging system by univariate and multivariate Cox regression analyses. Homogeneity, discriminatory ability, and monotonicity of gradients of two staging systems were compared using likelihood ratio χ statistics and Akaike information criterion calculations. RESULTS The survival differences were not significant for N2 versus N3 category (p = 0.231) and stages IIIB versus IIIC (p = 0.713) based on the 7th AJCC staging system. When the modified staging system was adopted, the survival difference for N2 versus N3 and IIIB versus IIIC could be well discriminated. Statistical analysis showed that the modified staging system had higher likelihood ratio χ scores and smaller Akaike information criterion values than the 7th AJCC staging system, which represented the optimum prognostic stratification. CONCLUSIONS The modified staging system with the revised N categories based on the number of LNs metastasis stations better predicts the survival of Chinese ESCC population than the 7th AJCC staging system. Further studies are required to confirm this result.
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Increasing tumor length is associated with regional lymph node metastases and decreased survival in esophageal cancer. Am J Surg 2016; 211:860-6. [DOI: 10.1016/j.amjsurg.2016.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/22/2022]
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Shapiro J, van Klaveren D, Lagarde SM, Toxopeus ELA, van der Gaast A, Hulshof MCCM, Wijnhoven BPL, van Berge Henegouwen MI, Steyerberg EW, van Lanschot JJB. Prediction of survival in patients with oesophageal or junctional cancer receiving neoadjuvant chemoradiotherapy and surgery. Br J Surg 2016; 103:1039-47. [DOI: 10.1002/bjs.10142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/23/2015] [Accepted: 02/03/2016] [Indexed: 12/27/2022]
Abstract
Abstract
Background
The value of conventional prognostic factors is unclear in the era of multimodal treatment for oesophageal cancer. This study aimed to quantify the impact of neoadjuvant chemoradiotherapy (nCRT) and surgery on well established prognostic factors, and to develop and validate a prognostic model.
Methods
Patients treated with nCRT plus surgery were included. Multivariable Cox modelling was used to identify prognostic factors for overall survival. A prediction model for individual survival was developed using stepwise backward selection. The model was internally validated leading to a nomogram for use in clinical practice.
Results
Some 626 patients who underwent nCRT plus surgery were included. In the multivariable model, only pretreatment cN category and ypN category were independent prognostic factors. The final prognostic model included cN, ypT and ypN categories, and had moderate discrimination (c-index at internal validation 0·63).
Conclusion
In patients with oesophageal or oesophagogastric cancer treated with nCRT plus surgery, overall survival can best be estimated using a prediction model based on cN, ypT and ypN categories. Predicted survival according to this model showed only moderate correlation with observed survival, emphasizing the need for new prognostic factors to improve survival prediction.
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Affiliation(s)
- J Shapiro
- Department of Surgery, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | - D van Klaveren
- Department of Public Health, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | - S M Lagarde
- Department of Surgery, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - E L A Toxopeus
- Department of Surgery, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | - A van der Gaast
- Department of Medical Oncology, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | - M C C M Hulshof
- Department of Radiotherapy, Academic Medical Centre, Amsterdam, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | | | - E W Steyerberg
- Department of Public Health, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
| | - J J B van Lanschot
- Department of Surgery, Erasmus MC – University Medical Centre, Rotterdam, The Netherlands
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Valmasoni M, Pierobon ES, Ruol A, De Pasqual CA, Zanchettin G, Moletta L, Salvador R, Costantini M, Merigliano S. Endoscopic Tumor Length Should Be Reincluded in the Esophageal Cancer Staging System: Analyses of 662 Consecutive Patients. PLoS One 2016; 11:e0153068. [PMID: 27088503 PMCID: PMC4835067 DOI: 10.1371/journal.pone.0153068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/23/2016] [Indexed: 12/23/2022] Open
Abstract
Esophageal cancer represents the 6th cause of cancer mortality in the World. New treatments led to outcome improvements, but patient selection and prognostic stratification is a critical aspect to gain maximum benefit from therapies. Today, patients are stratified into 9 prognostic groups, according to a staging system developed by the American Joint Committee on Cancer. Recently, trying to better select patients with curing possibilities several authors are reconsidering tumor length as a valuable prognostic parameter. Specifically, endoscopic tumor length can be easily measured with an esophageal endoscopy and, if its utility in esophageal cancer staging is demonstrated, it may represent a simple method to identify high risk patients and an easy-to-obtain variable in prognostic stratification. In this study we retrospectively analyzed 662 patients treated for esophageal cancer, stratified according to cancer histology and current staging system, to assess the possible role of endoscopic tumor length. We found a significant correlation between endoscopic tumor length, current staging parameters and 5-year survival, proving that endoscopic tumor length may be used as a simple risk stratification tool. Our results suggest a possible indication for preoperative therapy in early stage squamocellular carcinoma patients without lymph nodes involvement, who are currently treated with surgery alone.
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Affiliation(s)
- Michele Valmasoni
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Elisa Sefora Pierobon
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Alberto Ruol
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Carlo Alberto De Pasqual
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Gianpietro Zanchettin
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Lucia Moletta
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Renato Salvador
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Mario Costantini
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
| | - Stefano Merigliano
- 3 Surgical Clinic - Center for Esophageal Disease, Department of Surgical, Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova 35128, Italy
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Peng J, Wang WP, Dong T, Cai J, Ni PZ, Chen LQ. Refining the Nodal Staging for Esophageal Squamous Cell Carcinoma Based on Lymph Node Stations. Ann Thorac Surg 2016; 101:280-6. [DOI: 10.1016/j.athoracsur.2015.06.081] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 12/15/2022]
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Chen X, Chen J, Zheng X, Chen Y, Lin Y, Zheng Q, Zhu K, Pan J. Prognostic factors in patients with thoracic esophageal carcinoma staged pT1-4aN0M0 undergone esophagectomy with three-field lymphadenectomy. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:282. [PMID: 26697442 DOI: 10.3978/j.issn.2305-5839.2015.11.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To analyze prognostic factors in patients with thoracic esophageal carcinoma staged pT1-4aN0M0 and undergone esophagectomy with 3-field lymphadenectomy and to evaluate the effect of postoperative radiotherapy. METHODS From January 1993 to March 2007, 770 patients with stage pT1-4aN0M0 underwent 3-field lymphadenectomy at Fujian Province Cancer Hospital, China were enrolled for analysis. The study consisted of 770 patients with stage pT1-4aN0M0 who underwent 3-field lymphadenectomy at Fujian Province Cancer Hospital, China. A total of 687 had received surgery only, and 83 patients had undergone surgery followed by postoperative radiotherapy. Radiation dose was 50 Gy in 25 fractions. RESULTS The overall survival rates at 1, 3, 5, and 10 years were 92.9%, 80.8%, 71.7% and 57.4%, respectively. Univariate analysis showed that age and T staging were two independent factors on prognoses. Five-year survival in cases younger and older than 60 were 76.5% vs. 63.3% (P=0.001), while those of pT1, pT2, pT3 and pT4a were 83.8%, 78.8%, 67.8% and 54.1%, respectively (P=0.000). Five-year survival in group of simple surgery was 71.3%, compared with 74.5% in group of surgery plus postoperative radiotherapy (P=0.763), while stratified analysis indicated that postoperative radiotherapy was able to boost the survival of patients in pT4a which were 72.4% vs. 33.8% (P=0.036) and to lower relapse rate of tumor bed in patients with pT4a (P=0.005). Multivariate analysis showed that age and T staging were two independent factors on prognoses. CONCLUSIONS Patients with high T staging and at an age more than 60 turned out bad prognoses, neither could postoperative radiotherapy improve their survival.
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Affiliation(s)
- Xiaohui Chen
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Junqiang Chen
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Xiongwei Zheng
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Yuanmei Chen
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Yu Lin
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Qingfeng Zheng
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Kunshou Zhu
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
| | - Jianji Pan
- 1 Department of Oncological Surgery, 2 Department of Radiation Oncology, 3 Department of Pathology, The Teaching Hospital of Fujian Medical University, Fujian Provincial Cancer Hospital, Fuzhou 350014, China
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Yuan F, Qingfeng Z, Jia W, Chao L, Shi Y, Yuzhao W, Chao A, Yue Y. Influence of Metastatic Status and Number of Removed Lymph Nodes on Survival of Patients With Squamous Esophageal Carcinoma. Medicine (Baltimore) 2015; 94:e1973. [PMID: 26632887 PMCID: PMC4674190 DOI: 10.1097/md.0000000000001973] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to determine the impact of lymph node (LN) metastasis conditions on the prognosis of patients with esophageal squamous carcinoma and the minimum number of LNs that should be removed to maximize overall postoperative survival among patients with this specific pathologic subtype. In this study, 312 patients with thoracic squamous esophageal carcinoma who received in-patient thoracic surgery by the same surgeon in our hospital from August 1, 2003 to December 31, 2009 were recruited. Subsequently, Kaplan-Meier methods were used to determine associations between LN metastasis conditions and mortality and between the numbers of LNs removed during esophagectomy and mortality. Cox regression models were used to adjust for potential confounding covariates. According to Kaplan-Meier analyses, the number of metastatic LNs was a good predictor for the prognosis of patients with esophageal squamous carcinoma and the dissection of ≥ 29 LNs during thoracic surgery significantly improved patient survival (P = 0.011).Lymph node metastasis rates may be a significant predictor for the prognosis of patients with esophageal squamous carcinoma. The number of LNs removed during esophagectomy is an independent predictor for the survival of patients with esophageal squamous carcinoma with maximal postoperative survival after the removal of ≥ 29 LNs.
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Affiliation(s)
- Feng Yuan
- From the Department of Thoracic Surgery II, Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University School of Oncology, Beijing Cancer Hospital and Institute, Beijing, China
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Macrophage subtype predicts lymph node metastasis in oesophageal adenocarcinoma and promotes cancer cell invasion in vitro. Br J Cancer 2015; 113:738-46. [PMID: 26263481 PMCID: PMC4559839 DOI: 10.1038/bjc.2015.292] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/02/2015] [Accepted: 07/21/2015] [Indexed: 01/28/2023] Open
Abstract
Background: Currently, there is a lack of ideal biomarkers for predicting nodal status in preoperative stage of oesophageal adenocarcinoma (EAC) to aid optimising therapeutic options. We studied the potential of applying subtype macrophages to predict lymph node metastasis and prognosis in EAC. Material and Methods: Fifty-three EAC resection specimens were immunostained with CD68, CD40 (M1), and CD163 (M2). Lymphatic vessel density (LVD) was estimated with the staining of D2-40. Subsequently, we tested if M2d macrophage could promote EAC cell migration and invasion. Results: In EAC without neoadjuvant treatment, an increase in M2-like macrophage was associated with poor patient survival, independent of the locations of macrophages in tumour. The M2/M1 ratio that represented the balance between M2- and M1-like macrophages was significantly higher in nodal-positive EACs than that in nodal-negative EACs, and inversely correlated with patient overall survival. The M2/M1 ratio was not related to LVD. EAC cell polarised THP1 cell into M2d-like macrophage, which promoted EAC cell migration and invasion. Neoadjuvant therapy appeared to diminish the correlation between the M2/M1 ratio and survival. Conclusions: The ratio of M2/M1 macrophage may serve as a sensitive marker to predict lymph node metastasis and poor prognosis in EAC without neoadjuvant therapy. M2d macrophage may have important roles in EAC metastasis.
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Nomogram for predicting pathologically complete response after neoadjuvant chemoradiotherapy for oesophageal cancer. Radiother Oncol 2015; 115:392-8. [DOI: 10.1016/j.radonc.2015.04.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 12/13/2022]
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