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Margalit O, Shacham-Shmueli E, Strauss G, Yang YX, Lawrence YR, Ben Nun A, Levy I, Reiss KA, Golan T, Halpern N, Aderka D, Giantonio B, Mamtani R, Boursi B. Tumor Differentiation as a Prognostic Marker in Clinically Staged T1bN0 Esophageal Adenocarcinoma. Cancer Invest 2023; 41:734-738. [PMID: 37665657 DOI: 10.1080/07357907.2023.2255907] [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: 03/29/2023] [Accepted: 09/02/2023] [Indexed: 09/06/2023]
Abstract
Current guidelines recommend that clinically staged T1N0 esophageal cancers are to be referred to surgery or endoscopic resection. Using the National Cancer Database, we identified 733 individuals with clinically staged T1N0 esophageal carcinoma, who underwent upfront surgery and did not receive any prior treatment. We assessed upstaging, which was defined as ≥ T2 disease or positive lymph nodes. Poorly differentiated adenocarcinomas were associated with upstaging, whereas squamous cell carcinomas were not. Specifically, the percentage of upstaging among individuals with clinically staged T1b and poorly differentiated tumor was 33.8%. Therefore, clinically staged T1bN0 poorly differentiated esophageal adenocarcinomas are at high risk for upstaging following surgery.
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Affiliation(s)
- Ofer Margalit
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Gal Strauss
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Medicine, Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yaacov R Lawrence
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alon Ben Nun
- Faculty of Medicine, Ben-Gurion University, Be'er-Sheva, Israel
- Assuta Medical Center, Tel-Aviv, Israel
| | - Idan Levy
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Kim A Reiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Talia Golan
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Dan Aderka
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
| | - Bruce Giantonio
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronac Mamtani
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Faculty of Medicine, Ben-Gurion University, Be'er-Sheva, Israel
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Tel-Aviv, Israel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Chiappa A, Andreoni B, Dionigi R, Spaggiari L, Foschi D, Polvani G, Orecchia R, Fazio N, Pravettoni G, Cossu ML, Galetta D, Venturino M, Ferrari C, Macone L, Crosta C, Bonanni B, Biffi R. A rationale multidisciplinary approach for treatment of esophageal and gastroesophageal junction cancer: Accurate review of management and perspectives. Crit Rev Oncol Hematol 2018; 132:161-168. [PMID: 30447922 DOI: 10.1016/j.critrevonc.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/22/2018] [Accepted: 10/09/2018] [Indexed: 01/28/2023] Open
Abstract
Cancer of the esophagus and of gastroesophageal junction can be cured, even if with lacking cure rate. Different approaches have been developed, mostly when carcinoma has loco-regional pattern. Multimodality therapy showed a survival rate superior than 10% if compared to a single approach. This is a systematic review, carried to assess the following matters: Which therapeutic opportunities are available? Who could benefit of them? Which adverse reactions could possibly verify? How can physicians definitely choose the proper strategy? Which is the role of surgery? We mean to give either General Practitioner or specialists clear and efficient updates about current treatment of this tumour, starting from physical examination. Four eminent guidelines were consulted for our study: Cancer Care Ontario's Program in Evidence-Based Care, NCCN, Belgian Health Care Knowledge Centre and Esmo.
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Affiliation(s)
- Antonio Chiappa
- Unit of Innovative Techniques in Surgery, European Institute of Oncology, University of Milan, Italy.
| | | | - Renzo Dionigi
- Department of Surgery, University of Insubria, Varese, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, University of Milan, Italy
| | - Diego Foschi
- Department of Surgery, "Luigi Sacco" Hospital, University of Milan, Italy
| | - Gianluca Polvani
- Cardiothoracic Surgery, "Monzino" Cardiologic Institute, University of Milan, Italy
| | - Roberto Orecchia
- Department of Radiotherapy, European Institute of Oncology, University of Milan, Italy
| | - Nicola Fazio
- Unit of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - Gabriella Pravettoni
- Unit of Psycho-Oncology, European Institute of Oncology, University of Milan, Italy
| | - Maria Laura Cossu
- Division of General Surgery II, University Hospital of Sassari, Department of Clinical and Trial Medicine, University of Sassari, Italy
| | - Domenico Galetta
- Department of Thoracic Surgery, European Institute of Oncology, University of Milan, Italy
| | - Marco Venturino
- Division of Anaesthesiology European Institute of Oncology, Milan, Italy
| | - Carlo Ferrari
- Unit of Innovative Techniques in Surgery, European Institute of Oncology, University of Milan, Italy
| | - Lorenzo Macone
- Unit of Innovative Techniques in Surgery, European Institute of Oncology, University of Milan, Italy
| | - Cristiano Crosta
- Division of Endoscopy, European Institute of Oncology, Milan, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention, European Institute of Oncology, Milan, Italy
| | - Roberto Biffi
- Division of Digestive Tract Surgery, European Institute of Oncology, Milan, Italy
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Survival After Neoadjuvant and Adjuvant Treatments Compared to Surgery Alone for Resectable Esophageal Carcinoma: A Network Meta-analysis. Ann Surg 2017; 265:481-491. [PMID: 27429017 DOI: 10.1097/sla.0000000000001905] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This network meta-analysis compared overall survival after neoadjuvant or adjuvant chemotherapy (CT), radiotherapy (RT), or combinations of both (chemoradiotherapy, CRT) or surgery alone to identify the most effective approach. SUMMARY BACKGROUND DATA The optimal treatment for resectable esophageal cancer is unknown. METHODS A search for randomized controlled trials reporting on neoadjuvant and adjuvant therapies was conducted. Using a network meta-analysis, treatments were ranked based on their effectiveness for improving survival. RESULTS In 33 eligible randomized controlled trials, 6072 patients were randomized to receive either surgery alone (N = 2459) or neoadjuvant CT (N = 1332), RT (N = 58), and CRT (N = 1196) followed by surgery or surgery followed by adjuvant CT (N = 542), RT (N = 383), and CRT (N = 102). Twenty-one comparisons were generated. Neoadjuvant CRT followed by surgery compared with surgery alone was the only treatment to significantly improve survival [hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.68-0.87]. When trials were grouped considering neoadjuvant and adjuvant therapies and surgery alone, neoadjuvant therapies combined with surgery compared with surgery alone showed a survival advantage (HR = 0.83, 95% CI 0.76-0.90), whereas surgery along with adjuvant therapies showed no significant survival advantage (HR = 0.87, 95% CI 0.67-1.14). A subgroup analysis of neoadjuvant therapies showed a superior effectiveness of neoadjuvant CRT and surgery compared with surgery alone (HR = 0.77, 95% CI 0.68-0.87). CONCLUSIONS This network meta-analysis showed neoadjuvant CRT followed by surgery to be the most effective strategy in improving survival of resectable esophageal cancer. Resources should be focused on developing the most effective neoadjuvant CRT regimens for both adenocarcinomas and squamous cell carcinomas of the esophagus.
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Garg PK, Sharma J, Jakhetiya A, Goel A, Gaur MK. Preoperative therapy in locally advanced esophageal cancer. World J Gastroenterol 2016; 22:8750-8759. [PMID: 27818590 PMCID: PMC5075549 DOI: 10.3748/wjg.v22.i39.8750] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/23/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023] Open
Abstract
Esophageal cancer is an aggressive malignancy associated with dismal treatment outcomes. Presence of two distinct histopathological types distinguishes it from other gastrointestinal tract malignancies. Surgery is the cornerstone of treatment in locally advanced esophageal cancer (T2 or greater or node positive); however, a high rate of disease recurrence (systemic and loco-regional) and poor survival justifies a continued search for optimal therapy. Various combinations of multimodality treatment (preoperative/perioperative, or postoperative; radiotherapy, chemotherapy, or chemoradiotherapy) are being explored to lower disease recurrence and improve survival. Preoperative therapy followed by surgery is presently considered the standard of care in resectable locally advanced esophageal cancer as postoperative treatment may not be feasible for all the patients due to the morbidity of esophagectomy and prolonged recovery time limiting the tolerance of patient. There are wide variations in the preoperative therapy practiced across the centres depending upon the institutional practices, availability of facilities and personal experiences. There is paucity of literature to standardize the preoperative therapy. Broadly, chemoradiotherapy is the preferred neo-adjuvant modality in western countries whereas chemotherapy alone is considered optimal in the far East. The present review highlights the significant studies to assist in opting for the best evidence based preoperative therapy (radiotherapy, chemotherapy or chemoradiotherapy) for locally advanced esophageal cancer.
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