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Tankel J, Sakalla R, Boukhili N, Dehghani M, Spicer J, Najmeh S, Cools-Lartigue J, Asselah J, Soldera S, Alcindor T, Alfieri J, David M, Mueller C, Ferri L. Survival in esophageal cancer with nonregional lymphadenopathy: a propensity score-matched analysis. J Gastrointest Surg 2024:S1091-255X(24)00394-9. [PMID: 38574965 DOI: 10.1016/j.gassur.2024.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Survival among patients with esophageal cancer with stage IV nonregional lymphadenopathy treated with neoadjuvant therapy and surgical resection is not well described. This study aimed to compare the survival outcomes of patients with nonregional lymphadenopathy with a propensity-matched cohort of patients with locoregional disease. METHODS This was a retrospective cohort analysis of a prospectively maintained database from a regional upper gastrointestinal cancer network in Quebec, Canada. From January 2010 to December 2022, patients with radiologically suspicious nonregional retroperitoneal or supraclavicular lymphadenopathy were identified. Using 1:1 propensity score matching, a control group without nonregional disease was created. RESULTS Of the 1235 patients identified, 39 met the inclusion criteria and were allocated to the study group of whom 35 of 39 (89%) had adenocarcinoma. Retroperitoneal and supraclavicular lymphadenopathy occurred in 26 of 39 patients (67%) and 13 of 39 patients (33%). Of the 39 patients, 34 (87%) received neoadjuvant chemotherapy, and 5 (13%) received chemoradiotherapy. After resection, ypN0 of nonregional lymph node stations occurred in 21 of 39 patients (54%). When comparing the study group with a matched non-stage IV control group, the median overall survival was similar in patients with retroperitoneal lymphadenopathy (21.0 months [95% CI, 8.0-21.0] vs 27.0 months [95% CI, 13.0-41.0]; P = .262) but not with supraclavicular disease (13.0 months; 95% CI, 8.0-18.0; P = .039). The median follow-up intervals were 40.1 months (95% CI, 1.0-83.0) for the study group and 70.0 (95% CI, 33.0-106.0) for the control groups. CONCLUSION Compared with a matched cohort of patients with similar disease burden but not stage IV disease, retroperitoneal lymphadenopathy did not negatively affect survival outcomes. Multimodal curative intent therapy may be appropriate in select cases.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rawan Sakalla
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Neyla Boukhili
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mehrnoush Dehghani
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jamil Asselah
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Soldera
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Alcindor
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Joanne Alfieri
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marc David
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
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Wei L, Xu J, Hu X, Xie Y, Lyu G. A predictive scoring model to select suitable patients for surgery on primary tumor in metastatic esophageal cancer. Cancer Rep (Hoboken) 2023; 6:e1898. [PMID: 37702247 PMCID: PMC10728509 DOI: 10.1002/cnr2.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/28/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Surgery on primary tumor (SPT) has been a common treatment strategy for many types of cancer. AIMS This study aimed to investigate whether SPT could be considered a treatment option for metastatic esophageal cancer and to identify the patient population that would benefit the most from SPT. METHODS Data from 18 registration sites in the Surveillance, Epidemiology, and End Results Program database (SEER database) were analyzed to select patients with metastatic esophageal cancer. Multivariate Cox regression analysis was used to identify potential risk factors for pre-treatment survival. Variables with a p-value of less than 0.05 were used to construct a pre-treatment nomogram. A pre-surgery predictive model was then developed using the pre-surgery factors to score patients, called the "pre-surgery score". The optimal cut-off value for the "pre-surgery score" was determined using X-tile analysis, and patients were divided into high-risk and low-risk subsets. It was hypothesized that patients with a low "pre-surgery score" risk would benefit the most from SPT. RESULTS A total of 3793 patients were included in the analysis. SPT was found to be an independent risk factor for the survival of metastatic esophageal cancer patients. Subgroup analyses showed that patients with liver or lung metastases derived more benefit from SPT compared to those with bone or brain metastases. A pre-treatment predictive model was constructed to estimate the survival rates at one, two, and three years, which showed good accuracy (C-index: 0.705 for the training set and 0.701 for the validation set). Patients with a "pre-surgery score" below 4.9 were considered to have a low mortality risk and benefitted from SPT (SPT vs. non-surgery: median overall survival (OS): 24 months vs. 4 months, HR = 0.386, 95% CI: 0.303-0.491, p < 0.001). CONCLUSION This study demonstrated that SPT could improve the OS of patients with metastatic esophageal cancer. The pre-treatment scoring model developed in this study might be useful in identifying suitable candidates for SPT. The strengths of this study include the large patient sample size and rigorous statistical analyses. However, limitations should be noted due to the retrospective study design, and prospective studies are needed to validate the findings in the future.
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Affiliation(s)
- Laiming Wei
- School of Advanced Manufacturing EngineeringHefei UniversityHefeiChina
| | - Jing Xu
- Department of Oncologythe First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Xueyou Hu
- School of Advanced Manufacturing EngineeringHefei UniversityHefeiChina
| | - Yu Xie
- School of Advanced Manufacturing EngineeringHefei UniversityHefeiChina
| | - Gang Lyu
- School of Advanced Manufacturing EngineeringHefei UniversityHefeiChina
- School of Big data and Artificial IntelligenceChizhou UniversityChizhouChina
- Institute of Artificial IntelligenceHefei Comprehensive National Science CenterHefeiChina
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Wu X, Zhang X, Ge J, Li X, Shi C, Zhang M. Development and validation of a prognostic model for esophageal cancer patients with liver metastasis: a cohort study based on surveillance, epidemiology, and end results database. J Cancer Res Clin Oncol 2023; 149:13501-13510. [PMID: 37493687 DOI: 10.1007/s00432-023-05175-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE Our objective is to examine the independent prognostic risk factors for patients with Esophageal Cancer with Liver Metastasis (ECLM) and to develop a predictive model. METHODS In this study, clinical data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis was employed to identify independent prognostic factors and construct nomograms based on the results of multivariate regression. The predictive performance of the nomograms was assessed using several methods, including the consistency index (C-index), calibration curve, time-dependent receiver-operating characteristic curve (ROC), and decision curve analysis (DCA). Additionally, Kaplan-Meier survival curves were generated to demonstrate the variation in overall survival between groups. RESULTS A total of 1163 ECLM patients were included in the study. Multivariate Cox analysis revealed that age, tumor differentiation grade, bone metastasis, therapy, and income were independently associated with overall survival (OS) in the training set. Subsequently, a prognostic nomogram was constructed based on these independent predictors. The C-index values were 0.739 and 0.715 in the training and validation sets, respectively. The area under the curve (AUC) values at 0.5, 1, and 2 years were all higher than 0.700. Calibration curves indicated that the nomogram accurately predicted OS. Decision curve analysis (DCA) showed moderately positive net benefits. Kaplan-Meier survival curves demonstrated significant differences in survival between high- and low-risk groups, which were divided based on the nomogram risk score. CONCLUSIONS The nomogram we developed for ECLM patients has demonstrated good predictive capability, allowing clinicians to accurately evaluate patient prognosis and identify those at high risk, thereby facilitating the development of personalized treatment plans.
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Affiliation(s)
- Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xudong Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Jingjing Ge
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Cunzhen Shi
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
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Zhang Y, Liao JT, Lin Y, Liu C, Wu ZH, Yu B, Sun S, Yu H, Hui XH, Wu XH, Zhao XM, Wang HJ, Zheng Q, Li Y, Hu ZH, Wang JL. Clinicopathological features, treatment modalities, and prognosis of esophageal neuroendocrine carcinoma: A single-center retrospective study. J Dig Dis 2023; 24:472-479. [PMID: 37596865 DOI: 10.1111/1751-2980.13219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES Esophageal neuroendocrine carcinoma (ENEC) is a rare cancer that is highly malignant and related to a poor prognosis. In this retrospective study we aimed to elucidate the clinical characteristics, diagnosis and management of patients with ENEC and to evaluate the potential prognostic factors. METHODS Altogether 82 patients diagnosed with ENEC between January 2009 and December 2020 at the Fudan University Shanghai Cancer Center were retrospectively enrolled. Patients' survival was analyzed using the Kaplan-Meier and log-rank methods. Univariate and multivariate analyses and a Cox regression model were used to identify the prognostic factors. RESULTS The median overall survival (mOS) was 13 months in all patients. Multivariate analysis revealed that advanced tumor stage (hazard ratio [HR] 2.67, 95% confidence interval [CI] 1.07-6.66, P = 0.0353), liver (HR 3.36, 95% CI 1.53-7.41, P = 0.0026) and lung metastasis (HR 3.37, 95% CI 1.20-9.51, P = 0.0214) were associated with a poor prognosis. While positive chromogranin A (CgA) expression was related to a favorable outcome (HR 0.21, 95% CI 0.09-0.49, P < 0.001). Also, patients had adjustment of chemotherapy (dose reduction or less than three cycles) were prone to a worse prognosis compared with those did not (HR 4.36, 95% CI 2.10-9.08, P < 0.001). CONCLUSION In patients with ENEC, advanced cancer stage, adjustment of chemotherapy, liver and lung metastasis were associated with a poor survival, while CgA expression was related to a favorable prognosis.
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Affiliation(s)
- Yao Zhang
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiao Tao Liao
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Lin
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chang Liu
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhen Hua Wu
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Bo Yu
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Si Sun
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Yu
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiao Hua Hui
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xiang Hua Wu
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Min Zhao
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hui Jie Wang
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qiang Zheng
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuan Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhi Huang Hu
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jia Lei Wang
- Department of Thoracic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Thoracic Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Hu Y, Li Z, Gong L, Song Z. β-Asarone suppresses TGF-β/Smad signaling to reduce the invasive properties in esophageal squamous cancer cells. Med Oncol 2022; 39:243. [PMID: 36180656 DOI: 10.1007/s12032-022-01847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 09/08/2022] [Indexed: 12/24/2022]
Abstract
Esophageal cancer is one of the most common malignancies which induces cancer-related death. Cancer metastasis and recurrence are the main obstacle faced in esophageal cancer treatment. β-Asarone has been shown to act as an anti-cancer reagent in various cancer types. However, the anti-cancer activities of β-Asarone in esophageal cancer have not been shown. In the current study, we show that β-Asarone suppressed the proliferation of esophageal squamous cancer cells (ESCC) in both dose- and time-dependent manners. Moreover, β-Asarone treatment increases activated caspase 3, caspase 9, and cleaved poly ADP-ribose polymerase, and induces apoptosis in ESCC. Additionally, β-Asarone also suppresses epithelial-mesenchymal transition (EMT) and the invasive and migratory abilities in ESCC. Interestingly, β-Asarone suppresses TGF-β/Smad signaling by inhibition of TGF-β-induced phosphorylation of Smad2 and Smad3. Importantly, we show that inhibition of TGF-β/Smad signaling activation is critical for β-Asarone-suppressed EMT. Our data revealed a novel role of β-Asarone which targets invasive properties by inhibiting TGF-β/Smad signaling activation in ESCC. Our study suggests the potential application of β-Asarone to reduce cancer metastasis and recurrence in esophageal cancer treatment.
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Liao F, Yu S, Zhou Y, Feng B. A machine learning model predicting candidates for surgical treatment modality in patients with distant metastatic esophageal adenocarcinoma: A propensity score-matched analysis. Front Oncol 2022; 12:862536. [PMID: 35936753 PMCID: PMC9354694 DOI: 10.3389/fonc.2022.862536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo explore the role of surgical treatment modality on prognosis of metastatic esophageal adenocarcinoma (mEAC), as well as to construct a machine learning model to predict suitable candidates.MethodAll mEAC patients pathologically diagnosed between January 2010 and December 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A 1:4 propensity score-matched analysis and a multivariate Cox analysis were performed to verify the prognostic value of surgical treatment modality. To identify suitable candidates, a machine learning model, classification and regression tree (CART), was constructed, and its predictive performance was evaluated by the area under receiver operating characteristic curve (AUC).ResultsOf 4520 mEAC patients, 2901 (64.2%) were aged over 60 years and 4012 (88.8%) were males. There were 411 (9.1%) patients receiving surgical treatment modality. In the propensity score-matched analysis, surgical treatment modality was significantly associated with a decreased risk of death (HR: 0.47, 95% CI: 0.40-0.55); surgical patients had almost twice as much median survival time (MST) as those without resection (MST with 95% CI: 23 [17-27] months vs. 11 [11-12] months, P <0.0001). The similar association was also observed in the multivariate Cox analysis (HR: 0.47, 95% CI: 0.41-0.53). Then, a CART was constructed to identify suitable candidates for surgical treatment modality, with a relatively good discrimination ability (AUC with 95% CI: 0.710 [0.648-0.771]).ConclusionSurgical treatment modality may be a promising strategy to prolong survival of mEAC patients. The CART in our study could serve as a useful tool to predict suitable candidates for surgical treatment modality. Further creditable studies are warranted to confirm our findings.
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Affiliation(s)
- Fang Liao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shuangbin Yu
- Department of Medical Administration, Sichuan Academy of Medical Sciences and Sichuan People’s Hospital, Chengdu, China
| | - Ying Zhou
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Benying Feng
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, China
- Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
- *Correspondence: Benying Feng,
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Yang H, Wang K, Li Y, Li S, Yuan L, Ge H. Local Ablative Treatment Improves Survival in ESCC Patients With Specific Metastases, 2010–2016: A Population-Based SEER Analysis. Front Oncol 2022; 12:783752. [PMID: 35785182 PMCID: PMC9243329 DOI: 10.3389/fonc.2022.783752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to explore the role of local ablative treatment (LAT) in metastatic esophageal squamous cell cancer (ESCC) patients who received chemotherapy and identify patients who will most likely benefit. Methods We analyzed data of metastatic ESCC patients from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2016. The chi-square test was used to evaluate the unadjusted clinicopathological categorical variables between the two groups. Univariate and multivariate Cox regression analyses were conducted to identify independent prognostic factors of overall survival. Propensity score matching (PSM) was used to adjust the differences between the two groups. Results Overall, 720 metastatic ESCC patients treated with chemotherapy were analyzed in this study; 63.2% of patients (n = 455) received LAT, including radiotherapy (n = 444), primary site surgery (n = 12), or lymph node dissection (n = 27). Gender (HR = 1.220, 95% CI: 1.024–1.453, p = 0.026), bone metastases (HR = 1.559, 95% CI: 1.292–1.882, p < 0.001), and liver metastases (HR = 1.457, 95% CI: 1.237–1.716, p < 0.001) were independent prognostic factors in the entire population. However, LAT was not an independent prognostic factor. Further subgroup analyses showed that LAT improved OS from 8.0 months to 10.0 months in patients with metastases other than bone/liver (HR = 0.759, 95% CI: 0.600–0.961, p = 0.022). LAT was not a prognostic factor in patients with bone/liver metastases (HR = 0.995, 95% CI: 0.799–1.239, p = 0.961). After PSM, the median OS was 8.0 months (95% CI: 7.2–8.8 months) and patients who received LAT had a better OS than patients without LAT (HR = 0.796, 95% CI: 0.653–0.968, p = 0.023). Patients with metastases other than bone/liver could benefit from LAT compared with those with bone/liver metastases. Conclusions Our study indicated that metastatic ESCC patients with metastases other than bone/liver could derive additional benefit from LAT with systemic chemotherapy.
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Affiliation(s)
| | | | | | | | - Ling Yuan
- *Correspondence: Ling Yuan, ; Hong Ge,
| | - Hong Ge
- *Correspondence: Ling Yuan, ; Hong Ge,
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Guo J, Tong CY, Shi JG, Li XJ. Treatment paradigms and survival outcomes in esophageal adenocarcinoma with liver metastasis: a retrospective cohort study using the SEER database. J Gastrointest Oncol 2022; 13:935-948. [PMID: 35837204 DOI: 10.21037/jgo-22-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Esophageal adenocarcinoma with liver metastasis (EACLM) at the time of diagnosis has a poor prognosis and few therapeutic options. The best treatment options and prognostic factors for EACLM patients are unclear. The present study sought to explore the optimal treatment modalities for and the prognosis of these patients. Methods Patients diagnosed with EACLM at the time of diagnosis were identified from the Surveillance, Epidemiology and End Results (SEER) database between 2010 and 2015. The last follow-up date was December 31, 2018. Treatment patterns were divided into four groups: local therapy (surgery/radiation), systemic therapy [chemotherapy (CT)], combination therapy (surgery/radiation + CT), and no treatment. The Kaplan-Meier (K-M) method and log-rank test were used for overall survival (OS) and disease-specific survival (DSS). Univariable and multivariable Cox regression were performed to identify the prognostic factors. Propensity score-matching (PSM) analyses were performed for sensitive analyses. Results A total of 925 patients diagnosed with EACLM were included in the study. The median OS was 12, 10, 3, and 2 months for combination therapy, systemic therapy, local therapy, and no treatment, respectively (P<0.001). After PSM, the patients who received systemic treatment had a better OS (median 9 vs. 2 months; P<0.001) and DSS (median 9 vs. 3 months; P<0.001) than those who received no treatment. Compared to systemic therapy, combination therapy did not increase patients' OS (median 13 vs. 12 months, P=0.069) but did improve their DSS (median 19 vs. 13 months, P=0.048). Conclusions EACLM patients might benefit the most from systemic therapy and combination therapy. For patients who are well-tolerated, combination therapy should be considered as a preferable option.
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Affiliation(s)
- Jing Guo
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Chang-Yong Tong
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Jian-Guang Shi
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Xin-Jian Li
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
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Li LQ, Fu QG, Zhao WD, Wang YD, Meng WW, Su TS. Chemoradiotherapy Versus Chemotherapy Alone for Advanced Esophageal Squamous Cell Carcinoma: The Role of Definitive Radiotherapy for Primary Tumor in the Metastatic Setting. Front Oncol 2022; 12:824206. [PMID: 35433478 PMCID: PMC9005791 DOI: 10.3389/fonc.2022.824206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/28/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The role of definitive radiotherapy in advanced esophageal squamous cell carcinoma (ESCC), especially in the metastatic setting, remains unclear. Therefore, we aimed to investigate the efficacy of chemoradiotherapy (CRT) versus chemotherapy (CT) alone in these selected patients. Methods We retrospectively evaluated 194 newly diagnosed advanced ESCC who underwent definitive CRT or CT alone, including 97 patients with locally advanced and 97 patients with distant metastatic disease. Cumulative overall survival (OS) and progression-free survival (PFS) were evaluated with a log-rank test. Propensity score matching was used to simulate random allocation. In addition, we performed subgroup analysis in the locally advanced and metastatic disease. Results After matching, 63 well-paired patients were selected. The adjusted median OS (12.5 vs. 7.6 months, p = 0.002) and PFS (9.0 vs. 4.8 months, p = 0.0025) in the CRT group were superior to that in the CT-alone group. Further subgroup analysis revealed that CRT conferred survival benefits to both locally advanced and metastatic cohorts. For patients with distant metastasis, median OS (12.9 vs. 9.3 months, p = 0.029) and PFS (9.9 vs. 4.0 months, p =0.0032) in the CRT group were superior to that in the CT-alone group. In a multivariate Cox regression analysis of the entire cohort, additional definitive radiotherapy was independently associated with better OS (p = 0.041) and PFS (p = 0.007). Conclusions In both locally advanced and metastatic ESCC, additional definitive-dose radiotherapy was associated with improved clinical outcomes. Therefore, more consideration should be given to its application in the metastatic setting.
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Affiliation(s)
- Li-Qing Li
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Qing-Guo Fu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Wei-Dong Zhao
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Yu-Dan Wang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Wan-Wan Meng
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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Guo J, Zhang S, Wang J, Zhang P, Lu T, Zhang L. Hinokiflavone Inhibits Growth of Esophageal Squamous Cancer By Inducing Apoptosis via Regulation of the PI3K/AKT/mTOR Signaling Pathway. Front Oncol 2022; 12:833719. [PMID: 35178352 PMCID: PMC8844566 DOI: 10.3389/fonc.2022.833719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
Background Globally, esophageal cancer ranks as the seventh most common cancer. Esophageal squamous cell carcinoma (ESCC) is one of its major histological types. ESCC accounts for the vast majority of cases in China, and the mortality rate is high. Cisplatin, the standard adjuvant chemotherapy drug for ESCC, has a modest response rate due to the development of drug resistance. Hinokiflavone (HF) is a natural biflavonoid compound with anti-melanoma activity. However, its anti-tumor effect on ESCC and the underlying mechanisms remain largely unknown. Methods The ESCC cell lines KYSE150 and TE14 were used. The cell counting kit-8 assay and flow cytometry analysis, along with colony formation, EdU, wound healing, and Transwell migration assays, were performed to assess cell characteristics (viability, migration, invasion, and apoptosis) following treatment with HF. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), western blotting, and molecular docking were used to investigate the pathways potentially modulated by HF. In vivo anti-tumor effects of HF were also investigated using a mouse xenograft model. Results Our findings revealed that HF inhibited ESCC cell proliferation. Hoechst 33342 staining, annexin V-FITC/PI staining, and western blotting confirmed that HF causes caspase-dependent apoptosis. KEGG pathway enrichment analysis and western blotting indicated that the PI3K/AKT/mTOR pathway played an important role in the process of HF-induced apoptosis. Furthermore, HF effectively impaired the migration and invasion abilities of KYSE150 cells and downregulated the expression of the matrix metalloproteinases (MMP) MMP2 and MMP9. HF inhibited tumor growth and exhibited minimal toxicity in the organs of the KYSE150 xenograft model. Conclusion This is the first study to demonstrate the inhibition of ESCC growth and progression by HF. The underlying mechanism is through blocking the PI3K/AKT/mTOR signaling pathway, thereby inhibiting cell proliferation and inducing apoptosis. HF can be used as a complementary/alternative agent for ESCC therapy.
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Affiliation(s)
- Jida Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Shengqiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Jun Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Pengfei Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Tong Lu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
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Qin Y, Mao J, Liang X, Wang N, Yuan M, Zhu J, Wu D, Wang Q. Bone metastasis in esophageal adenocarcinoma and squamous cell carcinoma: a SEER-based study. Gen Thorac Cardiovasc Surg 2022; 70:479-490. [PMID: 35044634 DOI: 10.1007/s11748-021-01765-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Esophageal cancer is a common worldwide disease with a higher mortality rate. Studies on esophageal cancer patients with bone metastasis are rare. Our study focused on the clinicopathological features of patients with bone metastasis using the Surveillance, Epidemiology and End Results (SEER) database to further explore the risk factors and survival for bone metastasis. METHODS Esophageal cancer patients with bone metastasis were extracted from the SEER database. Univariable analysis and multivariable logistic regression were used to study the risk factors for bone metastasis. Univariable analysis and multivariable Cox regression were performed to reveal the survival and prognostic factors for bone metastasis. The competitive risk model was made to compare the association with bone metastasis among different causes of death. Propensity score matching was used to reduce the bias. RESULTS Male, middle esophagus, with brain metastasis, without lung metastasis and without liver metastasis were major independent risk factors of bone metastasis. Older age, poorly differentiated and undifferentiated, with brain metastasis and with liver metastasis were major independent prognostic factors of bone metastasis. Patients with bone metastasis had a worse prognosis before and after propensity score matching than patients with other metastasis. CONCLUSIONS Esophageal cancer patients with male sex, middle esophagus and brain metastasis were more likely to have bone metastasis. Compared to patients with other metastatic sites such as liver, brain and lung, patients with bone metastasis had a worse prognosis. Our findings provide recommendations about clinical guidelines for esophageal cancer patients with bone metastasis.
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Affiliation(s)
- Ya Qin
- Department of Oncology, Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Wuxi, 214400, Jiangsu, China
| | - Jiannan Mao
- Department of Orthopedics, Jiangyin People's Hospital, Wuxi, 214400, Jiangsu, China
| | - Xiao Liang
- Department of Medical Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210000, Jiangsu, China
| | - Nanyao Wang
- Department of Oncology, Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Wuxi, 214400, Jiangsu, China
| | - Ming Yuan
- Department of Oncology, Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Wuxi, 214400, Jiangsu, China
| | - Jiamin Zhu
- Department of Oncology, Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Wuxi, 214400, Jiangsu, China
| | - Dan Wu
- Department of Oncology, Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Wuxi, 214400, Jiangsu, China.
| | - Qiong Wang
- Department of Oncology, Jiangyin People's Hospital, 163# Shoushan Road, Jiangyin, Wuxi, 214400, Jiangsu, 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: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Weiss ARR, Donlon NE, Schlitt HJ, Hackl C. Resection of oesophageal and oesophagogastric junction cancer liver metastases - a summary of current evidence. Langenbecks Arch Surg 2021. [PMID: 34860291 DOI: 10.1007/s00423-021-02387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022]
Abstract
Purpose Metastatic oesophageal cancer is commonly considered as a palliative situation with a poor prognosis. However, there is increasing evidence that well-selected patients with a limited number of liver metastases (ECLM) may benefit from a multimodal approach including surgery. Methods A systematic review of the current literature for randomized trials, retrospective studies, and case series with patients undergoing hepatectomies for oesophageal and oesophagogastric junction cancer liver metastases was conducted up to the 31st of August 2021 using the MEDLINE (PubMed) and Cochrane Library databases. Results A total of 661 articles were identified. After removal of duplicates, 483 articles were screened, of which 11 met the inclusion criteria. The available literature suggests that ECLM resection in patients with liver oligometastatic disease may lead to improved survival and even long-term survival in some cases. The response to concomitant chemotherapy and liver resection seems to be of significance. Furthermore, a long disease-free interval in metachronous disease, low number of liver metastases, young age, and good overall performance status have been described as potential predictive markers of outcome for the resection of liver metastases. Conclusion Surgery may be offered to carefully selected patients to potentially improve survival rates compared to palliative treatment approaches. Studies with standardized patient selection criteria and treatment protocols are required to further define the role for surgery in ECLM. In this context, particular consideration should be given to neoadjuvant treatment concepts including immunotherapies in stage IVB oesophageal and oesophagogastric junction cancer.
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Qiu G, Zhang H, Wang F, Zheng Y, Wang Z, Wang Y. Metastasis Patterns and Prognosis of Elderly Patients With Esophageal Adenocarcinoma in Stage IVB: A Population-Based Study. Front Oncol 2021; 11:625720. [PMID: 34123784 PMCID: PMC8193932 DOI: 10.3389/fonc.2021.625720] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background Esophageal adenocarcinoma (EAC) is the most common kind of esophageal cancer. Age at diagnosis of advanced EAC is greater. Studies about practice patterns for elderly EAC patients with distant metastasis (DM) in stage IVB are limited. This retrospective, population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) to evaluate 855 elderly EAC patients with DM in stage IVB from 2010 to 2015. Methods 855 elderly EAC patients with DM in stage IVB between 2010 and 2015 were included in this study. Univariate and multivariate Cox-regression and Kaplan-Meier analyses were used to assess prognosis. These patients were classified to bone-only, brain-only, lung-only, liver-only, and multiple (patients with two or more organs in metastasis)-site group according to the site of metastasis. Overall survival (OS), cancer-specific survival (CSS), median survival time (MST), and survival rate (SR) were evaluated to analyze the survival outcomes. Results The most common metastasis site was the liver among the single-organ metastasis population, followed by lung, bone, and brain. Compared with the bone-only group, the multiple-site group was associated with worst OS (HR: 1.037, 95% CI: 0.811–1.327, p = 0.770) and CSS (HR: 1.052, 95% CI: 0.816–1.357, p = 0.695). The multiple-site group also had the lowest MST in the population (MST: 2 months in OS and 3 months in CSS) and SR (6-month SR: 27.1% in OS, 29.9% in CSS, 1-year SR: 10.7% in OS, 12.0% in CSS, 3-year SR: 2.5% in OS, 2.8% in CSS). Compared to untreated patients (N) in the total population, other patients who were treated with surgery (S), radiotherapy (R), and chemotherapy (C) are beneficial for the prognosis (OS and CSS: p < 0.001). Conclusion This population-based study was conducted to ascertain metastasis patterns and survival outcomes of EAC patients with DM in stage IVB. Elderly patients with multiple-site metastasis exhibited the worst OS and CSS among all the populations, and patients with bone-only metastasis had the worst OS and CSS among single-organ metastasis populations. Active treatment is beneficial for elderly EAC patients with DM in stage IVB, especially chemotherapy. This study also shows that more than one third of the patients had not received any therapy.
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Affiliation(s)
- Guanghao Qiu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fuqiang Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Zheng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zihao Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Wang
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Zhang L, Long X, Hu ZN, Wu Y, Song J, Zhang BX, Chen WX. An extremely atypical presentation of esophageal squamous cell carcinoma with pancreatic and hepatic metastases: A case report and overview of the literature. Medicine (Baltimore) 2021; 100:e25785. [PMID: 34011038 PMCID: PMC8137018 DOI: 10.1097/md.0000000000025785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Esophageal carcinoma is an aggressive cancer with extremely poor therapeutic outcomes due to its high metastatic potential and a significant risk of recurrence after radical resection. Liver is the most common metastatic target organ of esophageal carcinoma, followed by the lungs, bones, and brain. Few cases of solitary pancreatic and hepatic metastases of esophageal carcinoma have been reported. PATIENT CONCERNS We report the case of a 67-year-old male presenting with pancreatic and hepatic lesions. In addition, a friable lesion with an irregular nodular surface in the distal esophagus was detected by esophagogastroduodenoscopy. DIAGNOSIS Pathohistological examination confirmed esophageal squamous cell carcinoma. The pancreatic lesion was also biopsied via ultrasound-guided fine needle aspiration, which also revealed squamous cell carcinoma. The hepatic lesion was also identified as metastatic carcinoma by magnetic resonance imaging, most likely of the same origin. INTERVENTIONS Due to comorbidities that precluded surgery, the patient was administered adjuvant therapy and a multidisciplinary decision was made for palliative care. OUTCOMES The patient died 1 month later due to multiorgan failure caused by hemorrhage from a peptic ulcer. CONCLUSION To our knowledge, this is only the sixth case of pancreatic metastasis of esophageal squamous cell carcinoma. This case report suggests to clinicians the importance of considering potential comorbidities in every patient with advanced cancer, such as gastric ulcer and cachexia.
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Li H, Zhang S, Guo J, Zhang L. Hepatic Metastasis in Newly Diagnosed Esophageal Cancer: A Population-Based Study. Front Oncol 2021; 11:644860. [PMID: 34041021 PMCID: PMC8143266 DOI: 10.3389/fonc.2021.644860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background The hepatic metastasis pattern of esophageal cancer (EC) has not been fully explored. The primary objective of this study was to explore the predictors of esophageal cancer with hepatic metastasis (ECHM) at the time of diagnosis. In addition, we also analyzed the factors affecting ECHM prognosis. Methods We used the Surveillance, Epidemiology and End Result (SEER) database to identify ECHM patients at the time of initial diagnosis. The ECHM predictors were identified using multivariate logistic regression. Multivariate Cox regression and competing survival risk analyses were performed to identify factors associated with all-cause mortality and EC-specific mortality of ECHM, respectively. Results A total of 10,965 eligible EC patients were identified in the SEER database between 2010 and 2016, of which 1,197 were ECHM patients, accounting for 10.9% of the entire cohort. In the whole cohort, eight ECHM predictors (age, primary site, grade, histology type, T staging, N staging, insurance status, and number of extrahepatic metastatic sites) were determined using multivariate logistic regression analysis. Multivariate Cox regression and multivariate competing survival risks models confirmed that the male sex, advanced age, squamous cancer, and multiple extrahepatic metastasis increased the risk of both all-cause and EC-specific mortality, whereas chemotherapy and chemotherapy plus radiotherapy significantly reduced the risk of both. Conclusions This study explored population-level predictors of hepatic metastasis at the time of EC diagnosis and analyzed the clinical characteristics affecting the prognosis in ECHM patients. These findings may provide clinicians with a reference for the screening and treatment of hepatic metastasis in EC.
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Affiliation(s)
- Huawei Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengqiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jida Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Ghazy HF, El-Hadaad HA, Wahba HA, Abbas R, Abbas OA. Metastatic Esophageal Carcinoma: Prognostic Factors and Survival. J Gastrointest Cancer 2021. [PMID: 33847917 DOI: 10.1007/s12029-021-00610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Worldwide, esophageal cancer is the eighth most common cancer and the sixth leading cause of cancer-related death. At initial diagnosis, about 50% of esophageal cancer patients present with metastasis. The prognosis of metastatic esophageal cancer is poor with 5-year survival rate of less than 5%. METHODS This is a retrospective study of stage IV esophageal cancer patients registered at Clinical Oncology and Nuclear Medicine department and Oncology Center Mansoura University in the period from 2009 to 2018 inclusive. Eligibility criteria were all pathologically proven stage IV esophageal cancer patients. The medical files of patients were reviewed. RESULTS Most patients were ≥ 50 years (67.8%) with male predominance (76.7%). Middle third was the most common site of primary tumor (38.9%). Squamous cell carcinoma was more common with incidence of grade 3 (40%). T3-4 lesion was recorded in 61.1% and node positive in 66.7%. As regards metastasis; liver was the most common one (45.5%) followed by lung (30%). One-year survival rate was 25.6% with median survival time of 8 months. Multivariate analysis indicated that age (p = 0.03), site (p = 0.04), grade of primary tumor (p = 0.049), T classification (p = 0.0038), ECOG PS (p = 0.046), site (p = 0.026), and number of metastasis (p = 0.04) significantly affect prognosis while sex (p = 0.74) and histologic type (p = 0.94) do not. CONCLUSION Metastatic esophageal carcinoma is a disease of poor prognosis especially in patients with the following criteria: old age, lower third location, high grade and large tumors, poor performance status, multiple sites of metastasis and presence of bone secondaries.
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Guo J, Zhang S, Li H, Hassan MOO, Lu T, Zhao J, Zhang L. Lung Metastases in Newly Diagnosed Esophageal Cancer: A Population-Based Study. Front Oncol 2021; 11:603953. [PMID: 33718154 PMCID: PMC7947855 DOI: 10.3389/fonc.2021.603953] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Background Esophageal cancer is one of the most common cancer types, with its most common distant metastatic site being the lung. Currently, population-based data regarding the proportion and prognosis of patients with esophageal cancer with lung metastases (ECLM) at the time of diagnosis is insufficient. Therefore, we aimed to determine the proportion of patients with ECLM at diagnosis, as well as to investigate the prognostic parameters of ECLM. Methods This population-based observational study obtained data from the Surveillance, Epidemiology, and End Results (SEER) database registered between 2010 and 2016. Multivariable logistic regression was performed to identify predictors of the presence of ECLM at diagnosis. Multivariable Cox regression and competing risk analysis were used to assess prognostic factors in patients with ECLM. Median survival was estimated using Kaplan–Meier curves. Results Of 10,965 patients diagnosed with esophageal cancer between 2010 and 2016, 713 (6.50%) presented with initial lung metastasis at diagnosis. Lung metastasis represented 27.15% of all cases with metastatic disease to any distant site. Considering all patients with esophageal cancer, multivariable logistic regression indicated that pathology grade, pathology type, T staging, N staging, race, and number of extrapulmonary metastatic sites were predictive factors for the occurrence of lung metastases at diagnosis. The median survival time of patients with ECLM was 4.0 months. Patients receiving chemotherapy or chemoradiotherapy had the longest median overall survival, 7.0 months. Multivariable Cox regression indicated that age, histology type, T2 staging, number of extrapulmonary metastatic sites, and treatment (chemotherapy, radiotherapy, or chemoradiotherapy) were independent predictors for overall survival (OS). Multivariable competing risk analysis determined that age, number of extrapulmonary metastatic sites, and treatment were independent predictors for esophageal cancer-specific survival (CSS). Conclusion The findings of this study may provide important information for the early diagnosis of ECLM, as well as aid physicians in choosing appropriate treatment regimens for these patients.
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Affiliation(s)
- Jida Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shengqiang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huawei Li
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Mohamed Osman Omar Hassan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tong Lu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaying Zhao
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Linyou Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Liu Z, Zhang X, Li B, Jiang H, Yang Y, Hua R, Sun Y, Li Z. A population-based predictive model predicting candidate for primary tumor surgery in patients with metastatic esophageal cancer. J Thorac Dis 2021; 13:870-882. [PMID: 33717560 PMCID: PMC7947545 DOI: 10.21037/jtd-20-2347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The survival benefit of primary tumor surgery for metastatic esophageal cancer (mEC) patients has been observed, but methods for discriminating which individual patients would benefit from surgery have been poorly defined. Herein, a predictive model was developed to test the hypothesis that only certain metastatic patients would gain a survival benefit from primary tumor surgery. Methods Clinical data for patients with mEC were extracted from the Surveillance, Epidemiology and End Results (SEER) database [2004-2016] and then divided into surgery and no-surgery groups according to whether surgery was performed on the primary tumor. Propensity-score-matching (PSM) was performed to balance the confounding factors. We hypothesized that the patients who had undergone surgery and lived longer than the median cancer-specific-survival (CSS) of the no-surgery group could benefit from surgery. We constructed a nomogram to predict surgery benefit potential based on multivariable logistic-regression analysis using preoperative factors. The predictive performance of the nomogram was evaluated by the area under the receiver operating characteristic (AUC) and calibration curves. The clinical application value of the nomogram was estimated with decision curve analysis (DCA). Results A total of 5,250 eligible patients with mEC were identified, and 9.4% [492] received primary tumor surgery. After PSM, CSS for the surgery group was significantly longer [median: 19 vs. 9 months; hazard ratio (HR) 0.52, P<0.001] compared with the no-surgery group. Among the surgery group, 69.3% [327] survived >9 months (surgery-beneficial group). The prediction nomogram showed good discrimination both in training and validation sets (AUC: 0.72 and 0.70, respectively), and the calibration curves indicated a good consistency. DCA demonstrated that the nomogram was clinically useful. According to this nomogram, surgery patients were classified into two groups: no-benefit-candidate and benefit-candidate. The benefit-candidate group was associated with longer survival than the no-benefit-candidate group (median CSS: 19 vs. 6.5 months, P<0.001). Additionally, there was no difference in survival between the no-benefit-candidate and no-surgery groups (median CSS: 6.5 vs. 9 months, P=0.070). Conclusions A predictive model was created for the selection of candidates for surgical treatment among mEC patients. This predictive model might be used to select patients who may benefit from primary tumor surgery.
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Affiliation(s)
- Zhichao Liu
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaobin Zhang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haoyao Jiang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Yang
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Hua
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yifeng Sun
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Section of Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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20
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Seyedin SN, Parekh KR, Ginader T, Caster JM. The Role of Definitive Radiation and Surgery in Metastatic Esophageal Cancer: An NCDB Investigation. Ann Thorac Surg 2020; 112:459-466. [PMID: 33096068 DOI: 10.1016/j.athoracsur.2020.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/29/2020] [Accepted: 08/24/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Approximately 40% of patients with esophageal cancer present with metastatic disease. Survival with palliative treatment is poor, and the benefit of aggressive focal therapies is unclear. This study aimed to identify a subset of patients with metastatic esophageal cancer with favorable outcomes after curative doses of radiation therapy, esophagectomy, or both. METHODS Between 2004 and 2015, the study investigators found 28,101 patients with metastatic esophageal cancer in the National Cancer Database and identified those who underwent chemotherapy and definitive radiation therapy with or without surgery over the study period. The study compared the estimated median overall survival (OS) of all patients with metastatic esophageal cancer with the estimated median OS of patients with metastatic esophageal cancer who underwent radiation therapy with or without surgery. Multivariable analysis was used to examine clinical and pathologic factors associated with OS. RESULTS At a median follow-up of 11.1 months, 3219 patients with a median age of 64 years and a radiation dose of 50.4 Gy were identified. Only 202 (6.2%) patients undergoing definitive-dose radiation therapy underwent esophagectomy, with a median age of 60 years. The median OS durations for all patients, for patients treated with radiation, and for patients treated with radiation therapy in combination with esophagectomy were 6.6, 11.5, and 30.2 months, respectively. Among patients undergoing surgery, median OS after surgery was 23.7 months. Patients with lung, liver, or bone metastases were less likely to undergo esophagectomy. On multivariable analysis, esophagectomy and low tumor grade were associated with higher OS, whereas liver and bone metastases at diagnosis were associated with worse OS. CONCLUSIONS This analysis suggests that select subsets of patients with primarily nonvisceral, nonosseous metastatic esophageal cancer have favorable survival and may potentially benefit from aggressive local therapies.
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Affiliation(s)
- Steven N Seyedin
- Department of Radiation Oncology, University of California, Irvine-Chao Family Comprehensive Cancer Center, Orange, California; Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Kalpaj R Parekh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Timothy Ginader
- Holden Comprehensive Cancer Center, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Joseph M Caster
- Department of Radiation Oncology, University of Iowa Hospital and Clinics, Iowa City, Iowa.
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21
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Li B, Wang R, Zhang T, Sun X, Jiang C, Li W, Zou B, Xie P, Meng X, Sun X, Wang L, Yu J. Development and validation of a nomogram prognostic model for esophageal cancer patients with oligometastases. Sci Rep 2020; 10:11259. [PMID: 32647289 DOI: 10.1038/s41598-020-68160-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 06/17/2020] [Indexed: 12/24/2022] Open
Abstract
Platinum-based chemotherapy is recommended as the standard treatment for metastatic esophageal cancer (EC) patients; however, the outcome is poor. Oligometastasis is less aggressive and has limited growth potential. However, the prognostic factors for EC patients with oligometastases was largely unknown. Thus, we intend to determine the prognostic factors, and develop and validate nomograms for prediction of survival for EC patients with oligometastases. In this study, characteristics of 273 oligometastatic EC patients were analyzed using univariate and multivariate Cox models to determine the independent prognostic factors for progression-free survival (PFS) and overall survival (OS). The result showed that history of alcohol consumption, longer tumor, no local radiotherapy for EC, and no local treatment for metastases were independent factors for PFS. Sex, esophageal fistula, number of metastatic organs, and local radiotherapy for EC were independent prognostic factors for OS. On the basis of Cox models, the respective nomogram for prediction of PFS and OS was established with the corrected concordance index of 0.739 and 0.696 after internal cross-validation. In conclusion, local treatment for metastases and local radiotherapy for EC were demonstrated to be beneficial for oligometastatic EC patients, and the validated nomograms are valuable in prognosis prediction and could guide individualized management for these patients.
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22
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Zhang R, Zou J, Li P, Li Q, Qiao Y, Han J, Huang K, Ruan P, Lin H, Song Q, Fu Z. Surgery to the primary tumor is associated with improved survival of patients with metastatic esophageal cancer: propensity score-matched analyses of a large retrospective cohort. Dis Esophagus 2020; 33:5512616. [PMID: 31175353 DOI: 10.1093/dote/doz051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 03/15/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023]
Abstract
The survival advantage of surgery to the primary tumor for patients with distant metastatic esophageal cancer has not been adequately evaluated. This study aims to investigate the role of surgery to the primary tumor in distant metastatic esophageal cancer and to evaluate possible different effects of surgery on survival of esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC). This study included a cohort of 4,367 metastatic esophageal cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database, registered from January 2004 to December 2014. Kaplan-Meier and Cox proportional hazardous models were used to evaluate the overall survival (OS) and corresponding 95% confidence interval (CI). Propensity score matching (PSM) was used to adjust for potential baseline confounding. Both EAC (median OS for surgery group vs. no-surgery group-14.0 vs. 9.0 months, P < 0.001) and ESCC (median OS for surgery vs. no-surgery group-11.0 vs. 7.0 months, P = 0.002) experienced survival benefits from surgery. We found that surgery to the primary tumor, when combined with chemotherapy, was associated with improved survival for patients with M1b disease, both EAC and ESCC, with a greater benefit observed in younger patients, and those with EAC. While the present data indicate a potential survival benefit from surgery for some patients with metastatic esophageal cancer, it is possible that performance status and metastatic disease burden impacted patient selection, influencing these results. Further studies are needed to determine the role of surgery for patients with metastatic esophageal cancer.
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Affiliation(s)
- Rui Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiahua Zou
- Huanggang Cancer Center, Huanggang Hospital of Traditional Chinese Medicine, Huanggang City, Hubei Province, China
| | - Ping Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qin Li
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yunfeng Qiao
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jianglong Han
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kejie Huang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Ruan
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Huiqing Lin
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan
| | - Qibin Song
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenming Fu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
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23
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Schurink B, Mazza E, Ruurda JP, Roeling TAP, Bleys RLAW, van Hillegersberg R. Metastatic incidence of (PET)CT positive lung hilar and retroperitoneal lymph nodes in esophageal cancer patients. Surg Oncol 2020; 33:170-176. [PMID: 32561084 DOI: 10.1016/j.suronc.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Extra-regional lymph node metastases strongly determine treatment options in patients with esophageal cancer. Staging modalities such as (FDG-PET) CT scanning frequently show activity in retroperitoneal and lung hilar lymph nodes. This study evaluated the incidence of histologically confirmed metastases, treatment approach and recurrence patterns in patients with (FDG-PET) CT positivity in these regions. METHODS All patients with (FDG-PET-) CT positive hilar and/or retroperitoneal lymph nodes at primary staging or restaging discussed at a multidisciplinary tumor board meeting for staging of esophageal cancer between January 2012-December 2017 were included. Biopsies and follow-up were evaluated to determine the presence of metastases and progression rates. RESULTS From 2012 to 2017, 65 of 857 patients (7.6%) were selected with positive retroperitoneal and/or hilar lymph nodes. A total of 47/65 (72.3%) patients had positive retroperitoneal lymph nodes, which contained metastases in 19 (29.2%). When no biopsy was performed and curative treatment was given (n = 14), 9 patients had progression or locoregional and distant recurrence. Positive hilar lymph nodes were identified in 21 (32.3%) patients; 4 were biopsied and none contained metastases. In these patients no recurrence of disease was seen during follow-up. CONCLUSIONS The majority of biopsied (PET)CT-positive retroperitoneal lymph nodes at staging contained metastases, while biopsied (PET)CT-positive hilar nodes did not. Histological evaluation of (PET)CT -positive retroperitoneal lymph nodes at staging imaging is recommended, while based on this small series, (PET)CT-positive hilar lymph nodes most likely represent reactive lymphadenopathy.
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Affiliation(s)
- B Schurink
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands; Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands.
| | - E Mazza
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands
| | - T A P Roeling
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands
| | - R L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, P.O Box 85060, 3508 AB, Utrecht, the Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.
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Procopio F, Marano S, Gentile D, Da Roit A, Basato S, Riva P, De Vita F, Torzilli G, Castoro C. Management of Liver Oligometastatic Esophageal Cancer: Overview and Critical Analysis of the Different Loco-Regional Treatments. Cancers (Basel) 2019; 12:cancers12010020. [PMID: 31861604 PMCID: PMC7016815 DOI: 10.3390/cancers12010020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023] Open
Abstract
Esophageal cancer (EC) is an aggressive disease that is associated with a poor prognosis. Since metastastic EC is usually considered suitable only for palliative therapy with an estimated 5-year overall survival (OS) less than 5%, the optimal management of patients with liver oligometastatic EC (LOEC) is still undefined. The aim of this review is to provide an overview of the different treatment options for LOEC. A literature search was conducted using PubMed, Embase, and Cochrane to identify articles evaluating different treatment strategies for LOEC. Among 828 records that were identified, 20 articles met the inclusion criteria. These studies included patients who have undergone any type of surgical procedure and/or loco-regional therapy. Liver resection resulted in the best survival for patients with low tumor burden (3 lesions): 5-year OS 30–50% versus 8–12% after only chemotherapy (CHT). The 5-year OS of loco-regional therapies was 23% with a local recurrence risk ranging 0–8% for small lesions (2 to 3 cm). An aggressive multidisciplinary approach for LOEC patients may improve survival. Surgery seems to be the treatment of choice for resectable LOEC. If unfeasible, loco-regional therapies may be considered. In order to better select these patients and offer a chance of cure, prospective trials and a definition of treatment protocols are needed.
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Affiliation(s)
- Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.P.); (D.G.); (G.T.)
| | - Salvatore Marano
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Damiano Gentile
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.P.); (D.G.); (G.T.)
| | - Anna Da Roit
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Silvia Basato
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Pietro Riva
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
| | - Ferdinando De Vita
- Division of Medical Oncology, Department of Precision Medicine, School of Medicine, University of Study of Campania “Luigi Vanvitelli”, Via Pansini 5, 80131 Naples, Italy;
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (F.P.); (D.G.); (G.T.)
| | - Carlo Castoro
- Division of Upper Gastro-Intestinal Surgery, Department of Surgery, Humanitas University, Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (S.M.); (A.D.R.); (S.B.); (P.R.)
- Correspondence: ; Tel.: +39-02-8224-4769; Fax: +39-02-8224-4590
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Imura Y, Yamamoto S, Wakamatsu T, Tanaka T, Tamiya H, Sugimura K, Miyata H, Ishihara R, Yano M, Naka N. Clinical features and prognostic factors in patients with esophageal cancer with bone metastasis. Oncol Lett 2019; 19:717-724. [PMID: 31897187 PMCID: PMC6924156 DOI: 10.3892/ol.2019.11142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
There have been few reports on bone metastases (BMs) from esophageal cancer (EC). The aim of the present study was to investigate the clinicopathological features and prognostic factors in patients with EC with BMs. The present study retrospectively collected data from 58 patients with BMs from EC who were treated at our institution between 2007 and 2016. Patient, tumor and BM-associated characteristics were analyzed. Kaplan-Meier survival curves were constructed and analyzed using the univariate log-rank test. Multivariate analyses were conducted using the Cox proportional hazards model. The median patient age was 67 years (range, 39–84 years). Multiple BMs were detected in 38 patients (65.5%) and 52 patients (89.7%) exhibited osteolytic BMs. Skeletal-related events (SREs) occurred in 53 patients (91.4%). The one-year overall survival (OS) was 25.3%, and the median OS was 5 months (range, 0–54). Univariate analyses revealed that performance status, visceral or brain metastasis, serum carcinoembryonic antigen (CEA), C-reactive protein, albumin level, and receipt of chemotherapy following BM diagnosis were significantly associated with OS. Multivariate analyses of these factors demonstrated that higher serum CEA levels and no chemotherapy were significant risk factors for poor OS. Multiple osteolytic BMs are frequently observed in patients with EC with BMs, and SREs commonly occur. The prognoses of patients with EC with BMs are poor, but chemotherapy administration following the BM diagnosis should confer a survival benefit.
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Affiliation(s)
- Yoshinori Imura
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Sachiko Yamamoto
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Toru Wakamatsu
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Takaaki Tanaka
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hironari Tamiya
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Keijiro Sugimura
- Department of Gastrointestinal Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hiroshi Miyata
- Department of Gastrointestinal Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Masahiko Yano
- Department of Gastrointestinal Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Norifumi Naka
- Department of Musculoskeletal Oncology Service, Osaka International Cancer Institute, Osaka 541-8567, Japan
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Abstract
Esophageal cancer is an aggressive and highly lethal malignancy that has a high death-to-incidence ratio approaching 0.90. We present a 60-year-old man with a history of Barrett's esophagus, presented with dysphagia. An upper endoscopy with biopsy confirmed invasive esophageal adenocarcinoma (EAC). Workup, including positron emission tomography scan, showed no evidence of metastasis. A preoperative colonoscopy showed a nodule in the ascending colon that was proven later to be a metastatic lesion from the esophageal primary tumor. Esophageal adenocarcinoma with an isolated colonic metastasis is an extremely rare presentation of esophageal metastasis. These metastatic lesions may not be detected by the positron emission tomography scan.
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Xu J, Lu D, Zhang L, Li J, Sun G. Palliative resection or radiation of primary tumor prolonged survival for metastatic esophageal cancer. Cancer Med 2019; 8:7253-7264. [PMID: 31612596 PMCID: PMC6885868 DOI: 10.1002/cam4.2609] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 09/21/2019] [Accepted: 09/30/2019] [Indexed: 12/24/2022] Open
Abstract
PURPOSE We aimed to explore the value of palliative resection or radiation of primary tumor for metastatic esophageal cancer (EC) patients. METHODS Surveillance, Epidemiology, and End Results database was used for identifying metastatic EC patients. The patients were divided into resection and nonresection groups. And patients without resection were divided into radiation and nonradiation groups. Propensity score matching (PSM) analyses were adopted to reduce the baseline differences between the groups. Cancer specific survivals (CSSs) and overall survivals (OSs) were compared by Kaplan-Meier (K-M) curves. Multivariable analyses by COX proportion hazards model were performed to identify risk factors for CSS and OS. Predictive nomograms were conducted according to both postoperative factors and preoperative factors. RESULTS A total of 7982 metastatic EC patients were selected for our analyses. After PSM, 978 patients were included in the survival analyses comparing palliative resection and nonresection. The CSS and OS for patients underwent palliative resection were significantly longer than those without resection (median CSS: 21 months vs 7 months, P < .001; median OS: 20 months vs 7 months, P < .001). In the overall population without resection, 654 patients were matched for radiation and nonradiation groups. And K-M curves showed that patients with radiation had longer CSS and OS than those without radiation (median CSS: 11 months vs 6 months, P < .001; median OS: 10 months vs 6 months, P < .001). Nomograms were generated for prediction of 1-, 2-, and 3-year CSS and OS. All C-indexes implied moderate discrimination and accuracy. And all nomograms had good calibration. CONCLUSION Palliative resection or radiation of primary tumor could prolong CSS and OS of metastatic EC patients.
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Affiliation(s)
- Jing Xu
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Donghui Lu
- Department of Radiology, The 901st Hospital of the Joint Logistics Support Force of PLA, Hefei, Anhui Province, China
| | - Li Zhang
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jian Li
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Guoping Sun
- Department of Medical Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Kakuta T, Kosugi SI, Ichikawa H, Hanyu T, Ishikawa T, Kanda T, Wakai T. Palliative interventions for patients with incurable locally advanced or metastatic thoracic esophageal carcinoma. Esophagus 2019; 16:278-284. [PMID: 30949884 DOI: 10.1007/s10388-019-00665-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/18/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The aim of this study was to assess the clinical outcomes of palliative interventions for patients with incurable locally advanced or metastatic esophageal carcinoma. METHODS A total of 131 patients with thoracic esophageal carcinoma who underwent palliative interventions were enrolled. Insertion of a self-expandable metallic stent (SEMS), tube enterostomy for enteral nutrition (EN), and palliative esophagectomy (PE) were performed in 38, 65, and 28 patients, respectively. The clinicopathological characteristics and clinical outcomes of each group were retrospectively reviewed. RESULTS Patients in the EN group frequently received chemoradiotherapy (P < 0.01). SEMS insertion, but not PE or EN, improved the mean dysphagia score after the intervention (P < 0.01). For the SEMS, EN, and PE groups, the occurrence of intervention-related complications was 31.6, 10.8, and 96.4%, respectively, the median survival time was 88, 208, and 226 days (P < 0.01), and the mean ratio of duration of home care to survival time was 28.9, 38.5, and 39.6% (P = 0.95). CONCLUSIONS SEMS insertion effectively relieved obstructive symptoms, but had no survival benefit. Tube enterostomy showed a low complication rate and has the potential to improve survival in combination with additional treatment, with no palliation of obstructive symptoms.
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Affiliation(s)
- Tomoyuki Kakuta
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Shin-Ichi Kosugi
- Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takaaki Hanyu
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Ishikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuo Kanda
- Department of Surgery, Sanjo General Hospital, Niigata, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Land CF, Bowden BD, Morpeth BG, DeVine JG. Intradural extramedullary metastasis: a review of literature and case report. Spinal Cord Ser Cases 2019; 5:41. [PMID: 31632701 PMCID: PMC6786287 DOI: 10.1038/s41394-019-0181-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Intradural extramedullary (IDEM) metastatic disease is infrequently encountered by spine surgeons and consequently poorly understood. Discovery often corresponds with the onset of neurologic symptoms and no consensus exists regarding the importance of complete resection or anticipated postoperative outcome. We aim to elucidate treatment methodologies that exist in the literature. Case presentation We present a unique case of a 57-year-old male with a known history of esophageal adenocarcinoma, including brain and visceral metastases, who presented with cauda equina syndrome. An IDEM metastatic esophageal adenocarcinoma lesion was identified on advanced imaging and biopsy. This was treated operatively without return of neurologic function. Discussion We reviewed and summarized the existing literature. Trends are highlighted to further guide surgeons treating this unusual metastatic phenomenon. Conclusion Intradural metastasis is a harbinger of advanced disease with a poor prognosis regardless of the etiology of the primary lesion. There are a number of proposed mechanisms for metastatic spread with little available literature for surgeon guidance. Most authors are advocates of a palliative, decompressive approach.
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Affiliation(s)
- Charles F. Land
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | - Blake D. Bowden
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | - Brice G. Morpeth
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
| | - John G. DeVine
- Department of Orthopaedic Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912 USA
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Lyu J, Li T, Wang Q, Li F, Diao P, Liu L, Li C, Lang J. Outcomes of concurrent chemoradiotherapy versus chemotherapy alone for stage IV esophageal squamous cell carcinoma: a retrospective controlled study. Radiat Oncol 2018; 13:233. [PMID: 30477531 PMCID: PMC6257959 DOI: 10.1186/s13014-018-1183-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022] Open
Abstract
Background The purpose of this study is to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) versus chemotherapy alone for patients with stage IV esophageal squamous cell carcinoma (ESCC). Methods Eligible patients were retrospectively enrolled at the authors’s institution from January 2010 to October 2015. Of the 141 patients enrolled, 55 (39.0%) received CCRT and 86 (61.0%) received chemotherapy alone. The outcomes and adverse events (AEs) were compared between the two groups. Results The baseline clinical characteristics of the two groups were similar. However, the CCRT group showed a significantly better primary tumor objective response rate (ORR) than that of the chemotherapy group (74.5% versus 45.3%, p = 0.001). The 1-year, 2-year, 3-year overall survival (OS) rates and median OS were 58.0% versus 43.0%, 25.5% versus 14.0%, 10.7% versus 4.7%, and 14 months versus 11 months for patients treated with CCRT or chemotherapy, respectively (p = 0.007). The 1-year and median progression-free survival (PFS) were 29.8% versus 14.9% and 8 months versus 6 months (p = 0.005). Multivariate analysis identified CCRT (p = 0.013) and solitary metastasis (p = 0.037) as independent factors for greater OS. The frequency of leucocytopenia (grade 3 or higher) was significantly higher in the CCRT group than in the chemotherapy-alone group (p = 0.040), whereas the rates of other AEs did not differ. Conclusions In this study, it is suggested that CCRT is more effective than chemotherapy alone for stage IV ESCC, yielding better primary responses and survival outcomes with tolerable side effects.
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Affiliation(s)
- Jiahua Lyu
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Tao Li
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China.
| | - Qifeng Wang
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Fang Li
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Peng Diao
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Li Liu
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Churong Li
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer hospital institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55, 4th section of Renmin South Road Chengdu, Chengdu, 610041, Sichuan Province, People's Republic of China
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Liu M, Wang C, Gao L, Lv C, Cai X. A nomogram to predict long-time survival for patients with M1 diseases of esophageal cancer. J Cancer 2018; 9:3986-3990. [PMID: 30410603 PMCID: PMC6218766 DOI: 10.7150/jca.27579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/19/2018] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate the clinicopathologic characteristics of the long-time survivals and construct a clinical nomogram using the Surveilance, Epidemiology, and End Results (SEER) database. Materials and Methods: Information of patients diagnosed with M1 stage esophageal cancer from 2010-2014 was retrieved from SEER database. Patients with unknown information of AJCC TNM stage or metastatic sites or marital status or surgery or survival were excluded. Demographic and clinicopathologic characteristics were compared between LTS (long time survivals: patients who have survived for no less than 2 years) and STS (shorter time survivals: patients who have survived for less than 2 years). Cox regression analysis was performed to evaluate prognostic factors. A nomogram comprising demographic and clinicopathologic factors was established to predict 1-year survival and 2-year survival for patients with M1 diseases. Results: A total of 2981 patients from the SEER database were included for analysis. Compared with the STS, married people and patients with well differentiated tumors or oligometastatic site were more likely to be LTS. Also, LTS were associated with significantly less bone metastasis and more surgery. The OS nomogram, which had a c-index of 0.633, was based on the eleven variables: gender, age, marital status, T stage, N stage, histology, grade, number of important metastatic organs and primary surgery. Conclusions: Married patients, patients with well differentiated tumors, patients with oligometastatic site, patients without bone metastasis or liver metastasis and those who underwent surgery are associated with long time survivals. We developed a nomogram predicting 1- and 2-year OS and CSS for M1 stage esophageal cancer. The prognostic model may improve clinicians' abilities to predict individualized survival and to make treatment recommendations.
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Affiliation(s)
- Mina Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Lanting Gao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Changxing Lv
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
| | - Xuwei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University. 241 West Huaihai Road, Shanghai, 200030, China
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Van Daele E, Scuderi V, Pape E, Van de Putte D, Varin O, Van Nieuwenhove Y, Ceelen W, Troisi R, Pattyn P. Long-term survival after multimodality therapy including surgery for metastatic esophageal cancer. Acta Chir Belg 2018; 118:227-232. [PMID: 29258384 DOI: 10.1080/00015458.2017.1411557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Esophageal cancer (EC) remains an aggressive disease with a poor survival. Management of metastatic EC is limited to palliative chemotherapy (CT). Scientific contributions regarding the role of surgery are scarce and controversial. We analysed outcome of surgically treated metastatic EC patients. METHODS We retrospectively identified surgically treated metastatic EC patients from our esophagectomy database. The aim of this study was to evaluate surgical complications, pathological response, oncological outcome and mean survival of these aggressively treated stage IV cancer patients. RESULTS Twelve stage IV patients with disease presentation limited to outfield lymph node (LN) and/or liver metastasis were treated with an aggressive multimodality treatment including surgery. Mean age was 58 years (75% male, 75% Adenocarcinomas). Median postoperative hospital stay was 15 d. Radiological anastomotic leakage occurred in one patient. In hospital, mortality was nil. Complete resection was achieved in all but one. Metastatic recurrence occurred in 64% of R0 resected patients. At date of censoring, after a median follow-up of 22 months, 50% of the surgical resected patients are still alive and 33% are free of disease recurrence. Kaplan-Meier curves show a possibility to long-term survival after aggressive multimodality therapy including surgery. CONCLUSIONS In selected metastatic EC patients, multimodality treatment including surgery has an acceptable surgical outcome with a potentially long-term survival.
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Affiliation(s)
- Elke Van Daele
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Vincenzo Scuderi
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Eva Pape
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Dirk Van de Putte
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Oswald Varin
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Yves Van Nieuwenhove
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Wim Ceelen
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Roberto Troisi
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal and Hepatobilliairy Surgery, Ghent University Hospital, Ghent, Belgium
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Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N, Saito T. Clinical results of multimodality therapy for esophageal cancer with distant metastasis. J Thorac Dis 2018; 10:1500-1510. [PMID: 29707300 DOI: 10.21037/jtd.2018.03.45] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background The purpose of this study is to evaluate outcomes in upfront local response and survival of patients with esophageal cancer and distant metastasis. Methods This retrospective study included 34 patients (25 males) aged 42-92 years (median, 70 years) with a histological diagnosis of esophageal squamous cell cancer with distant metastasis. Staging was performed according to the UICC's TNM (6th edition) classification of malignant tumor. Results The median survival time (MST) was 5 months. The 1-year overall survival (OS) was 20.6%. Improved OS was associated with receipt of surgery [hazard ratio (HR), 3.857; 95% CI, 1.142-13.024; P=0.030] on both univariate and multivariate analyses, and the MST was 11 months. The overall objective local response rate was 82%. Ten patients had complete response (CR), 18 had partial response (PR). The overall symptom response was 88% patients. Six had CR, 24 had PR. There was no significant difference in the objective and symptom response between ≤50 and >50 Gy. Concurrent chemoradiotherapy (CCRT) with 50 Gy gave results of objective and symptom responses comparable to those of 60 Gy, which has been reported previously. Conclusions CCRT with 50 Gy gave results comparable to those of 60 Gy, which has been reported previously, and the toxicity was acceptable. Our findings showed that a multimodality therapy that includes surgery may improve survival in only a select group.
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Affiliation(s)
- Masakuni Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Toshiya Maebayashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Takuya Aizawa
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
| | - Naoya Ishibashi
- Department of Radiology, Nihon University School of Medicine, Tokyo, Japan
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Abstract
Background There are few population-based studies of the sites of distant metastasis (DM) and survival from esophageal cancer (EC). The aim of this study was to assess the patterns and survival outcomes for site-specific DM from EC using a population-based approach. Methods Patients diagnosed with de novo stage IV EC between 2010 and 2014 were identified from the Surveillance, Epidemiology, and End Results program database. Overall survival (OS) was compared according to the site of DM. Results We included 3218 patients in this study; the most common site of DM was the liver, followed by distant lymph nodes, lung, bone and brain. Median OS for patients with liver, distant lymph node, lung, bone, and brain metastases was 5, 10, 6, 4, and 6 months, respectively (p<0.001). Site and number of distant metastases were independent prognostic factors for OS. In patients with a single site of DM, using liver metastases as reference, OS was lower for bone metastases (p=0.026) and higher for distant lymph node metastases (p=0.008), while brain (p=0.653) or lung (p=0.081) metastases had similar OS compared with liver metastases. Similar site-specific survival differences were observed in the subgroup with esophageal adenocarcinoma. However, distant lymph node metastases was associated with better survival (p=0.002) compared to liver, bone, or lung metastases in esophageal squamous cell carcinoma. Conclusion Site of metastasis affects survival in metastatic EC; OS was worst for bone metastases and greatest for distant lymph node metastases.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen
| | - Wen-Wen Zhang
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou
| | - Yong-Xiong Chen
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Medical College, Xiamen University, Xiamen
| | - Ling Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
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Janmaat VT, Steyerberg EW, van der Gaast A, Mathijssen RHJ, Bruno MJ, Peppelenbosch MP, Kuipers EJ, Spaander MCW. Palliative chemotherapy and targeted therapies for esophageal and gastroesophageal junction cancer. Cochrane Database Syst Rev 2017; 11:CD004063. [PMID: 29182797 PMCID: PMC6486200 DOI: 10.1002/14651858.cd004063.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Almost half of people with esophageal or gastroesophageal junction cancer have metastatic disease at the time of diagnosis. Chemotherapy and targeted therapies are increasingly used with a palliative intent to control tumor growth, improve quality of life, and prolong survival. To date, and with the exception of ramucirumab, evidence for the efficacy of palliative treatments for esophageal and gastroesophageal cancer is lacking. OBJECTIVES To assess the effects of cytostatic or targeted therapy for treating esophageal or gastroesophageal junction cancer with palliative intent. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Web of Science, PubMed Publisher, Google Scholar, and trial registries up to 13 May 2015, and we handsearched the reference lists of studies. We did not restrict the search to publications in English. Additional searches were run in September 2017 prior to publication, and they are listed in the 'Studies awaiting assessment' section. SELECTION CRITERIA We included randomized controlled trials (RCTs) on palliative chemotherapy and/or targeted therapy versus best supportive care or control in people with esophageal or gastroesophageal junction cancer. DATA COLLECTION AND ANALYSIS Two authors independently extracted data. We assessed the quality and risk of bias of eligible studies according to the Cochrane Handbook for Systematic Reviews of Interventions. We calculated pooled estimates of effect using an inverse variance random-effects model for meta-analysis. MAIN RESULTS We identified 41 RCTs with 11,853 participants for inclusion in the review as well as 49 ongoing studies. For the main comparison of adding a cytostatic and/or targeted agent to a control arm, we included 11 studies with 1347 participants. This analysis demonstrated an increase in overall survival in favor of the arm with an additional cytostatic or targeted therapeutic agent with a hazard ratio (HR) of 0.75 (95% confidence interval (CI) 0.68 to 0.84, high-quality evidence). The median increased survival time was one month. Five studies in 750 participants contributed data to the comparison of palliative therapy versus best supportive care. We found a benefit in overall survival in favor of the group receiving palliative chemotherapy and/or targeted therapy compared to best supportive care (HR 0.81, 95% CI 0.71 to 0.92, high-quality evidence). Subcomparisons including only people receiving second-line therapies, chemotherapies, targeted therapies, adenocarcinomas, and squamous cell carcinomas all showed a similar benefit. The only individual agent that more than one study found to improve both overall survival and progression-free survival was ramucirumab. Palliative chemotherapy and/or targeted therapy increased the frequency of grade 3 or higher treatment-related toxicity. However, treatment-related deaths did not occur more frequently. Quality of life often improved in the arm with an additional agent. AUTHORS' CONCLUSIONS People who receive more chemotherapeutic or targeted therapeutic agents have an increased overall survival compared to people who receive less. These agents, administered as both first-line or second-line treatments, also led to better overall survival than best supportive care. With the exception of ramucirumab, it remains unclear which other individual agents cause the survival benefit. Although treatment-associated toxicities of grade 3 or more occurred more frequently in arms with an additional chemotherapy or targeted therapy agent, there is no evidence that palliative chemotherapy and/or targeted therapy decrease quality of life. Based on this meta-analysis, palliative chemotherapy and/or targeted therapy can be considered standard care for esophageal and gastroesophageal junction carcinoma.
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Affiliation(s)
- Vincent T Janmaat
- Erasmus University Medical CenterDepartment of Gastroenterology and HepatologyRotterdamNetherlands
| | - Ewout W Steyerberg
- Erasmus University Medical CenterDepartment of Public HealthPO Box 2040RotterdamNetherlands3000 CA
| | - Ate van der Gaast
- Erasmus MC Cancer Institute, Erasmus University Medical CenterDepartment of Medical OncologyDr. Molewaterplein 40RotterdamNetherlands3015 GD
| | - Ron HJ Mathijssen
- Erasmus MC Cancer Institute, Erasmus University Medical CenterDepartment of Medical OncologyDr. Molewaterplein 40RotterdamNetherlands3015 GD
| | - Marco J Bruno
- Erasmus University Medical CenterDepartment of Gastroenterology and HepatologyRotterdamNetherlands
| | - Maikel P Peppelenbosch
- Erasmus University Medical CenterDepartment of Gastroenterology and HepatologyRotterdamNetherlands
| | - Ernst J Kuipers
- Erasmus University Medical CenterDepartment of Gastroenterology and HepatologyRotterdamNetherlands
| | - Manon CW Spaander
- Erasmus University Medical CenterDepartment of Gastroenterology and HepatologyRotterdamNetherlands
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Ai D, Zhu H, Ren W, Chen Y, Liu Q, Deng J, Ye J, Fan J, Zhao K. Patterns of distant organ metastases in esophageal cancer: a population-based study. J Thorac Dis 2017; 9:3023-3030. [PMID: 29221275 DOI: 10.21037/jtd.2017.08.72] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Esophageal cancer is the eighth most common cancer worldwide. The prognosis of esophageal cancer patients is dismal, especially those with distant organ metastasis. However, there are few studies describing the patterns of distant metastasis in esophageal cancer systematically. Methods We gathered the data from Surveillance Epidemiology and End Results (SEER) database between 2010 and 2013. Categorical variables were analyzed by the Pearson Chi square test, and continuous variables were analyzed by the two-sample t test. Survival estimation and comparison among different variables were performed using Kaplan-Meier method. A multivariable logistic regression model was used to calculate odds ratios (OR) for sex, age, anatomical site, and histological type on specific metastases. Proportional hazards regression model was conducted to obtain adjusted hazard ratio (HRs) for different predictors of overall survival. Results A total of 9,934 patients were eligible. Liver was the most common metastatic site in the patients of esophageal cancer and followed by lung, bone and brain. Some clinical features, including age, sex, histology type and histologic grade were independent risk factors for different sites of metastasis. Younger age, poorer differentiation, adenoma type and more metastatic sites might lead to poorer prognosis. Conclusions Our findings revealed the patterns of metastasis in esophageal cancer, which could help clinicians to identify patients with metastasis and provide proper treatment.
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Affiliation(s)
- Dashan Ai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hanting Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Wenjia Ren
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Yun Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Qi Liu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiaying Deng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jinjun Ye
- Department of Radiation Oncology, Jiangsu province cancer hospital, Nanjing 210009, China
| | - Jianhong Fan
- Department of Gynecology, Renhe hospital, Baoshan district, Shanghai 200431, China
| | - Kuaile Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Wang J, Suri JS, Allen PK, Liao Z, Komaki R, Ho L, Hofstetter WL, Lin SH. Factors Predictive of Improved Outcomes With Multimodality Local Therapy After Palliative Chemotherapy for Stage IV Esophageal Cancer. Am J Clin Oncol 2016; 39:228-35. [PMID: 24710122 DOI: 10.1097/COC.0000000000000066] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We reviewed survival outcomes and factors associated with improved outcomes for patients with stage IVB esophageal cancer who received multimodality therapy with initial chemotherapy followed by concurrent chemoradiation (CRT)±surgery. METHODS We retrospectively identified 96 patients with stage IVB esophageal carcinoma (with positive nonregional lymph nodes and/or distant organ metastasis) treated at a single institution with chemotherapy followed by concurrent CRT, with or without surgery. The Cox proportional hazard model was used to test associations between overall survival (OS), disease-free survival (DFS), locoregional relapse, distant metastasis-free survival, and potential predictive factors. RESULTS Median patient age at diagnosis was 59 years. The median OS time among all patients was 21.0 months, and 1-, 2-, and 5-year OS rates were 84.4%, 46.8%, and 17.9%, respectively; corresponding DFS time and rates were 8.1 months and 37%, 24.6%, and 24.6%, respectively. On multivariate analysis, factors that predicted improved OS with aggressive multimodal therapy included young age; lack of anorexia, fatigue at diagnosis; distant nodal metastasis without organ metastasis at diagnosis; and radiographic response to initial chemotherapy. A subset of 14 patients who had surgery after chemotherapy and concurrent CRT also had better median OS (not reached vs. 20 mo for 82 patients who did not receive surgery, P=0.001), DFS (14.6 vs. 5.9 mo, P=0.021), and distant metastasis-free survival (26.7 vs. 9.2 mo, P=0.042). CONCLUSIONS Aggressive local therapy with radiation and potentially surgery after initial palliative chemotherapy can improve prognosis for a select group of patients with stage IVB esophageal cancer.
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Wu SG, He ZY, Wang Y, Sun JY, Lin HX, Su GQ, Li Q. Lymph node dissection improved survival in patients with metastatic thoracic esophageal cancer: An analysis of 220 patients from the SEER database. Int J Surg 2016; 35:13-18. [PMID: 27613123 DOI: 10.1016/j.ijsu.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND To assess the clinical value of lymph node dissection and lymph node status in patients with metastatic thoracic esophageal cancer (MTEC). METHODS The Surveillance Epidemiology and End Results (SEER) database was used to identify patients with MTEC who had undergone esophagectomy from 2004 to 2012. Kaplan-Meier survival analysis and Cox proportional hazard regression were used to identify factors significantly associated with overall survival. RESULTS A total 220 eligible patients were identified, 162 (73.6%) of which underwent lymph node dissection. The 1-year, 3-year, and 5-year overall survival rates were 55.0%, 17.9%, and 9.2%, respectively; the median survival time was 13 months. Lymph node dissection was an independent prognostic factor of overall survival (hazard ratio: 0.527, 95% confidence interval: 0.377-0.736, p < 0.001). Patients who had undergone lymph node dissection had better overall survival than those who did not (1-year, 62.8% vs. 33.7%; 3-year, 21.4% vs. 7.9%). In patients who had undergone lymph node dissection, multivariate analysis determined that nodal stage was an independent prognostic factor. However, the extent of lymph node dissection was not associated with overall survival. CONCLUSIONS Lymph node dissection improves survival in patients with MTEC who undergo esophagectomy, and the current lymph node staging can be used as a prognostic factor in patients with MTEC.
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Affiliation(s)
- San-Gang Wu
- Department of Radiation Oncology, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China
| | - Zhen-Yu He
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Yan Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Jia-Yuan Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Huan-Xin Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China
| | - Guo-Qiang Su
- Department of Gastrointestinal Surgery, Xiamen Cancer Hospital, The First Affiliated Hospital of Xiamen University, Xiamen 361003, People's Republic of China.
| | - Qun Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, People's Republic of China.
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Wu SG, Xie WH, Zhang ZQ, Sun JY, Li FY, Lin HX, Yong Bao, He ZY. Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study. Sci Rep 2016; 6:28280. [PMID: 27323696 DOI: 10.1038/srep28280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/31/2016] [Indexed: 02/06/2023] Open
Abstract
This retrospective study used a population-based national registry to determine the impact of local treatment modalities on survival in patients with metastatic esophageal cancer (EC). The Surveillance Epidemiology and End Results (SEER) database was used to identify patients with metastatic EC from 1988 to 2012. A total of 9,125 patients were identified. There were 426 patients underwent primary surgery, 4,786 patients were administered radiotherapy (RT) alone, 847 patients underwent surgery plus RT, and 3,066 patients without any local treatment. Multivariate analysis results indicated that year of diagnosis, age, race, histologic subtype, grade, and local treatment modalities were independent prognostic factors for overall survival (OS). The 5-year OS were 8.4%, 4.5%, 17.5%, and 3.4% in primary surgery, RT only, surgery plus RT, and no local treatment, respectively (P < 0.001). Subgroup analyses showed that the impact of RT was mainly reflected by preoperative radiotherapy, as patients received preoperative radiotherapy had significantly better OS than patients who underwent primary surgery alone and postoperative RT, the 5-year OS rates were 24.7%, 6.5%, and 7.8%, respectively, respectively (P < 0.001). Surgery plus RT, especially preoperative RT, may improve long-term survival of patients with metastatic EC.
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Fujinaka Y, Morita M, Ohga T, Kakeji Y, Yano T, Maehara Y. Definitive chemoradiotherapy and salvage esophagectomy for esophageal cancer associated with multiple lung metastases: a case report. Int Surg 2014; 99:640-4. [PMID: 25216435 DOI: 10.9738/INTSURG-D-13-00123.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prognosis of esophageal cancer with distant metastasis is dismal. We report a 70-year-old man with esophageal cancer and multiple lung and lymph node metastases. Complete response was achieved following definitive chemoradiotherapy. Twenty-four months after the initial chemoradiotherapy, local recurrence was detected but there was no evidence of distant metastasis. Therefore, the patient underwent salvage esophagectomy. The surgery was well tolerated without any postoperative complications. The patient is still alive 48 months after the salvage surgery. Our experience suggests that salvage esophagectomy is an important component of multimodal therapy for the recurrence of esophageal cancer.
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Ikeda E, Kojima T, Kaneko K, Minashi K, Onozawa M, Nihei K, Fuse N, Yano T, Yoshino T, Tahara M, Doi T, Ohtsu A. Efficacy of concurrent chemoradiotherapy as a palliative treatment in stage IVB esophageal cancer patients with dysphagia. Jpn J Clin Oncol 2011; 41:964-72. [PMID: 21742654 DOI: 10.1093/jjco/hyr088] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To retrospectively assess the efficacy and safety of palliative chemoradiotherapy in Stage IVB esophageal cancer patients with dysphagia due to the primary lesion. METHODS Forty patients with dysphagia caused by metastatic esophageal cancer, which had been treated between January 2004 and June 2009, were retrospectively investigated. The treatment consisted of two courses of chemotherapy (5-fluorouracil and cisplatin) and concurrent irradiation of 40 Gy in 20 fractions to the esophageal primary tumor. The grade of dysphagia was evaluated; nutrition-support-free survival was evaluated using the status of nutritional support of patients. Response to treatment, overall survival, progression-free survival and toxicities were also evaluated. RESULTS Dysphagia score improved in 75% of the patients. Seventeen of the 20 patients (85%) who had required nutritional support at baseline improved their oral intake to no longer need the support, in a median time of 43 days. The median nutrition-support-free survival was 301 days in the 20 patients who had had adequate oral intake before the treatment. Disease control rate of the primary lesion was 95%, including 12 patients (30%) who achieved a complete response. The overall response rate was 55%. The median survival was 308 days, and the 1-year-survival rate was 45.0%. The median progression-free survival was 139 days. Toxicities were generally well tolerated. Major toxicities (Grade 3 or 4) involved hemoglobin (23%), leukocytes (15%), neutrophils (20%), anorexia (10%), nausea (3%), esophageal perforation (5%) and febrile neutropenia (3%). Two patients (5%) died within 30 days of terminating radiotherapy. CONCLUSIONS Palliative chemoradiotherapy using 5-fluorouracil plus cisplatin combined with concurrent 40 Gy irradiation effectively improved the symptom of dysphagia in Stage IVB esophageal cancer with acceptable toxicity and favorable survival.
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Affiliation(s)
- Eiji Ikeda
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan
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