Validation of a new approach for mortality risk assessment in oesophagectomy for cancer based on age- and gender-corrected body mass index

Meta-analysis of prognostic factors of overall survival in patients undergoing oesophagectomy for oesophageal cancer

INTRODUCTION

Currently, the American Joint Commission on Cancer (AJCC) staging system is used for prognostication for oesophageal cancer. However, several prognostically important factors have been reported but not incorporated. This meta-analysis aimed to characterize the impact of preoperative, operative, and oncological factors on the prognosis of patients undergoing curative resection for oesophageal cancer.

METHODS

This systematic review was performed according to PRISMA guidelines and eligible studies were identified through a search of PubMed, Scopus, and Cochrane CENTRAL databases up to 31 December 2018. A meta-analysis was conducted with the use of random-effects modeling to determine pooled univariable hazard ratios (HRs). The study was prospectively registered with the PROSPERO database (Registration: CRD42018157966).

RESULTS

One-hundred and seventy-one articles including 73,629 patients were assessed quantitatively. Of the 122 factors associated with survival, 39 were significant on pooled analysis. Of these. the strongly associated prognostic factors were 'pathological' T stage (HR: 2.07, CI95%: 1.77-2.43, P < 0.001), 'pathological' N stage (HR: 2.24, CI95%: 1.95-2.59, P < 0.001), perineural invasion (HR: 1.54, CI95%: 1.36-1.74, P < 0.001), circumferential resection margin (HR: 2.17, CI95%: 1.82-2.59, P < 0.001), poor tumor grade (HR: 1.53, CI95%: 1.34-1.74, P < 0.001), and high neutrophil:lymphocyte ratio (HR: 1.47, CI95%: 1.30-1.66, P < 0.001).

CONCLUSION

Several tumor biological variables not included in the AJCC 8th edition classification can impact on overall survival. Incorporation and validation of these factors into prognostic models and next edition of the AJCC system will enable personalized approach to prognostication and treatment.

Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma

BACKGROUND

The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed.

AIM

To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC.

METHODS

This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy.

RESULTS

Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m² and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m² and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m² and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m² and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS (P < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors.

CONCLUSION

PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.

Predictive value of preoperative weight loss on survival of elderly patients undergoing surgery for esophageal squamous cell carcinoma

Background

The role of preoperative weight loss (PWL) has rarely been studied in elderly patients undergoing surgery for esophageal squamous cell carcinoma (ESCC). The aim of this study is to evaluate whether PWL is an important determinant of survival in elderly patients following surgery for ESCC.

Methods

This retrospective study included a total of 974 elderly patients (≥65 years) who underwent esophagectomy for ESCC at the West China Hospital, Sichuan University from August 2005 to April 2013. PWL was determined as the percentage weight loss during the 3 months before admission. Patients were divided into three groups according to the PWL, defined as normal (PWL =0), slight PWL (0< PWL <10%) and severe PWL (PWL ≥10%). Prognostic factors were evaluated by using univariate and multivariate analyses.

Results

Patients were categorized as normal (n=605, 62.11%), slight PWL (n=284, n=29.17%) and severe PWL (n=85, 8.73%). Compared with patients without PWL, both the patients with slight and severe PWL suffered from higher risk of tumor depth invasion (P=0.002 and P<0.001, respectively), lymph node metastasis (P=0.009 and P=0.004, respectively) and advanced stage (P=0.006 and P<0.001, respectively). Both patients with slight and severe PWL were significantly associated with worse overall survival compared with patients without PWL (P=0.036 and P<0.001, respectively). Multivariate analysis revealed severe PWL was an independent prognostic factor of overall survival [hazard ratio (HR) =1.534, 95% CI: 1.163-2.024] after correcting for sex, body mass index (BMI), T stage, N stage, grade, and adjuvant therapy.

Conclusions

For elderly patients undergoing surgery for ESCC, PWL provided prognostic value for depth of tumor invasion, lymph node metastasis and advanced stage. PWL ≥10% was an independent predictor of worse overall survival.

Evolving management of metaplasia and dysplasia in Barrett's epithelium

Oesophageal cancer affects more than 450000 people worldwide and despite continued medical advancements the incidence of oesophageal cancer is increasing. Oesophageal cancer has a 5 year survival of 15%-25% and now globally attempts are made to more aggressively diagnose and treat Barrett's oesophagus the known precursor to invasive disease. Currently diagnosis the of Barrett's oesophagus is predominantly made after endoscopic visualisation and histopathological confirmation. Minimally invasive techniques are being developed to improve the viability of screening programs. The management of Barrett's oesophagus can vary greatly dependent on the presence and severity of dysplasia. There is no consensus between the major international medical societies to determine and agreed surveillance and intervention pathway. In this review we analysed the current literature to demonstrate the evolving management of metaplasia and dysplasia in Barrett's epithelium.