Factors affecting survival in esophageal squamous cell carcinoma: Single-center experience

Correlation of Porphyromonas gingivalis with esophageal squamous cell carcinoma: a systematic review

OBJECTIVES

This study aimed to assess the correlation of Porphyromonas gingivalis (P. gingivalis) with esophageal squamous cell carcinoma (ESCC).

MATERIALS AND METHODS

This systematic review evaluated case-control, cohort, and cross-sectional studies published between 1990 and 2024 that compared ESCC patients and healthy controls regarding the presence of P. gingivalis, risk of ESCC development, overall survival rate and prognosis of ESCC, lymph node metastasis, clinical stage of the disease, cancer cell proliferation and migration, efficacy of chemotherapy, invasion depth, and cell differentiation. Searching process was conducted in Web of Science, Scopus, PubMed, and Cochrane Library. The quality of included studies was assessed by the Newcastle Ottawa scale (NOS).

RESULTS

Of 270 articles, 11 underwent a systematic review with NOS scores ranging from 7 to 9. 5 studies found a correlation between P.gingivalis and overall survival rate of ESCC patients (P < 0.05). 5 studies found a significant correlation between P.gingivalis count and the risk of ESCC development (P < 0.05). 2 studies showed a significant correlation between lymph node metastasis and 3 studies showed a significant correlation between clinical TNM stage and P.gingivalis (P < 0.05).

CONCLUSIONS

High P. gingivalis count increases the risk of development of ESCC, lymph node metastasis, progression to stages 3 and 4, proliferation and migration of cancer cells, and depth of invasion, decreases the overall survival rate and prognosis of the disease, and efficacy of chemotherapy, and results in poorer differentiation of cells.

CLINICAL RELEVANCE

According to our findings, dental clinicians and patients should be informed about the significance of oral hygiene and its relationship with ESCC to prevent future life-threatening diseases.

Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan

Objective

To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi.

Methods

We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit - Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan-Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival.

Results

Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes.

Conclusion

Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.

Prognostic significance of neutrophil-to-lymphocyte ratio in esophageal squamous cell carcinoma

OBJECTIVE:

The purpose of the study was to assess the effect of neutrophil-to-lymphocyte ratio (NLR) on recurrence and survival in patients with Esophageal Squamous Cell Carcinoma (ESCC) undergoing surgery.

METHODS:

This was a retrospective analysis of the 80 resectable ESCC patients who underwent surgery at Yuzuncu Yil University Faculty of Medicine between 2008 and 2018. Receiver operator characteristics curve of NLR was plotted for disease-free survival (DFS). The area under the curve of NLR was 0.692 (p=0.008) with 65.2% sensitivity and 2.8 with 69.5% specificity. Patients were divided into two groups based on the NLR as follows: NLR <2.8 and NLR ≥2.8.

RESULTS:

Among 80 ESCC patients, 54 (65.5%) were female. The median age was 55 years (range, 26–77). The NLR was <2.8 in 47 (58.7%) patients. Median DFS was 55 months in patients with NLR ≥2.8, whereas it was not reached in those with NLR <2.8 (p=0.008), with corresponding overall survival (OS) durations of 71 months and not reached (p=0.027). Eastern Cooperative Oncology Group performance score 2, presence of obstruction at diagnosis, lower 1/3 esophageal localization, neoadjuvant treatment, and NLR ≥2.8 were found to be the factors related to survival.

CONCLUSION:

The present study demonstrated that high pre-treatment NLR was associated with worse DFS and OS in patients with resectable esophageal cancer. We believe that pre-treatment NLR may help guide predicting treatment outcomes in non-metastatic resectable ESCC patients.