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Lemdani MS, Choudhry HS, Tseng CC, Fang CH, Sukyte-Raube D, Patel P, Eloy JA. Impact of Facility Volume on Patient Safety Indicator Events After Transsphenoidal Pituitary Surgery. Otolaryngol Head Neck Surg 2023; 168:227-233. [PMID: 35380889 DOI: 10.1177/01945998221089826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/07/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS). STUDY DESIGN Retrospective database review. SETTING National Inpatient Sample database (2003-2011). METHODS The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed. RESULTS An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P < .001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P < .001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P < .001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P < .001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P < .001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P < .001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P < .001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P < .001). CONCLUSION PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.
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Affiliation(s)
- Mehdi S Lemdani
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Hannaan S Choudhry
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, USA
| | - Donata Sukyte-Raube
- Center of Ear, Nose, and Throat Diseases, Vilnius University Hospital Santaros Clinics, Vilnius University, Vilnius, Lithuania
| | - Prayag Patel
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, USA
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Abstract
The aim of this study is to present 2 rare cases of cutaneous metastases originated from adenocarcinoma of the gastro-esophageal junction, thus, underline the need for early diagnosis and possible treatment of suspicious skin lesions among patients with esophageal malignancy. Metastatic cancer to the skin originated from internal malignancies, mostly lung cancer, breast cancer, and colorectal cancer, constitute 0.5 to 9% of all metastatic cancers. (5, 8, 15) Skin metastases, mainly from squamous cell carcinomas of the esophagus, are rarely reported. Cutaneous metastasis is a finding indicating progressiveness of the disease. (17) More precisely, median survival is estimated approximately 4.7 months. (2, 14) This study is a retrospective review of 2 cases of patients with adenocarcinoma of the esophagus and a review of the literature. Two patients aged 60 and 32 years old, respectively, underwent esophagectomy. Both pathologic reports disclosed adenocarcinoma of the gastro-esophageal junction staged T3 N2 M0 (stage IIIB). During follow-up time, the 2 patients were diagnosed with cutaneous metastases originated from the primary esophageal tumor 11 and 4 months after surgery, respectively. The first patient is alive 37 months after diagnosis, while the second one died 16 months after surgery. Cutaneous metastasis caused by esophageal adenocarcinoma is possible. Therefore, follow-up of patients who were diagnosed with esophageal malignancy and underwent esophagectomy is mandatory in order to reveal early surgical stages.
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3
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Leng XF, Zhu Y, Wang GP, Jin J, Xian L, Zhang YH. Accuracy of ultrasound for the diagnosis of cervical lymph node metastasis in esophageal cancer: a systematic review and meta-analysis. J Thorac Dis 2016; 8:2146-57. [PMID: 27621871 DOI: 10.21037/jtd.2016.07.71] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Esophageal cancer is considered a serious malignancy with respect to its prognosis and mortality rate. Cervical lymph node status is one of the keys to determining prognosis and treatment methods. However, published data vary regarding the accuracy of ultrasound in the diagnosis of cervical lymph node metastasis. We performed a meta-analysis to assess the efficacy of ultrasound for detecting cervical lymph node metastasis in patients with esophageal cancer. METHODS The PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane Library databases were searched to identify studies related to cervical lymph node metastasis, and 22 studies comprising 3,513 patients met our inclusion criteria. We used a bivariate meta-analysis following a random effects model to summarize the data. We also explored reasons for statistical heterogeneity using meta-regression, subgroup, and sensitivity analyses. Publication bias was assessed with a Deeks funnel plot. RESULTS The area under the receiver operating characteristic curve was 0.97 [95% confidence interval (CI): 0.95-0.98], and the pooled diagnostic odds ratio was 121.00 (95% CI: 47.57-307.79). With cut-off values of 5 mm and >5 mm for cervical lymph node size, the sensitivities and specificities (95% confidence interval) for ultrasound detection of cervical lymph node metastasis were 84% (67-93%) and 93% (90-95%); and 94% (76-98%) and 98% (89-100%), respectively. CONCLUSIONS We show for the first time the diagnostic accuracy of ultrasound for predicting cervical lymph node-positive metastasis in esophageal cancer. Our analysis shows that ultrasonography may be an effective and reliable approach to detect cervical lymph node metastasis in esophageal cancer. However, to accommodate heterogeneity, high-quality studies are needed to further verify the efficacy of ultrasound detection.
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Affiliation(s)
- Xue-Feng Leng
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Yi Zhu
- Department of Ultrasound, Sichuan Cancer Hospital, Chengdu 610041, China
| | - Ge-Ping Wang
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Jian Jin
- Department of Cardiothoracic Surgery, the Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lei Xian
- Department of Thoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Yu-Hong Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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4
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Luo LN, He LJ, Gao XY, Huang XX, Shan HB, Luo GY, Li Y, Lin SY, Wang GB, Zhang R, Xu GL, Li JJ. Endoscopic Ultrasound for Preoperative Esophageal Squamous Cell Carcinoma: a Meta-Analysis. PLoS One 2016; 11:e0158373. [PMID: 27387830 PMCID: PMC4936717 DOI: 10.1371/journal.pone.0158373] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Treatment options and prognosis of esophageal squamous cell carcinoma (ESCC) depend on the primary tumor depth (T-staging) and regional lymph node status (N-staging). Endoscopic ultrasound (EUS) has emerged as a useful staging tool, but studies regarding its benefits have been variable. The objective of this study was to evaluate the diagnostic accuracy of EUS for detecting preoperative ESCC. Methods We included in our meta-analysis studies involving EUS-based staging of preoperative ESCC compared with pathological staging. Using a random-effects model, we performed a meta-analysis of the accuracy of EUS by calculating pooled estimates of sensitivity, specificity and the diagnostic odds ratio. In addition, we created a summary receiver operating characteristic (SROC) curve. Results Forty-four studies (n = 2880) met the inclusion criteria. The pooled sensitivity and specificity of T1 were 77% (95%CI: 73 to 80) and 95% (95%CI: 94 to 96). Among the T1 patients, EUS had a pooled sensitivity in differentiating T1a and T1b of 84% (95%CI: 80 to 88) and 83% (95%CI: 80 to 86), and a specificity of 91% (95%CI: 88 to 94) and 89% (95%CI: 86 to 92). To stage T4, EUS had a pooled sensitivity of 84% (95%CI: 79 to 89) and a specificity of 96% (95%CI: 95 to 97). The overall accuracy of EUS for T-staging was 79% (95%CI: 77 to 80), and for N-staging, 71% (95%CI: 69 to 73). Conclusions EUS has good diagnostic accuracy for staging ESCC, which has better performance in T1 sub-staging (T1a and T1b) and advanced disease (T4).
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Affiliation(s)
- Lin-na Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Long-jun He
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao-yan Gao
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xin-xin Huang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Hong-bo Shan
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guang-yu Luo
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yin Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Shi-yong Lin
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-bao Wang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rong Zhang
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guo-liang Xu
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail: (GLX); (JJL)
| | - Jian-jun Li
- Department of Endoscopy, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Guangdong Esophageal Cancer Institute, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail: (GLX); (JJL)
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5
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Koëter M, van Steenbergen LN, Lemmens VEPP, Rutten HJT, Roukema JA, Wijnhoven BPL, Nieuwenhuijzen GAP. Hospital of diagnosis and probability to receive a curative treatment for oesophageal cancer. Eur J Surg Oncol 2014; 40:1338-45. [PMID: 24484779 DOI: 10.1016/j.ejso.2013.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 11/23/2013] [Accepted: 12/28/2013] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Surgical treatment of oesophageal cancer in the Netherland is performed in high volume centres. However, the decision to refer patients for curative surgery is made in the referring hospital of diagnosis. The objective of this study was to determine the influence of hospital of diagnosis on the probability of receiving a curative treatment and survival. MATERIAL AND METHOD All patients with resectable oesophageal cancer (cT1-3, cN0-3, cM0-1A) diagnosed between 2003 and 2010 (n = 849) were selected from the population-based Eindhoven Cancer Registry, an area with ten non-academic hospitals. Multivariate logistic regression analysis was conducted to examine the independent influence of hospital of diagnosis on the probability to receive curative treatment. Furthermore, the effect of hospital of diagnosis on overall survival was examined using multivariate Cox regression analysis. RESULTS 849 patients were included in the study. A difference in proportion of patients referred for surgery was observed ranging from 33% to 67% (p = 0.002) between hospitals of diagnosis. Multivariate logistic regression analysis confirmed the effect of hospital of diagnosis on the chance of undergo curative treatment (OR 0.1, 95% CI 0.1-0.4). Multivariate Cox regression analysis showed that hospital of diagnosis also had an effect on overall survival, up to hazard ratio (HR) 2.2 (95% CI 1.3-3.7). CONCLUSION There is a strong relation between hospital of diagnosis and the chance of referring patients with oesophageal cancer for a curative treatment as well as overall survival. Patients diagnosed with oesophageal cancer should be discussed within a regional multidisciplinary expert panel.
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Affiliation(s)
- M Koëter
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands
| | - L N van Steenbergen
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands
| | - V E P P Lemmens
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - H J T Rutten
- Department of Surgery, Catharina Hospital Eindhoven, The Netherlands; Department of Surgery, Maastricht University Medical Centre, The Netherlands
| | - J A Roukema
- Department of Surgery, St. Elisabeth Hospital Tilburg, The Netherlands
| | - B P L Wijnhoven
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Herbella FA, Patti MG, Takassi GF. Skin metastases from esophageal and esophagogastric junction cancer. J Gastrointest Oncol 2012; 2:104-5. [PMID: 22811836 DOI: 10.3978/j.issn.2078-6891.2011.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Accepted: 02/05/2011] [Indexed: 12/26/2022] Open
Affiliation(s)
- Fernando Am Herbella
- Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo, Brazil
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7
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Mahar AL, McLeod RS, Kiss A, Paszat L, Coburn NG. A Systematic Review of the Effect of Institution and Surgeon Factors on Surgical Outcomes for Gastric Cancer. J Am Coll Surg 2012; 214:860-8.e12. [DOI: 10.1016/j.jamcollsurg.2011.12.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/14/2011] [Accepted: 12/21/2011] [Indexed: 02/06/2023]
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8
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Detterbeck F, Puchalski J, Rubinowitz A, Cheng D. Classification of the Thoroughness of Mediastinal Staging of Lung Cancer. Chest 2010; 137:436-42. [DOI: 10.1378/chest.09-1378] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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9
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Abstract
Esophageal cancer is the third most common malignancy of the alimentary tract. The incidence of esophageal cancer has steadily increased over the past three decades. Almost all therapeutic modalities for esophageal cancer are associated with a considerable mortality and morbidity. Consequently, there has been growing concern regarding effective management of esophageal cancer. 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is playing an increasing role in the management of esophageal cancer, offering potential advantages in the accuracy of disease assessment at a number of decision points in the management pathway. This review evaluates the critical role of FDG-PET in (i) diagnosis, (ii) preoperative staging, (iii) monitoring of response to neoadjuvant therapy, (iv) assessment of recurrence and (v) prediction of prognosis of esophageal cancer. We have also compared diagnostic performance of FDG-PET and other current technologies such as computed tomography scan and endoscopic ultrasonography based on available evidence.
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Abstract
The incidence of esophageal cancer, in particular esophageal adenocarcinoma, is increasing, largely due to an increase in risk factors for adenocarcinoma. When esophageal cancer is confirmed by upper endoscopy, staging is required for the optimal selection of patients who should undergo esophageal resection. Neoadjuvant chemoradiation may be able to improve survival after esophageal cancer surgery. Endoscopic therapy for early esophageal neoplasia is effective and safe, with the best results being obtained by an individualized approach using endoscopic mucosal resection, ablative therapy, or both. Finally, dysphagia from esophageal cancer can be successfully treated with stent placement or single-dose brachytherapy. Future research should establish whether combinations of chemotherapy with or without radiation therapy play a role in survival.
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11
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Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer. Eur Radiol 2008; 18:2475-84. [DOI: 10.1007/s00330-008-1052-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 04/19/2008] [Indexed: 02/07/2023]
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12
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Tsirlis TD, Papastratis G, Masselou K, Tsigris C, Papachristodoulou A, Kostakis A, Nikiteas NI. Circulating lymphangiogenic growth factors in gastrointestinal solid tumors, could they be of any clinical significance? World J Gastroenterol 2008; 14:2691-701. [PMID: 18461654 PMCID: PMC2709051 DOI: 10.3748/wjg.14.2691] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Metastasis is the principal cause of cancer mortality, with the lymphatic system being the first route of tumor dissemination. The glycoproteins VEGF-C and VEGF-D are members of the vascular endothelial growth factor (VEGF) family, whose role has been recently recognized as lymphatic system regulators during embryogenesis and in pathological processes such as inflammation, lymphatic system disorders and malignant tumor metastasis. They are ligands for the VEGFR-3 receptor on the membrane of the lymphatic endothelial cell, resulting in dilatation of existing lymphatic vessels as well as in vegetation of new ones (lymphangiogenesis). Their determination is feasible in the circulating blood by immunoabsorption and in the tissue specimen by immunohistochemistry and reverse transcription polymerase chain reaction (RT-PCR). Experimental and clinicopathological studies have linked the VEGF-C, VEGF-D/VEGFR3 axis to lymphatic spread as well as to the clinical outcome in several human solid tumors. The majority of these data are derived from surgical specimens and malignant cell series, rendering their clinical application questionable, due to subjectivity factors and post-treatment quantification. In an effort to overcome these drawbacks, an alternative method of immunodetection of the circulating levels of these molecules has been used in studies on gastric, esophageal and colorectal cancer. Their results denote that quantification of VEGF-C and VEGF-D in blood samples could serve as lymph node metastasis predictive biomarkers and contribute to preoperative staging of gastrointestinal malignancies.
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13
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van Vliet EPM, van der Lugt A, Kuipers EJ, Tilanus HW, van der Gaast A, Hermans JJ, Siersema PD. Ultrasound, computed tomography, or the combination for the detection of supraclavicular lymph nodes in patients with esophageal or gastric cardia cancer: a comparative study. J Surg Oncol 2007; 96:200-6. [PMID: 17455243 DOI: 10.1002/jso.20819] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Both ultrasound (US) and computed tomography (CT) can be used to detect supraclavicular lymph node metastases. Aim was to compare US, US plus fine-needle aspiration (US-FNA), CT, US + CT, and US-FNA + CT for the detection of these metastases in esophageal or gastric cardia cancer patients. METHODS Between 1994 and 2004, 567 patients underwent US and CT for esophageal or gastric cardia cancer staging. Gold standard was postoperative detection of lymph nodes in the resected specimen, FNA, or a radiological result with follow-up. RESULTS Sensitivities of US (75%), US-FNA (72%), US + CT (80%), and US-FNA + CT (79%) were higher than sensitivity of CT alone (25%) (P < 0.001). Specificities were high for US-FNA (100%), CT (99%), and US-FNA + CT (99%), whereas those of US alone (91%) and US + CT (91%) were lower (P < 0.001). In 4/65 (6%) patients with true-positive malignant lymph nodes, CT was positive with US and/or US-FNA being negative. However, in 36/65 (55%) patients, US and/or US-FNA were positive with CT being negative. CONCLUSION US-FNA seems the preferred diagnostic modality for the detection of supraclavicular lymph node metastases in patients with esophageal or gastric cardia cancer. Sensitivity of metastases detection only slightly improves if US-FNA is combined with CT. A prospective, comparative study is however needed.
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Affiliation(s)
- Evelyn P M van Vliet
- Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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14
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van Vliet EPM, Steyerberg EW, Eijkemans MJC, Kuipers EJ, Siersema PD. Detection of distant metastases in patients with oesophageal or gastric cardia cancer: a diagnostic decision analysis. Br J Cancer 2007; 97:868-76. [PMID: 17848957 PMCID: PMC2360396 DOI: 10.1038/sj.bjc.6603960] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Computed tomography (CT) is presently a standard procedure for the detection of distant metastases in patients with oesophageal or gastric cardia cancer. We aimed to determine the additional diagnostic value of alternative staging investigations. We included 569 oesophageal or gastric cardia cancer patients who had undergone CT neck/thorax/abdomen, ultrasound (US) abdomen, US neck, endoscopic ultrasonography (EUS), and/or chest X-ray for staging. Sensitivity and specificity were first determined at an organ level (results of investigations, i.e., CT, US abdomen, US neck, EUS, and chest X-ray, per organ), and then at a patient level (results for combinations of investigations), considering that the detection of distant metastases is a contraindication to surgery. For this, we compared three strategies for each organ: CT alone, CT plus another investigation if CT was negative for metastases (one-positive scenario), and CT plus another investigation if CT was positive, but requiring that both were positive for a final positive result (two-positive scenario). In addition, costs, life expectancy and quality adjusted life years (QALYs) were compared between different diagnostic strategies. CT showed sensitivities for detecting metastases in celiac lymph nodes, liver and lung of 69, 73, and 90%, respectively, which was higher than the sensitivities of US abdomen (44% for celiac lymph nodes and 65% for liver metastases), EUS (38% for celiac lymph nodes), and chest X-ray (68% for lung metastases). In contrast, US neck showed a higher sensitivity for the detection of malignant supraclavicular lymph nodes than CT (85 vs 28%). At a patient level, sensitivity for detecting distant metastases was 66% and specificity was 95% if only CT was performed. A higher sensitivity (86%) was achieved when US neck was added to CT (one-positive scenario), at the same specificity (95%). This strategy resulted in lower costs compared to CT only, at an almost similar (quality adjusted) life expectancy. Slightly higher specificities (97–99%) were achieved if liver and/or lung metastases found on CT, were confirmed by US abdomen or chest X-ray, respectively (two-positive scenario). These strategies had only slightly higher QALYs, but substantially higher costs. The combination of CT neck/thorax/abdomen and US neck was most cost-effective for the detection of metastases in patients with oesophageal or gastric cardia cancer, whereas the performance of CT only had a lower sensitivity for metastases detection and higher costs. The role of EUS seems limited, which may be due to the low number of M1b celiac lymph nodes detected in this series. It remains to be determined whether the application of positron emission tomography will further increase sensitivities and specificities of metastases detection without jeopardising costs and QALYs.
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Affiliation(s)
- E P M van Vliet
- Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
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15
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Abstract
PURPOSE OF REVIEW This article reviews developments in pathogenesis, diagnosis and therapy of esophageal cancer published in 2006. RECENT FINDINGS Gene expression profiles in esophageal adenocarcinoma reveal information on its pathogenesis. One study disputed the UK guideline to perform upper endoscopy only in the presence of alarm symptoms. Evidence was presented that staging investigations for esophageal cancer should preferentially be performed in expert centers. Early [F]fluorodeoxyglucose PET was shown to predict response to neoadjuvant chemotherapy. A large randomized study demonstrated that peroperative chemotherapy improved survival in esophagogastric adenocarcinoma. The current American Joint Committee on Cancer staging system probably needs revision in that the number of involved lymph nodes and extent of lymphadenectomy should be included. Socioeconomic factors are involved in treatment decisions and outcome of esophageal cancer. Chemotherapy and chemoradiotherapy are increasingly being used in the palliation of esophageal cancer. Palliation of dysphagia with stents was disputed as these devices may be associated with a high complication risk and may not improve nutritional status. SUMMARY In 2006, microarray technology was introduced to elucidate the pathogenesis of esophageal cancer. In addition, refinements in staging of esophageal cancer were proposed. Finally, (chemo-)radiotherapy is increasingly being used in the neoadjuvant setting and for palliation of esophageal cancer.
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Affiliation(s)
- Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
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16
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Abstract
We present two cases of Down syndrome with inoperable esophageal cancer at a relatively young age. The first patient had a locally advanced squamous cell carcinoma of the distal esophagus. The second had a short circular adenocarcinoma of the distal esophagus with peritoneal and liver metastases. The cases are discussed with regard to the current literature on Down syndrome and esophageal cancer.
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Affiliation(s)
- T G Moreels
- Department of Gastroenterology & Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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17
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van Vliet EPM, Eijkemans MJC, Steyerberg EW, Kuipers EJ, Tilanus HW, van der Gaast A, Siersema PD. The role of socio-economic status in the decision making on diagnosis and treatment of oesophageal cancer in The Netherlands. Br J Cancer 2006; 95:1180-5. [PMID: 17031405 PMCID: PMC2360583 DOI: 10.1038/sj.bjc.6603374] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the United States (USA), a correlation has been demonstrated between socio-economic status (SES) of patients on the one hand, and tumour histology, stage of the disease and treatment modality of various cancer types on the other hand. It is unknown whether such correlations are also involved in patients with oesophageal cancer in The Netherlands. Between 1994 and 2003, 888 oesophageal cancer patients were included in a prospective database with findings on the diagnostic work-up and treatment of oesophageal cancer. Socio-economic status of patients was defined as the average net yearly income. Linear-by-linear association testing revealed that oesophageal adenocarcinoma was more frequently observed in patients with higher SES and squamous cell carcinoma in patients with lower SES (P=0.02). Multivariable logistic regression analysis showed no correlation between SES and staging procedures and preoperative TNM stage. The adjusted odds ratio (OR) for stent placement was 0.82 (95% CI 0.71–0.95), indicating that with an increase in SES by 1200 €, the likelihood that a stent was placed declined by 18%. Patients with a higher SES more frequently underwent resection or were treated with chemotherapy (OR: 1.15; 95% CI 1.01–1.32 and OR: 1.16; 95% CI 1.02–1.32, respectively). Socio-economic factors are involved in oesophageal cancer in The Netherlands, as patients with a higher SES are more likely to have an adenocarcinoma and patients with a lower SES a squamous cell carcinoma. Moreover, the correlations between SES and different treatment modalities suggest that both patient and doctor determinants contribute to the decision on the most optimal treatment modality in patients with oesophageal cancer.
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Affiliation(s)
- E P M van Vliet
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - M J C Eijkemans
- Department of Public Health, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E W Steyerberg
- Department of Public Health, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - E J Kuipers
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - H W Tilanus
- Department of Surgery, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - A van der Gaast
- Department of Oncology, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - P D Siersema
- Department of Gastroenterology and Hepatology, Erasmus MC – University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
- E-mail:
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Abstract
PURPOSE OF THIS REVIEW This article reviews the most notable results of esophageal interventions for dysphagia and bleeding published in 2005. RECENT FINDINGS Long-term rubber tube placement was shown to be an interesting treatment option for difficult esophageal strictures. Two studies demonstrated that only 50% of patients who had undergone pneumatic dilation for achalasia were dysphagia-free after long-term follow-up. It was shown that patients with dysphagia from esophageal cancer should be treated by intraluminal radiotherapy (brachytherapy), whereas stent placement was preferable in those with a poor prognosis. Temporary stent placement is an option in patients undergoing radiotherapy for inoperable esophageal cancer to increase the dysphagia-free period. Two studies were published on the successful use of silicone-covered plastic stents for sealing of leaks after surgery of the esophagus. The optimal treatment for bleeding varices was confirmed to be endoscopic band ligation. A meta-analysis demonstrated that adding sclerotherapy to band ligation for secondary prophylaxis of bleeding varices had no effect on clinical outcome. SUMMARY In 2005, new techniques for the treatment of complicated strictures were presented. In addition, expanding indications for stents were reported. Finally, endoscopic band ligation was confirmed to be the most optimal technique for the treatment of varices.
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Affiliation(s)
- Peter D Siersema
- Department of Gastroenterology & Hepatology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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