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Mohapatra S, Al Ghamdi SS, Charilaou P, Lopimpisuth C, Das A, Ngamruengphong S. Predictors for lymph node metastasis and survival of patients with T1b esophageal adenocarcinoma treated with surgery and endoscopic therapy: an analysis of the Surveillance, Epidemiology, and End Results database. Gastrointest Endosc 2024:S0016-5107(24)03190-0. [PMID: 38734257 DOI: 10.1016/j.gie.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND AIMS Limited data exist regarding the long-term outcomes of endoscopic therapy (ET) with or without chemoradiation therapy (CRT) for T1b esophageal adenocarcinoma (EAC). Our aim was to identify the risk factors for lymph node metastasis (LNM) in T1b EAC and assess how the chosen treatment modality affects overall survival (OS) and cancer-specific survival (CSS). METHODS We analyzed patients with histologically confirmed T1b EAC diagnosed between 2004 and 2018 using the Surveillance, Epidemiology, and End Results database. Focusing on T1bN0M0 staging, the patients were divided into 2 groups (ET [n = 174] and surgery [n = 769]), and OS and CSS rates were calculated. RESULTS Of 1418 patients with T1b EAC, 228 cases (16.1%) exhibited LNM at diagnosis. Notable risk factors for LNM included poorly differentiated tumor and lesion size ≥20 mm. For T1bN0M0 cases, ET was commonly performed from 2009 to 2018 (odds ratio [OR], 4.3), especially for patients aged ≥65 years (OR, 3.1) with tumor size <20 mm (OR, 2.3). During the median 50 months of follow-up, age ≥65 years (hazard ratio [HR], 1.9), ET (HR, 1.5), and CRT (HR, 1.4) were associated with poorer OS. Factors linked to decreased CSS were age ≥65 years (subhazard ratio [SHR], 1.6), poorly differentiated tumors (SHR, 1.5), and CRT (SHR, 1.5). CONCLUSIONS In T1b EAC, tumor size ≥20 mm and poor differentiation are notable risk factors for LNM. ET exhibited comparable CSS outcomes to surgery for carefully selected T1bN0M0 lesions. CRT did not provide additional survival benefit for these lesions; however, large-scale studies are required to validate this finding.
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Affiliation(s)
- Sonmoon Mohapatra
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Sarah S Al Ghamdi
- Department of Gastroenterology and Hepatology, Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paris Charilaou
- Department of Gastroenterology and Hepatology, New York Presbyterian Hospital/Weill-Cornell Medical College, New York, New York, USA
| | - Chawin Lopimpisuth
- Department of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Amit Das
- Department of Computer Science, Dartmouth College, Hanover, New Hampshire, USA
| | - Saowanee Ngamruengphong
- Department of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA.
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Song JY, Moon SH, Suh YG, Kim JH, Oh D, Noh JM, Jeong JU, Cho IJ, Kang MK, Kim JH, Kim YS, Kim HJ, Park WY, Kim BH, Kim HJ. Definitive radiotherapy in patients with clinical T1N0M0 esophageal squamous cell carcinoma: A multicenter retrospective study (KROG 21-10). Radiother Oncol 2023; 189:109936. [PMID: 37783290 DOI: 10.1016/j.radonc.2023.109936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/30/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To assess the failure pattern and analyze the treatment scheme of definitive radiation therapy (RT) for T1N0M0 esophageal squamous cell carcinoma (ESCC). METHODS We performed a multi-institutional retrospective analysis in T1N0M0 ESCC patients who underwent definitive RT from 2010 to 2019. Patterns of failure were demonstrated as in-, and out-field locoregional, and distant metastasis. In the analysis, freedom-from locoregional recurrence (FFLRR) and their association with clinicopathologic factors were evaluated. Propensity score matching in cT1b patients was done. RESULTS 168 patients were included with a median follow-up of 34.0 months, and 26 cT1a, 116 cT1b disease. The rates of 3-year all and locoregional recurrence for cT1a were 30.5% and 24.1% and those for cT1b were 27.1% and 25.9%, respectively. Among 116 cT1b patients, 69 patients received elective nodal irradiation (ENI) and 47 received involved field irradiation (IFI). After propensity score matching, the 3-year FFLRR rate was 84.5%. There was no difference between ENI and IFI in FFLRR (P = 0.831) and OS (P = 0.525). The 3-year FFLRR was 83.8% (95% Confidence interval (CI), 61.8-93.8%) in IFI group and 85.3% (95% CI, 65.1-94.3%) in ENI group. In multivariate analysis, concurrent chemotherapy use was marginally associated with FFLRR (Hazard ratio, 0.16; P = 0.064). CONCLUSION cT1a patients who cannot receive endoscopic resection showed similar failure rates as cT1b patients, questioning the staging accuracy and raised the need for thorough treatment like chemoradiotherapy. In cT1b patients, IFI with 50 to 60 Gy and concurrent chemotherapy could be reasonable.
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Affiliation(s)
- Jun Yeong Song
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Sung Ho Moon
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea.
| | - Yang-Gun Suh
- Proton Therapy Center, National Cancer Center, Goyang, Republic of Korea
| | - Jong-Hoon Kim
- Department of Radiation Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae-Uk Jeong
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Ick Joon Cho
- Department of Radiation Oncology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jin Hee Kim
- Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Young Suk Kim
- Department of Radiation Oncology, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Hun Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University of Medicine, Inchon, Republic of Korea
| | - Woo-Yoon Park
- Department of Radiation Oncology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul National University, College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University, College of Medicine, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University, College of Medicine, Seoul, Republic of Korea.
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Li Y, Wang JX, Yibi RH. Prediction of lymph node metastasis in early esophageal cancer. World J Gastrointest Surg 2023; 15:2294-2304. [PMID: 37969711 PMCID: PMC10642458 DOI: 10.4240/wjgs.v15.i10.2294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Given the poor prognosis of patients with lymph node metastasis, estimating the lymph node status in patients with early esophageal cancer is crucial. Indicators that could be used to predict lymph node metastasis in early esophageal cancer have been reported in many recent studies, but no recent studies have included a review of this subject. AIM To review indicators predicting lymph node metastasis in early esophageal squamous cell carcinoma (ESCC) and early esophageal adenocarcinoma (EAC). METHODS We searched PubMed with "[early esophageal cancer (Title/Abstract)] and [lymph node (Title/Abstract)]" or "[early esophageal carcinoma (Title/Abstract)] and [lymph node (Title/Abstract)]" or "[superficial esophageal cancer (Title/Abstract)] and [lymph node (Title/Abstract)]." A total of 29 studies were eligible for analysis. RESULTS Preoperative imaging (size), serum markers (microRNA-218), postoperative pathology and immunohistochemical analysis (depth of invasion, tumor size, differentiation grade, lymphovascular invasion, neural invasion, expression of PIM-1 < 30%) were predictive factors for lymph node metastasis in both early ESCC and EAC. Serum markers (thymidine kinase 1 ≥ 3.38 pmol/L; cytokeratin 19 fragment antigen 21-1 > 3.30 ng/mL; stathmin-1) and postoperative pathology and immunohistochemical analysis (overexpression of cortactin, mixed-lineage leukaemia 2, and stanniocalcin-1) were predictive for lymph node metastasis in early ESCC. Transcription of CD69, myeloid differentiation protein 88 and toll-like receptor 4 and low expression of olfactomedin 4 were predictive of lymph node metastasis in early EAC. A total of 6 comprehensive models for early ESCC, including logistic regression model, nomogram, and artificial neural network (ANN), were reviewed. The areas under the receiver operating characteristic curve of these models reached 0.789-0.938, and the ANN performed best. As all these models relied on postoperative pathology, further models focusing on serum markers, imaging and immunohistochemical indicators are still needed. CONCLUSION Various factors were predictive of lymph node metastasis in early esophageal cancer, and present comprehensive models predicting lymph node metastasis in early ESCC mainly relied on postoperative pathology. Further studies focusing on serum markers, imaging and immunohistochemical indicators are still in need.
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Affiliation(s)
- Yan Li
- Department of Gastroenterology, Lhasa People’s Hospital, Lhasa 850000, Tibet Autonomous Region, China
| | - Jun-Xiong Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
- National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing 100000, China
| | - Ran-Hen Yibi
- Department of Gastroenterology, Lhasa People’s Hospital, Lhasa 850000, Tibet Autonomous Region, China
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Endoscopic therapy replaces surgery for clinical T1 oesophageal cancer in the Netherlands: a nationwide population-based study. Surg Endosc 2023:10.1007/s00464-023-09914-x. [PMID: 36849563 DOI: 10.1007/s00464-023-09914-x] [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: 09/04/2022] [Accepted: 01/28/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Endoscopic resection for early oesophageal cancer was introduced around 2000 in the Netherlands. The scientific question was how the treatment and survival of early oesophageal and gastro-oesophageal junction cancer has changed over time in the Netherlands. METHODS Data were obtained from the nationwide population-based Netherlands Cancer Registry. All patients diagnosed with clinical in situ or T1 oesophageal or GOJ cancer without lymph node or distance metastasis during the study period (2000-2014) were extracted. Primary outcome parameters were the trends in treatment modalities over time and relative survival of each treatment regime. RESULTS A total of 1020 patients were diagnosed with a clinical in situ or T1 oesophageal or gastro-oesophageal junction cancer without lymph node or distance metastasis. The proportion of patients who received endoscopic treatment increased from 2.5% in 2000 to 58.1% in 2014. During the same period the proportion of patients who received surgery decreased from 57.5 to 23.1%. Five-year relative survival of all patients was 69%. Five-year relative survival after endoscopic therapy was 83% and after surgery 80%. Relative excess risk analyses showed no significant difference in survival between patients in the endoscopic therapy group and patients in the surgery group after adjustment for age, sex, clinical TNM classification, morphology and tumour location (RER 1.15; CI 0.76-1.75; p 0.76). CONCLUSION Our results demonstrate an increase in endoscopic treatment and a decrease of surgical treatment for in situ and T1 oesophageal/GOJ cancer between 2000-2014 in the Netherlands. The relative 5-year survival after endoscopic treatment is high (83%) and comparable with surgery (80%).
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Zhu K, Jia M, Ji L, Wang G. Risk factors for distant metastasis and prognosis in stage T1 esophageal cancer: A population-based study. Front Surg 2023; 9:988460. [PMID: 36684271 PMCID: PMC9852716 DOI: 10.3389/fsurg.2022.988460] [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: 07/07/2022] [Accepted: 11/14/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose Stage T1 esophageal cancer (EC) with distant metastasis (DM) is rare and poorly understood. In this study, we aimed to construct and validate a novel nomogram for predicting the probability of DM in T1 EC patients. Methods A total of 1,663 eligible T1 EC patients were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. The patients were randomly divided into training and validation cohorts. Univariate and multivariate logistic analyses in the training cohort were used to identify risk factors related to DM, and then these risk factors were applied to construct the nomogram. Receiver operating characteristic (ROC) curves, the area under the curve (AUC), calibration plots, the Hosmer-Lemeshow (HL) test, and decision curve analysis (DCA) were used to evaluate the nomogram. Results Among the 1,663 patients identified, 143 (8.6%) had DM. Five risk factors (tumor location, lymph node status, tumor length, T1 subtype, and grade) were significant predictors of DM. The AUC values were 0.828 and 0.851 in the training cohort and validation cohort, respectively, revealing good discrimination. The calibration plots in the training cohort and validation cohort both showed good consistency. DCA showed that the nomogram was clinically effective. In addition, the nomogram has a good risk stratification ability to identify patients with different risks according to the nomogram score. In terms of survival analysis, univariate and multivariate Cox analyses showed that age, race, tumor length, grade, lymph node status, M stage and treatment were significant prognostic factors for overall survival (OS). For cancer-specific survival (CSS), the independent prognostic factors were age, tumor length, histology, grade, lymph node status, M stage and treatment. Conclusion The nomogram could effectively predict the probability of DM in T1 EC patients. It can aid clinicians in detecting high-risk patients and making individual clinical decisions.
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Affiliation(s)
- Kai Zhu
- Department of Thoracic Surgery, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Mingyue Jia
- Department of Obstetrics and Gynecology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Linlin Ji
- Department of Thoracic Surgery, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China
| | - Guangshun Wang
- Department of Thoracic Surgery, Tianjin Baodi Hospital, Baodi Clinical College of Tianjin Medical University, Tianjin, China,Correspondence: Guangshun Wang
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Zhang H, Yan X, Yang YS, Yang H, Yuan Y, Tian D, Li Y, Wu ZY, Wang Y, Fu JH, Chen LQ. The Least Nodal Disease Burden Defines the Minimum Number of Nodes Retrieved for Esophageal Squamous Cell Carcinoma. Front Oncol 2022; 12:764227. [PMID: 35340267 PMCID: PMC8948424 DOI: 10.3389/fonc.2022.764227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
Background Clinically, a single positive lymph node (SPLN) should indicate the least nodal disease burden in node-positive patients with esophageal squamous cell carcinoma (ESCC) and may also be used to define the minimum number of examined lymph nodes (NELNs) in ESCC patients. Methods Data from three Chinese cohorts of 2448 ESCC patients who underwent esophagectomy between 2008 and 2012 were retrospectively analyzed. Based on lymph node status, patients were divided into two groups: N0 ESCC and SPLN ESCC. A Cox proportional hazards regression model was used to determine the minimum NELNs retrieved to maximize survival for ESCC patients with localized lymph node involvement. The results were then validated externally in the SEER database. Results A total of 1866 patients were pathologically diagnosed with N0 ESCC, and 582 patients were diagnosed with SPLN ESCC. The overall survival rate of patients with N0 ESCC was significantly better than that of patients with SPLN ESCC (HR 1.88, 95% CI 1.64-2.13, P<0.001), but no significant difference was found between SPLN ESCC patients with ≥ 20 lymph nodes harvested and N0 ESCC patients (HR 1.20, 95% CI 0.95-1.52, P=0.13). Analysis of patients selected from the SEER database showed the same trend, and no significant difference was observed between N0 ESCC patients and SPLN ESCC patients with ≥ 20 lymph nodes retrieved (HR: 1.02, 95% CI 0.72-1.43, P=0.92). Conclusions A minimum of 20 lymph nodes retrieved should be introduced as a quality indicator for ESCC patients with localized lymph node involvement.
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Affiliation(s)
- Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xiuji Yan
- Department of Plastic and Burns Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Shang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Yang
- Department of Thoracic Oncology, Sun Yatsen University Cancer Center, Guangzhou, China
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Dong Tian
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China.,Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nangchong, China
| | - Yin Li
- Department of Thoracic Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Zhi-Yong Wu
- Department of Oncology Surgery, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jian-Hua Fu
- Department of Thoracic Oncology, Sun Yatsen University Cancer Center, Guangzhou, China
| | - Long-Qi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
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Shi M, Zhai GQ. Models for Predicting Early Death in Patients With Stage IV Esophageal Cancer: A Surveillance, Epidemiology, and End Results-Based Cohort Study. Cancer Control 2022; 29:10732748211072976. [PMID: 35037487 PMCID: PMC8777366 DOI: 10.1177/10732748211072976] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Despite enormous progress in the stage IV esophageal cancer (EC) treatment,
some patients experience early death after diagnosis. This study aimed to
identify the early death risk factors and construct models for predicting
early death in stage IV EC patients. Methods Stage IV EC patients diagnosed between 2010 and 2015 in the Surveillance,
Epidemiology, and End Results (SEER) database were selected. Early death was
defined as death within 3 months of diagnosis, with or without therapy.
Early death risk factors were identified using logistic regression analyses
and further used to construct predictive models. The concordance index
(C-index), calibration curves, and decision curve analyses (DCA) were used
to assess model performance. Results Out of 4411 patients enrolled, 1779 died within 3 months. Histologic grade,
therapy, the status of the bone, liver, brain and lung metastasis, marriage,
and insurance were independent factors for early death in stage IV EC
patients. Histologic grade and the status of the bone and liver metastases
were independent factors for early death in both chemoradiotherapy and
untreated groups. Based on these variables, predictive models were
constructed. The C-index was .613 (95% confidence interval (CI),
[.573–.653]) and .635 (95% CI, [.596–.674]) in the chemoradiotherapy and
untreated groups, respectively, while calibration curves and DCA showed
moderate performance. Conclusions More than 40% of stage IV EC patients suffered from an early death. The
models could help clinicians discriminate between low and high risks of
early death and strategize individually-tailed therapeutic interventions in
stage IV EC patients.
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Affiliation(s)
- Min Shi
- Department of Gastroenterology, Changzhou Maternal and Child Health Care Hospital, Changzhou, China
| | - Guo-Qing Zhai
- Department of Gastroenterology, Liyang People's Hospital, Liyang Branch of Jiangsu Province Hospital, Liyang, China
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Li Y, Ye LS, Hu B. Synchronous multiple primary malignancies of the esophagus, stomach, and jejunum: A case report. World J Clin Cases 2021; 9:9889-9895. [PMID: 34877327 PMCID: PMC8610897 DOI: 10.12998/wjcc.v9.i32.9889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/26/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Treatment of synchronous multiple primary malignancies is quite often very challenging. Herein, we report on a rare case of synchronous multiple primary malignancies in the esophagus, stomach, and jejunum.
CASE SUMMARY A 50-year-old man who was a heavy drinker and smoker with a poor diet, and had a family history of cancer sought treatment due to dysphagia lasting for 4 mo. He was finally diagnosed with lower esophageal squamous cell carcinoma (pT3N2M0, G2, stage IIIB), gastric angular adenocarcinoma (pT3N2M0, G2-G3, stage IIIA) with greater omental lymph node metastasis, and jejunal stromal tumor (high risk). The high-risk jejunal stromal tumor was found during surgery. In spite of radical resection and adjuvant chemotherapy, lymph node metastasis occurred 21 mo later. The patient responded poorly to additional chemotherapy and refused further examination and therapy. He died of widespread metastases 33 mo after surgery.
CONCLUSION This case indicates a poor prognosis of synchronous multiple advanced primary malignancies and the importance of comprehensive assessment in the population at high risk for cancer.
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Affiliation(s)
- Yan Li
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lian-Song Ye
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Pan L, Liu X, Wang W, Zhu L, Yu W, Lv W, Hu J. The Influence of Different Treatment Strategies on the Long-Term Prognosis of T1 Stage Esophageal Cancer Patients. Front Oncol 2021; 11:700088. [PMID: 34722247 PMCID: PMC8551622 DOI: 10.3389/fonc.2021.700088] [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: 04/25/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the long-term prognosis effects of non-esophagectomy and esophagectomy on patients with T1 stage esophageal cancer. Methods All esophageal cancer patients in the study were included from the National Surveillance Epidemiology and End Results (SEER) database between 2005-2015. These patients were classified into non-esophagectomy group and esophagectomy group according to therapy methods and were compared in terms of esophagus cancer specific survival (ECSS) and overall survival (OS) rates. Results A total of 591 patients with T1 stage esophageal cancer were enrolled in this study, including 212 non-esophagectomy patients and 111 esophagectomy patients in the T1a subgroup and 37 non-esophagectomy patients and 140 esophagectomy patients in the T1b subgroup. In all T1 stage esophageal cancer patients, there was no difference in the effect of non-esophagectomy and esophagectomy on postoperative OS, but postoperative ECSS in patients treated with non-esophagectomy was significantly better than those treated with esophagectomy. Cox proportional hazards regression model analysis showed that the risk factors affecting ECSS included race, primary site, tumor size, grade, and AJCC stage but factors affecting OS only include tumor size, grade, and AJCC stage in T1 stage patients. In the subgroup analysis, there was no difference in either ECSS or OS between the non-esophagectomy group and the esophagectomy group in T1a patients. However, in T1b patients, the OS after esophagectomy was considerably better than that of non-esophagectomy. Conclusions Non-esophagectomy, including a variety of non-invasive procedures, is a safe and available option for patients with T1a stage esophageal cancer. For some T1b esophageal cancer patients, esophagectomy cannot be replaced at present due to its diagnostic and therapeutic effect on lymph node metastasis.
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Affiliation(s)
- Liang Pan
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingyu Liu
- Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weidong Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linhai Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wenfeng Yu
- Department of Thoracic Surgery, The Hangzhou Chest Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wang Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Hong TH, Kim HK, Lee G, Shin S, Cho JH, Choi YS, Zo JI, Shim YM. Role of Recurrent Laryngeal Nerve Lymph Node Dissection in Surgery of Early-Stage Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2021; 29:627-639. [PMID: 34480274 DOI: 10.1245/s10434-021-10757-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/01/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND In esophageal cancer surgery, it is difficult to perform thorough dissection of lymph nodes along the recurrent laryngeal nerve (RLN-LN). However, there are limited data regarding the necessity of RLN-LN dissection in surgery for superficial esophageal squamous carcinoma (focused on T1b tumor) and its role in locoregional control and accurate nodal staging. METHODS Between 2001 and 2016, 567 patients with pT1N0 and 927 patients with cT1N0 squamous cell carcinoma were identified in a prospectively maintained, single institution esophagectomy registry. Sufficient or insufficient RLN-LN assessment group was defined by receiver operating characteristic curve analysis of the number of RLN-LN harvested. To mitigate bias, inverse probability weighting adjustment and several sensitivity analyses were performed. RESULTS In the pT1N0 cohort, patients with sufficient (≥ 4) harvested RLN-LNs showed significantly superior 5-year recurrence-free survival (89.1% versus 74.8%, log-rank P < 0.001). Patients with insufficient RLN-LN dissection mainly developed locoregional failure at the upper mediastinal or cervical area (87% of total recurred cases). The survival impact of sufficient RLN-LN dissection was more prominent in subsets of upper-middle thoracic tumors or with deep submucosal invasion. In the analysis on cT1N0 cohort, sufficient RLN-LN assessment conferred a 1.5-fold increase in the discovery of positive-nodal disease (19.4% versus 27.8%, P = 0.008). CONCLUSIONS Adequate RLN-LN dissection during surgery may help reduce the risk of recurrence and enhance the accuracy of nodal staging in early-stage esophageal squamous cell carcinoma. Therefore, meticulous surgical evaluation for this region should not be underrated, particularly in the high-risk subset with lymph node metastasis. Visual Abstract Graphical summary of key study findings. T wo cohorts (pT1 and cT1 ; both mainly comprised T1b ) were analyzed for separate purposes; the former controlled for pathologic stage was primarily analyzed in terms of survival and recurrence hazard, whereas the latter (controlled for clinical was used for stage migration ( and intention to treat analysis. Th e results show the significance of adequate bilateral RLN LN in the surgery for early stage ESCC (particularly those with T1b)T1b), in terms of accurate nodal staging, effective nodal clearance, and reduced regional.
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Affiliation(s)
- Tae Hee Hong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Genehee Lee
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.,Samsung Medical Center, Patient-Centered Outcomes Research Institute, Seoul, Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. .,Samsung Medical Center, Patient-Centered Outcomes Research Institute, Seoul, Korea.
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11
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Wang W, Chen D, Sang Y, Chen C, Zhang Y, Mao Y, Chen Y. Endoscopic resection versus esophagectomy for patients with small-sized T1N0 esophageal cancer: A propensity-matched study. Clin Res Hepatol Gastroenterol 2021; 45:101543. [PMID: 33554864 DOI: 10.1016/j.clinre.2020.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/25/2020] [Accepted: 09/11/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Endoscopic resection (ER) has been rapidly adopted in the treatment of early-stage esophageal cancer. We aimed to compare the outcomes of ER with esophagectomy for patients with small-sized (≤2 cm) stage T1a and T1b esophageal cancer in a population-based cohort. METHODS We queried the Surveillance, Epidemiology, and End Results database for patients with T1N0M0 esophageal cancer who underwent ER or esophagectomy and generated a balanced cohort with 217 matched pairs using propensity score matching (PSM). Kaplan-Meier method and multivariable Cox regression analysis were employed to investigate the matched cohort. Subgroup analyses of T stage were also performed. RESULTS We identified 702 patients; 309 (44.0 %) underwent ER, and 393 (56.0 %) underwent esophagectomy. In the unmatched cohort, patients who underwent ER were older, more likely to have a T1a stage, and less likely to receive lymph node sampling. In the entire matched cohort, multivariate analysis found esophagectomy were associated with better overall survival (OS) (HR: 0.62, 95 % CI: 0.40-0.96, p = 0.032) than ER, but no significant difference in esophageal cancer-specific survival (ECSS) (HR: 1.37, 95 % CI: 0.64-2.96, p = 0.420) between the two procedures. The results were similar for subgroup analyses of stage T1b patients. However, ER and esophagectomy were associated with similar OS (HR: 0.74, 95 % CI: 0.41-1.36; p = 0.334) and ECSS (HR: 3.69, 95 % CI: 0.95-14.39; p = 0.060) in patients with stage T1a disease. CONCLUSIONS In patients with stage T1 esophageal cancer, ER was similar to esophagectomy in terms of oncologic outcomes. More prospective studies should be implemented to determine the optimal treatment for T1b esophageal cancer patients with risk factors.
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Affiliation(s)
- Wenjia Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Donglai Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yonghua Sang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yongsheng Zhang
- Department of Pathology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiming Mao
- Department of Thoracic Surgery, Suzhou Kowloon Hospital Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Yongbing Chen
- Department of Thoracic Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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12
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Yang J, Shang J, Song Q, Yang Z, Chen J, Yu Y, Shi L. ECCDIA: an interactive web tool for the comprehensive analysis of clinical and survival data of esophageal cancer patients. BMC Cancer 2020; 20:985. [PMID: 33046018 PMCID: PMC7552344 DOI: 10.1186/s12885-020-07479-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Esophageal cancer (EC) is considered as one of the deadliest malignancies with respect to incidence and mortality rate, and numerous risk factors may affect the prognosis of EC patients. For better understanding of the risk factors associated with the onset and prognosis of this malignancy, we develop an interactive web-based tool for the convenient analysis of clinical and survival characteristics of EC patients. METHODS The clinical data were obtained from The Surveillance, Epidemiology, and End Results (SEER) database. Seven analysis and visualization modules were built with Shiny. RESULTS The Esophageal Cancer Clinical Data Interactive Analysis (ECCDIA, http://webapps.3steps.cn/ECCDIA/ ) was developed to provide basic data analysis, visualization, survival analysis, and nomogram of the overall group and subgroups of 77,273 EC patients recorded in SEER. The basic data analysis modules contained distribution analysis of clinical factor ratios, Sankey plot analysis for relationships between clinical factors, and a map for visualizing the distribution of clinical factors. The survival analysis included Kaplan-Meier (K-M) analysis and Cox analysis for different subgroups of EC patients. The nomogram module enabled clinicians to precisely predict the survival probability of different subgroups of EC patients. CONCLUSION ECCDIA provides clinicians with an interactive prediction and visualization tool for visualizing invaluable clinical and prognostic information of individual EC patients, further providing useful information for better understanding of esophageal cancer.
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Affiliation(s)
- Jingcheng Yang
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Shanghai Cancer Hospital/Cancer Institute, Fudan University, Shanghai, 200438, China
| | - Jun Shang
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Shanghai Cancer Hospital/Cancer Institute, Fudan University, Shanghai, 200438, China
| | - Qian Song
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Shanghai Cancer Hospital/Cancer Institute, Fudan University, Shanghai, 200438, China
| | - Zuyi Yang
- Department of Hematology and Oncology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, 310015, Zhejiang, China
| | - Jianing Chen
- Medical College of Soochow University, Suzhou, 215000, Jiangsu, China
| | - Ying Yu
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Shanghai Cancer Hospital/Cancer Institute, Fudan University, Shanghai, 200438, China. .,Human Phenome Institute, Fudan University, Shanghai, 201203, China. .,Fudan-Gospel Joint Research Center for Precision Medicine, Fudan University, Shanghai, 200438, China.
| | - Leming Shi
- State Key Laboratory of Genetic Engineering, School of Life Sciences and Shanghai Cancer Hospital/Cancer Institute, Fudan University, Shanghai, 200438, China. .,Human Phenome Institute, Fudan University, Shanghai, 201203, China. .,Fudan-Gospel Joint Research Center for Precision Medicine, Fudan University, Shanghai, 200438, China.
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13
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Yu X, Gao S, Xue Q, Tan F, Gao Y, Mao Y, Wang D, Zhao J, Li Y, He J, Mu J. Development of a predictive nomogram for cause-specific mortality in surgically resected early-stage oesophageal cancer: a Surveillance, Epidemiology, and End Results (SEER) analysis. J Thorac Dis 2020; 12:2583-2594. [PMID: 32642166 PMCID: PMC7330307 DOI: 10.21037/jtd.2020.03.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background The aim of this population-based study was to perform competing risk analysis and estimate cancer- and other cause-specific mortality in patients who underwent oesophagectomy with pT1N0M0 oesophageal cancer (EC). A competing risks nomogram was also developed to predict the proportional of death from each specific cause. Methods A total of 1,144 patients who received oesophagectomy for pT1N0M0 EC between 2010 and 2015 from SEER database were included. The cumulative incidence function was used to evaluate each cause of death, and the significant difference was assessed by the Grey’s test. A nomogram was established using the proportional subdistribution hazard analysis to identify predictors for each cause-specific death. Results The 5-year cumulative incidence of cancer-specific death for surgically resected pT1N0M0 EC was 15.7%, and the incidence was 11.2% for other cause-specific death. Age, tumour length, pT1 substage, grade, history and primary site were identified as predictive factors for EC-specific death, but only age, tumor length and pT1 substage were associated with death from other cause. Our nomograms showed a relative good discriminative ability, with c-index of 0.663 for the EC-specific mortality model and 0.699 for the other cause-specific mortality model. The calibration curves showed a good match between the nomogram-predicted probabilities and the actual probabilities. Conclusions In patients who underwent curative-intent resection for pT1N0M0 EC, death from other causes was an important competing event. During clinical decision making and patient-clinician communication, our quantifiable nomograms could provide a rapid and precise judgement of the risk of death from each cause.
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Affiliation(s)
- Xiangyang Yu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Dali Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
| | - Juwei Mu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.,Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
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14
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Ethics (Informed Consent and Conflicts of Interest). Clin Trials 2020. [DOI: 10.1007/978-3-030-35488-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Qin J, Peng Y, Chen W, Ma H, Zheng Y, Li Y, Wang J. Comparative study of esophagectomy, endoscopic therapy, and radiotherapy for cT1N0M0 esophageal cancer in elderly patients: A SEER database analysis. Thorac Cancer 2019; 10:1511-1520. [PMID: 31199600 PMCID: PMC6610249 DOI: 10.1111/1759-7714.13080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The number of patients diagnosed with early stage disease (T1a or T1b) has been increasing. This study was conducted to investigate the effect of esophagectomy (ES), endoscopic therapy (ET), and radiotherapy (RT) on long-term survival in elderly patients with cT1N0M0 esophageal cancer. METHODS We searched the Surveillance, Epidemiology, and End Results (SEER) database to identify the records of elderly patients (≥ 75 years) with cT1N0M0 esophageal cancer between 2004 and 2014. Patient demographics and esophageal cancer parameters were compared among ES, ET, and RT groups. The Kaplan-Meier method and Cox proportional hazard modeling were used to compare long-term survival. RESULTS Data from 954 esophageal cancer patients (ES: n = 196; ET: n = 224; RT: n = 534) were identified. Multivariate Cox regression analysis showed that five-year survival in the ET and ES groups was significantly higher than in the RT group. After propensity score matching, we found no difference in five-year survival between ES and ET. CONCLUSION Using SEER data, we identified a significant survival advantage with the use of ES and ET compared to RT in patients with cT1N0M0 esophageal cancer aged > 75 years, while the long-term survival of patients after ET and ES was not significantly different.
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Affiliation(s)
- Jianjun Qin
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yinjie Peng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Weipeng Chen
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Haibo Ma
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Wang
- Department of Radiation Oncology, Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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16
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Kamel MK, Lee B, Rahouma M, Harrison S, Nguyen AB, Port JL, Altorki NK, Stiles BM. T1N0 oesophageal cancer: patterns of care and outcomes over 25 years. Eur J Cardiothorac Surg 2019; 53:952-959. [PMID: 29244113 DOI: 10.1093/ejcts/ezx430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/05/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Historically, surgical resection has been the mainstay of treatment for T1N0 oesophageal cancer (OC). More recently, oesophageal sparing endoscopic techniques have shown value for local control in a large institutional series. However, the effect of their utilization upon survival rates in large population series is largely unknown. METHODS The surveillance, epidemiology, and end results (SEER) database was queried for T1N0M0-OC patients (1988-2013). Patients with multiple treatment types were excluded. Time periods were divided by 5-year increments. Overall survival and cancer-specific survival (CSS) were compared in the group as a whole and in propensity-matched subgroups. Independent predictors of cancer-specific mortality were studied by the Cox proportional hazard models. RESULTS We identified 5497 patients with cT1N0M0 OC. Treatment modalities used were changed significantly over time. The ratio of oesophagectomy when compared with local therapy decreased from 15:1 in 1998-92 to 1.4:1 in 2008-13. The proportion of patients treated with radiation slightly increased (35% vs 41%) between 1988-92 and 2008-13. In the propensity-matched groups, 5-year CSS was similar in patients treated with oesophagectomy and local therapy (81% vs 89%; P = 0.257) (n = 216 in each group), whereas oesophagectomy had superior 5-year CSS compared with radiation alone (73% vs 38%; P < 0.001) (n = 497 in each group). In multivariable analysis, significant predictors of cancer-specific mortality included age [hazard ratio (HR) 1.022], tumour size (HR 1.005), radiation therapy (HR 3.67), tumour Grade III/IV (HR 1.25) and early time period of diagnosis (HR 1.75). CONCLUSIONS Oesophageal sparing endoscopic techniques have been increasingly utilized in the treatment of cT1N0-OC but without compromising CSS. Local therapy, either endoscopic techniques or surgery, remains superior to radiation therapy.
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Affiliation(s)
- Mohamed K Kamel
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Benjamin Lee
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Mohamed Rahouma
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Sebron Harrison
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Andrew B Nguyen
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Jeffrey L Port
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Nasser K Altorki
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Brendon M Stiles
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
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17
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Sun Y, Wang J, Li Y, Pan S, Yang T, Sun X, Wang Y, Shi X, Zhao X, Zhang X. Nomograms to predict survival rates for esophageal cancer patients with malignant behaviors based on ICD-0-3. Future Oncol 2018; 15:121-132. [PMID: 30232909 DOI: 10.2217/fon-2018-0493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We aimed to investigate the effect of current treatment based on stage and histology type, which were important factors for treating esophageal cancer. METHODS Log-rank test, COX and nomograms were used for survival analysis. DCA, C-index and calibration curves were used for validation. RESULTS A total of 3224 patients were recruited. As for cT2-T4aM0 patients, chemotherapy and radiation prolonged overall survival (OS) for esophageal squamous cell carcinoma (ESCC) and chemotherapy improved OS for esophageal adenocarcinoma (EAC). Meanwhile, neoadjuvant radiotherapy had longer OS than adjuvant radiotherapy for ESCC. As for T4b patients, radiation and chemotherapy correlated with better OS for ESCC and chemotherapy prolonged OS for EAC. CONCLUSION Neoadjuvant radiotherapy might be optimal for cT2-T4aM0 ESCC. Radiation was recommended for T4b ESCC while chemotherapy was recommended for T4b EAC.
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Affiliation(s)
- Yuchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Jizhao Wang
- The Second Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Yingchao Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Shupei Pan
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Tian Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Xuanzi Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Ya Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Xiaobo Shi
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Xu Zhao
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
| | - Xiaozhi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, Shaanxi, 710061, PR China
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18
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Fiorelli A, Prencipe A, Santini M. The renaissance of photodynamic therapy for early esophageal cancer: is it the time? J Thorac Dis 2018; 10:S1013-S1015. [PMID: 29849187 DOI: 10.21037/jtd.2018.03.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alfonso Fiorelli
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Aldo Prencipe
- Cardio-Thoracic Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Mario Santini
- Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy
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19
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Survival Implications of Increased Utilization of Local Excision for cT1N0 Esophageal Cancer. Ann Surg 2018; 270:295-301. [PMID: 29672407 DOI: 10.1097/sla.0000000000002782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE We hypothesized that patients with cT1N0 esophageal cancer undergoing local excision would have lower survival compared with esophagectomy due to potential discordant staging. BACKGROUND Local excision has become an attractive alternative for management of early esophageal cancer, avoiding the morbidity of esophagectomy. It is uncertain if occult nodal metastasis impacts survival. METHODS An observational study was conducted using the National Cancer Database (1998-2012) for patients with clinical T1N0 esophageal cancer who underwent local excision (n = 1625) or esophagectomy (n = 3255). RESULTS The proportion of patients undergoing local excision increased from 12% in 1998 to 50% in 2012 (P < 0.001). After esophagectomy, 61% of cT1N0 cancers had concordant clinical and pathological staging, with 5.2% having positive nodal disease; 37% were staged concordant after local excision, with excess missing data (60%). Ninety-day mortality was 7.4% after esophagectomy compared with 2.8% after local excision (P < 0.001). While no significant difference was seen in unadjusted survival, adjusted Cox regression analysis indicated worse survival after esophagectomy compared with local excision for all cases [hazard ratio (HR) 1.57, 95% confidence interval (CI) 1.27-1.95] and for patients with concordant staging (HR 1.68, 95% CI 1.23-2.28). CONCLUSIONS Local excision for cT1N0 esophageal cancer has increased over time. Contrary to our hypothesis, despite incomplete nodal staging, patients undergoing local excision have favorable survival, particularly in the adenocarcinoma subgroup. This may reflect early differences in mortality due to differences in procedure-related complications and/or selection bias. As this study has limited power to compare outcomes between T1a and T1b cancers, further analysis is warranted.
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20
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Yang J, Luo GY, Liang RB, Zeng TS, Long H, Fu JH, Xu GL, Yang MZ, Li S, Zhang LJ, Lin P, Wang X, Hou X, Yang HX. Efficacy of Endoscopic Ultrasonography for Determining Clinical T Category for Esophageal Squamous Cell Carcinoma: Data From 1434 Surgical Cases. Ann Surg Oncol 2018; 25:2075-2082. [PMID: 29667114 DOI: 10.1245/s10434-018-6406-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND The efficacy of endoscopic ultrasonography (EUS) for determining T category is variable for esophageal squamous cell carcinoma (ESCC). We aimed to assess the efficacy of EUS in accurately identifying T category for ESCC based on the 8th AJCC Cancer Staging Manual. METHODS A retrospective analysis was conducted using a prospectively collected ESCC database from January 2003 to December 2015, in which all patients underwent EUS examination followed by esophagectomy. The efficacy of EUS was evaluated by sensitivity, specificity, and accuracy compared with pathological T category as gold standard. Overall survival of different EUS-T (uT) categories was assessed. RESULTS In total, 1434 patients were included, of whom 58.2% were correctly classified by EUS, with 17.9% being overstaged and 23.9% being understaged. The sensitivity and accuracy of EUS for Tis, T1a, T1b, T2, T3, and T4a categories were 15.8 and 98.8%, 16.3 and 95.7%, 33.1 and 89.3%, 56.8 and 65.0%, 65.8 and 70.0%, and 27.3 and 97.5%, respectively. The survival difference between uT1a and uT1b was not statistically significant (p = 0.90), nor was that between uT4a and uT4b (p = 0.34). However, when uT category was integrated as uTis, uT1, uT2, uT3, and uT4, overall survival was clearly distinguished between the categories (p < 0.01). CONCLUSIONS EUS is in general feasible for classifying clinical T category for ESCC. However, EUS should be used with caution for discriminating between Tis, T1a, and T1b disease, as well as T4 disease.
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Affiliation(s)
- Jie Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Guang-Yu Luo
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Run-Bin Liang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Tai-Shan Zeng
- School of Mathematical Sciences, South China Normal University, Guangzhou, Guangdong, China
| | - Hao Long
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Jian-Hua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Guo-Liang Xu
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
| | - Mu-Zi Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Shuo Li
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Lan-Jun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Peng Lin
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xin Wang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China
| | - Xue Hou
- State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China. .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China.
| | - Hao-Xian Yang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China. .,State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, China. .,Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
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21
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Moreno AC, Zhang N, Verma V, Giordano SH, Lin SH. Treatment disparities affect outcomes for patients with stage I esophageal cancer: a national cancer data base analysis. J Gastrointest Oncol 2018; 10:74-84. [PMID: 30788162 DOI: 10.21037/jgo.2018.10.04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background To examine patterns of care and outcomes for patients with stage I esophageal cancer (EC) in the United States. Methods We identified patients in the National Cancer Data Base diagnosed with stage I EC from 2004 to 2012 and grouped them by primary treatment: esophagectomy (Eso), local excision (LE), concurrent chemoradiation (CRT), or observation (Obs). Multinomial logistic regression was used to predict receipt of treatments. Overall survival (OS) was estimated by Kaplan-Meier methods adjusted for inverse probability of treatment weighting (IPTW) and Cox proportional hazard regressions. Results Of 5,480 patients, 2,312 (42%) underwent Eso, 1,250 (23%) LE, 758 (14%) CRT, and 1,160 (21%) Obs. LE use increased over time from 17% to 29% while Obs declined from 26% to 19%. Patients least likely to undergo surgery were older, had greater comorbidity, were uninsured, were treated at non-academic centers, and were Black. The rate of surgery for Black patients was half of that for White patients (33% vs. 67%). Postoperative mortality rates were higher after Eso vs. LE at 30 days (2.9% vs. 0.5%; P<0.001) and at 90 days (5.5% vs. 1.4%, P<0.001). Five-year OS was 59% with Eso, 63% LE, 29% CRT, and 31% Obs (P<0.001). On multivariate analysis, outcomes were best after LE [vs. Eso: hazard ratio (HR) =1.15, 95% CI: 1.01-1.30, P=0.037; CRT: HR =2.41, 95% CI: 2.09-2.78, P<0.001; Obs: HR =3.79, 95% CI: 3.33-4.32, P<0.001). Conclusions Disparities are evident in the care of patients with stage I EC throughout the United States. LE was associated with favorable outcomes compared to Eso, CRT, and Obs.
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Affiliation(s)
- Amy C Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ning Zhang
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Buffett Cancer Center, Omaha, NE, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Mizrak Kaya D, Harada K, Ajani JA. Advances in therapeutic options for esophageal and esophagogastric junctional adenocarcinoma. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1330146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dilsa Mizrak Kaya
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kazuto Harada
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jaffer A. Ajani
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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23
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Moreno AC, Verma V, Hofstetter WL, Lin SH. Patterns of Care and Treatment Outcomes of Elderly Patients with Stage I Esophageal Cancer: Analysis of the National Cancer Data Base. J Thorac Oncol 2017; 12:1152-1160. [PMID: 28455149 DOI: 10.1016/j.jtho.2017.04.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/12/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION This study analyzes practice patterns, treatment-related mortality, survival, and predictors thereof in elderly patients with early-stage esophageal cancer (EC). METHODS The National Cancer Data Base was queried for cT1-2 N0 EC in patients 80 years of age and older. Patients were divided into four treatment groups: observation (Obs), chemoradiotherapy (CRT), local excision (LE), and esophagectomy (Eso). Patient, tumor, and treatment parameters were extracted and compared. Analyses were performed on overall survival (OS) and postoperative 30- and 90-day mortality. RESULTS A total of 923 patients from 2004 to 2012 were analyzed. Of these, 43% underwent clinical Obs, 22% underwent CRT, 25% underwent LE, and 10% underwent Eso. Patients undergoing Obs were older, had more comorbidities, were treated at nonacademic centers, and lived 25 miles or less from the facility. Patients receiving an operation (Eso or LE) were more often younger, male, white, and in the top income quartile. The postoperative 30-day mortality rates in the LE and Eso groups were 1.3% and 9.6%, respectively (p < 0.001) and increased to 2.6% and 20.2% at 90 days, respectively (p < 0.001). The 5-year OS rate was 7% for Obs, 20% for CRT, 33% for LE, and 45% for Eso (p < 0.001). Multivariate analyses showed improved OS with any local definitive therapy: CRT (hazard ratio [HR] = 0.42, 95% confidence interval [CI]: 0.34-0.52, p < 0.001), LE (HR = 0.3, 95% CI: 0.24-0.38, p < 0.001), and Eso (HR = 0.32, 95% CI: 0.23-0.44, p < 0.001). CONCLUSIONS There are noteworthy demographic, socioeconomic, and regional disparities influencing management of elderly patients with stage I EC. Despite high rates of Obs, careful consideration of all local therapy options is warranted, given the improved outcomes with treatment.
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Affiliation(s)
- Amy C Moreno
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Wayne L Hofstetter
- Department of Thoracic Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas.
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24
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Comparison of Endoscopic Resection and Minimally Invasive Esophagectomy in Patients With Early Esophageal Cancer. J Clin Gastroenterol 2017; 51:223-227. [PMID: 27306943 DOI: 10.1097/mcg.0000000000000560] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine whether endoscopic resection (ER) and minimally invasive esophagectomy (MIE) are safe and effective for treating squamous intraepithelial neoplasia of the esophagus. MATERIALS AND METHODS This study retrospectively analyzed a total of 99 consecutive patients with pathologically confirmed early esophageal cancer between December 2007 and 2011. ER was performed in 59 patients, whereas MIE was performed in 40 patients. We compared the 2 groups according to R0 resection rates, treatment-related complications, mean hospital stay, local recurrence rates, and 3- and 4-year overall survival. RESULTS No significant differences were found in the R0 resection rates between ER and MIE (94.9% vs. 97.5%, P>0.05). The occurrence rate of minor complications in the ER group was significantly lower than that in the thoracoscopic esophagectomy group (11.8% vs. 32.5%, P>0.05). The mean operative time in the ER group was 74±23 minutes, which was significantly shorter than that in the MIE group (298±46 min). The average length of hospital stay in the ER group was significantly shorter than that in the MIE group (P<0.001). No significant differences were observed in the local recurrence rates between the 2 groups (P>0.05). Similarly, no differences were found in the 3-year survival rate (ER: 96.6%, vs. MIE: 97.5%, P>0.05) and 4-year survival rate (ER: 91.5% vs. MIE: 90%, P>0.05) between the 2 groups. CONCLUSIONS ER achieves the same positive results as MIE in the treatment of early esophageal cancer and is associated with a lower complication rate, a shorter recovery time, and a similar survival rate. However, multiple ER procedures were required for several patients in this study.
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25
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Taylor LJ, Greenberg CC, Lidor AO, Leverson GE, Maloney JD, Macke RA. Utilization of surgical treatment for local and locoregional esophageal cancer: Analysis of the National Cancer Data Base. Cancer 2016; 123:410-419. [PMID: 27680893 DOI: 10.1002/cncr.30368] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Previous studies have suggested that esophagectomy is severely underused for patients with resectable esophageal cancer. The recent expansion of endoscopic local therapies, advances in surgical techniques, and improved postoperative outcomes have changed the therapeutic landscape. The impact of these developments and evolving treatment guidelines on national practice patterns is unknown. METHODS Patients diagnosed with clinical stage 0 to III esophageal cancer were identified from the National Cancer Database (2004-2013). The receipt of potentially curative surgical treatment over time was analyzed, and multivariate logistic regression was used to identify factors associated with surgical treatment. RESULTS The analysis included 52,122 patients. From 2004 to 2013, the overall rate of potentially curative surgical treatment increased from 36.4% to 47.4% (P < .001). For stage 0 disease, the receipt of esophagectomy decreased from 23.8% to 17.9% (P < .001), whereas the use of local therapies increased from 34.3% to 58.8% (P < .001). The use of surgical treatment increased from 43.4% to 61.8% (P < .001), from 36.1% to 45.0% (P < .001), and from 30.8% to 38.6% (P < .001) for patients with stage I, II, and III disease, respectively. In the multivariate analysis, divergent practice patterns and adherence to national guidelines were noted between academic and community facilities. CONCLUSIONS The use of potentially curative surgical treatment has increased for patients with stage 0 to III esophageal cancer. The expansion of local therapies has driven increased rates of surgical treatment for early-stage disease. Although the increased use of esophagectomy for more advanced disease is encouraging, significant variation persists at the patient and facility levels. Cancer 2017;123:410-419. © 2016 American Cancer Society.
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Affiliation(s)
- Lauren J Taylor
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | | | - Anne O Lidor
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Glen E Leverson
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - James D Maloney
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Ryan A Macke
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
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26
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Berry MF. The Role of Induction Therapy for Esophageal Cancer. Thorac Surg Clin 2016; 26:295-304. [PMID: 27427524 DOI: 10.1016/j.thorsurg.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Survival of esophageal cancer generally is poor but has been improving. Induction chemoradiation is recommended before esophagectomy for locally advanced squamous cell carcinoma. Both induction chemotherapy and induction chemoradiation are found to be beneficial for locally advanced adenocarcinoma. Although a clear advantage of either strategy has not yet been demonstrated, consensus-based guidelines recommend induction chemoradiation for locally advanced adenocarcinoma.
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Affiliation(s)
- Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, 870 Quarry Road, Falk Cardiovascular Research Building, 2nd Floor, Stanford, CA 94305, USA.
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27
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Moghissi K, Dixon K, Gibbins S. A Surgical View of Photodynamic Therapy in Oncology: A Review. Surg J (N Y) 2015; 1:e1-e15. [PMID: 28824964 PMCID: PMC5530619 DOI: 10.1055/s-0035-1565246] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/25/2015] [Indexed: 12/18/2022] Open
Abstract
Clinical photodynamic therapy (PDT) has existed for over 30 years, and its scientific basis has been known and investigated for well over 100 years. The scientific foundation of PDT is solid and its application to cancer treatment for many common neoplastic lesions has been the subject of a huge number of clinical trials and observational studies. Yet its acceptance by many clinicians has suffered from its absence from the undergraduate and/or postgraduate education curricula of surgeons, physicians, and oncologists. Surgeons in a variety of specialties many with years of experience who are familiar with PDT bear witness in many thousands of publications to its safety and efficacy as well as to the unique role that it can play in the treatment of cancer with its targeting precision, its lack of collateral damage to healthy structures surrounding the treated lesions, and its usage within minimal access therapy. PDT is closely related to the fluorescence phenomenon used in photodiagnosis. This review aspires both to inform and to present the clinical aspect of PDT as seen by a surgeon.
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Affiliation(s)
- K. Moghissi
- The Yorkshire Laser Centre, Goole and District Hospital, Goole, East Yorkshire, United Kingdom
| | - Kate Dixon
- The Yorkshire Laser Centre, Goole and District Hospital, Goole, East Yorkshire, United Kingdom
| | - Sally Gibbins
- The Yorkshire Laser Centre, Goole and District Hospital, Goole, East Yorkshire, United Kingdom
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28
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Berry MF. Esophageal cancer: staging system and guidelines for staging and treatment. J Thorac Dis 2014; 6 Suppl 3:S289-97. [PMID: 24876933 DOI: 10.3978/j.issn.2072-1439.2014.03.11] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/05/2014] [Indexed: 12/25/2022]
Abstract
Survival of esophageal cancer is improving but remains poor. Esophageal cancer stage is based on depth of tumor invasion, involvement of regional lymph nodes, and the presence or absence of metastatic disease. Appropriate work-up is critical to identify accurate pre-treatment staging so that both under-treatment and unnecessary treatment is avoided. Treatment strategy should follow guideline recommendations, and generally should be developed after multidisciplinary evaluation.
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Affiliation(s)
- Mark F Berry
- Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
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