scholarly journals Predictors of Survival in Esophageal Squamous Cell Carcinoma with Pathologic Major Response after Neoadjuvant Chemoradiation Therapy and Surgery: The Impact of Chemotherapy Protocols

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Chia-Ying Li ◽  
Pei-Ming Huang ◽  
Pei-Yi Chu ◽  
Po-Ming Chen ◽  
Mong-Wei Lin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Disease Progression ◽  
Cancer Patients ◽  
Chemoradiation Therapy ◽  
Major Response

Tumor recurrence is an important problem threatening esophageal cancer patients after surgery, even when they achieve a pathologic major response (pMR) after neoadjuvant concurrent chemoradiation therapy (CCRT). The predictors related to overall survival and disease progression for these patients remain elusive. We aimed to identify factors that predict disease progression and overall survival in esophageal squamous cell carcinoma (SCC) patients who achieve a pMR after neoadjuvant CCRT followed by surgery. We conducted a retrospective study to analyze the factors influencing survival and disease progression after esophagectomy for esophageal cancer patients who had a major response to CCRT, which is defined by complete pathological response or microscopic residual disease without lymph node metastasis. From our study cohort, 285 patients underwent CCRT and subsequent esophagectomy; 171 (60%) of these patients achieved pMR. After excluding patients with lymph node metastases, incomplete clinical data, and adenocarcinomas, we enrolled 117 patients in this study. We found that the CCRT regimen was the only factor that influenced overall survival. The overall survival of the patients receiving taxane-incorporated CCRT was superior to that of patients receiving traditional cisplatin and 5-fluorouracil (PF) (P=0.011). The CCRT regimen can significantly influence the clinical outcome of esophageal SCC patients who achieve pMR after neoadjuvant CCRT and esophagectomy. Incorporation of taxanes into cisplatin-based CCRT may be associated with prolonged survival.

RA03.04: COMPARISON OF THE CLINICAL OUTCOMES OF ESOPHAGECTOMY AND CHEMORADIOTHERAPY AFTER NONCURATIVE ENDOSCOPIC SUBMUCOSAL DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 23-23
Author(s):  
Yasufumi Koterazawa ◽  
Tetsu Nakamura ◽  
Taro Oshikiri ◽  
Shingo Kanaji ◽  
Kimihiro Yamashita ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Endoscopic Submucosal Dissection ◽  
Cell Carcinoma ◽  
Tumor Invasion ◽  
Lymphovascular Invasion ◽  
Definitive Treatment

Abstract Background Endoscopic submucosal dissection (ESD) is widely used to treat esophageal cancer, but some patients require additional definitive treatment owing to the possibility of residual tumor cells or lymph node metastasis. The aim of this study was to elucidate the efficacy and clinical outcomes of these additional treatments. Methods ESD was performed for cT1a esophageal cancer, and additional definitive treatment was recommended for patients who had undergone noncurative ESD for submucosa (SM) or muscularis mucosae cancers with lymphovascular invasion and a positive resection margin. The study included 59 patients who developed superficial esophageal squamous cell carcinoma after noncurative ESD treated between 2005 and 2016, of whom 28 underwent esophagectomy with lymph node dissection and 31 received chemoradiotherapy (CRT) by choice or because their conditions did not permit surgery. Results The median follow-up periods were 45 months (range, 3–89 months) in the esophagectomy group and 41 months (range, 12–84 months) in the CRT group. Overall survival didn’t differ between the groups (P = 0.46). But there were no recurrences in the esophagectomy group, and the disease-specific survival rate was significantly higher in this group (P = 0.042). Among the patients at high risk for recurrence owing to massive tumor invasion (≥ SM2) with lymphovascular invasion (esophagectomy group, 6 patients; CRT group, 10 patients), none in the esophagectomy group had a recurrence, whereas 4 in the CRT group died of esophageal cancer (P = 0.031). Conclusion Overall survival did not differ between the esophagectomy and CRT groups after noncurative ESD. However, compared with CRT, esophagectomy provided more favorable disease control for patients with massive tumor invasion (≥ SM2) with lymphovascular invasion. Disclosure All authors have declared no conflicts of interest.

676 NECESSITY OF EXTENDED LOWER PARATRACHEAL LYMPH NODE RESECTION DURING ESOPHAGECTOMY FOR CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
C Mann ◽  
F Berlth ◽  
E Hadzijusufovic ◽  
E Uzun ◽  
E Tagkalos ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
P Value ◽  
Lymph Node Resection ◽  
Paratracheal Lymph Node ◽  
Esophagectomy For Cancer

Abstract Objective To evaluate the impact of lower paratracheal lymph node resection on oncological radicality and complication rate during esophagectomy for cancer. Backround The ideal extend of lymphadenectomy (LAD) in esophageal surgery is debated. Until today, there has been no proof for improved survival after standardized paratracheal lymph node resection performing oncological esophagectomy. Methods Lymph nodes from the lower paratracheal station are not standardly resected during 2-field Ivor-Lewis esophagectomy for esophageal cancer. Retrospectively, we identified 200 patients operated in our center for esophageal cancer from January 2017—December 2019. Histopathologically, 143 patients suffered from adenocarcinoma, 53 patients from squamous cell carcinoma, two patients from neuroendocrine carcinoma, and one from melanoma of the esophagus. Patients with and without lower paratracheal LAD were compared to patients regarding demographic data, tumor characteristics, operative details, postoperative complications, tumor recurrence and overall survival. Results 103 of 200 patients received lower paratracheal lymph node resection. On average, six lymph nodes were resected in the paratracheal region with histopathological cancer positivity in two patients. Those two patients suffered from neuroendocrine carcinoma and melanoma, none of the AC or SCC patients were positive. There was no significant difference between both groups regarding age, gender, BMI, or comorbidity. Harvesting of lower paratracheal lymph nodes was associated with less postoperative overall complications (p-value 0,029). Regarding overall survival and recurrence rate no difference could be detected between both groups (p-value 0,168, respectively 0,371). Conclusion The resection of lower paratracheal lymph nodes during esophagectomy seems not mandatory for distal squamous cell carcinoma or adenocarcinoma of the esophagus. It may be necessary in NEC, Melanoma of the esophagus or on demand if suspicious LN are detected in the CT scan. No increase of morbidity was caused by paratracheal dissection.

scholarly journals Salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jie Chen ◽  
Wenming Yin ◽  
Hui Yao ◽  
Wendong Gu
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Regional Lymph Node ◽  
Radical Resection ◽  
Salvage Treatment ◽  
Lymph Node Recurrence

Abstract Background Patients with regional lymph node recurrence after radical resection of esophageal cancer have poor therapeutic outcomes. Currently, there is no standard treatment for regional lymph node recurrence, and its prognostic risk factors are not well-understood. This study retrospectively analyzed 83 patients with postoperative regional lymph node recurrence after radical resection of esophageal squamous cell carcinoma. The aim was to evaluate the clinical efficacy and prognostic factors of salvage radiotherapy with or without chemotherapy in these patients. Methods The survival and prognostic factors of 83 patients with esophageal squamous cell carcinoma with regional lymph node recurrence after radical surgery were retrospectively analyzed. All patients underwent radiotherapy, of which 74 patients received volumetric modulated arc therapy (VMAT), 9 patients received three-dimensional conformal radiation therapy (3DCRT), administered using a conventional segmentation protocol with a dose distribution range of 50.4–66.2Gy (median dose of 60Gy). In total, 41 patients received radiotherapy alone, 42 received radiotherapy combined with chemotherapy, and the concurrent chemotherapy regimen was mainly composed of either platinum or fluorouracil monotherapy, except for 4 patients who were given 5-fluorouracil plus platinum (FP) or paclitaxel plus platinum (TP). Results The median follow-up time was 24 (range, 9–75) months. The overall survival (OS) rates at 1 year, 2 years, 3 years, and 5 years were 83.0, 57.1, 40.1, and 35.1%, respectively. The median overall survival (OS) time was 18 (range, 5–75) months. The 3-year survival rate was 47.5% in patients with radiation alone and 41.9% in patients receiving concurrent chemoradiotherapy(p = 0.570), while the response rate (CR + PR) in those two groups was 73.2 and 91.4%, respectively. By multivariate analysis of OS, age (worse in younger patients, p = 0.034) was found to be significantly associated with disease prognosis. The commonly toxicities were esophagitis, neutropenia and anemia. 18% patients experienced grade 3 toxicity and no treatment-related death occurred. Conclusions These results of this retrospective analysis suggest that radiotherapy with or without chemotherapy is an effective and feasible salvage treatment for lymph node recurrence after radical resection of esophageal squamous cell carcinoma.

Lactate dehydrogenase and baseline markers associated with clinical outcomes of advanced esophageal squamous cell carcinoma patients treated with camrelizumab (SHR-1210), a novel anti-PD-1 antibody.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15559-e15559
Author(s):  
Xi Wang ◽  
Bo Zhang ◽  
Xuelian Chen ◽  
Hongnan Mo ◽  
Dawei Wu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Lactate Dehydrogenase ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Disease Progression ◽  
Squamous Cell ◽  
Peripheral Blood ◽  
Group Performance ◽  
Blood Biomarkers

e15559 Background: A small proportion of patients with advanced esophageal squamous cell carcinoma (ESCC) could benefit from immune checkpoint inhibitors, and reliable peripheral blood biomarkers for outcomes of anti-PD-1 immunotherapy were not identified in ESCC. Methods: A total of 43 patients were retrospectively reviewed in the ESCC cohort of a phase I trial from our center. All patients received intravenous camrelizumab (SHR-1210), a novel anti-PD-1 antibody, at a dose of 60 mg, 200 mg or 400 mg (4-week interval after first dose followed by a 2-week schedule) and repeated every two weeks until disease progression or intolerable toxicity. The associations between lactate dehydrogenase (LDH) as well as other peripheral blood biomarkers at baseline and the efficacy of camrelizumab were also investigated. Results: With a median follow-up of 19.6 months, the overall response rate was 25.6% (11/43), including one complete response. Median progression-free survival (PFS) and overall survival were 2.0 months (95% CI: 0-4.1 months) and 8.0 months (95% CI: 7.2-8.8 months), respectively. Notably, four patients achieved a PFS exceeding 12 months, including three patients with a long-lasting duration of response over 1 year. Patients with an elevated baseline lactate dehydrogenase had lower tumor response rates (8.3% vs. 32.3%, p = 0.02) as well as shorter PFS (median: 1.8 vs. 4.0 months; HR 0.39, p = 0.002) and overall survival (median: 4.2 vs. 10.4 months; HR 0.22, p < 0.0001) compared with patients with normal levels. An increase of lactate dehydrogenase level during treatment was significantly associated with disease progression (p = 0.014). Multivariate Cox analysis identified LDH (HR = 0.18), C-reactive protein (HR = 0.27), number of involved organs (HR = 0.31), absolute monocyte count (HR = 0.33) and Eastern Cooperative Oncology Group performance status (HR = 0.36) as independent prognostic factors. Conclusions: Serum LDH, as is readily available in routine clinical practice, is a potential marker for response and a powerful independent factor for survival in advanced ESCC patients receiving anti-PD-1 treatment.

scholarly journals Profiling Patient-Reported Symptom Recovery from Esophagectomy for Patients with Esophageal Squamous Cell Carcinoma: A Real World Longitudinal Study

2021 ◽  
Author(s):  
Xi Luo ◽  
Qin Xie ◽  
Qiuling Shi ◽  
Yan Miao ◽  
Qingsong Yu ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Cancer Patients ◽  
Squamous Cell ◽  
Post Surgery ◽  
Disturbed Sleep ◽  
Patient Reported ◽  
Symptom Recovery

Abstract Purpose: Esophageal squamous cell carcinoma (ESCC) patients have severe symptom burden after esophagectomy; however, longitudinal studies of symptom recovery after surgery are scarce. This study used longitudinal patient-reported outcome (PRO)-based symptoms to identify severe symptoms and profile symptom recovery from surgery in patients undergoing esophagectomy.Methods: Esophageal cancer patients (N=327) underwent esophagectomy were consecutivly included between April 2019 and March 2020. Data were extracted from the Sichuan Cancer Hospital’s Esophageal Cancer Case Management Registration Database. Symptom assessment time points were pre-surgery and 1, 3, 5, 7, 14, 21, 30, and 90 days post-surgery using the Chinese version of the MD Anderson Symptom Inventory. The symptom recovery trajectories were profiled using mixed-effect models and Kaplan–Meier analysis. Results: The most-servere symptoms after esophagectomy were pain, fatigue, dry mouth, disturbed sleep, and distress. The severity of symptoms peaked on day 1 after surgery. The top two symptoms were fatigue (mean: 5.44[SD 1.88]) and pain (mean: 5.23[SD 1.29]). Fatigue was more severe 90 days after surgery than at baseline (mean: 1.77 [SD 1.47] vs 0.65 [SD 1.05]; P<.0001). Disturbed sleep and distress persisted from pre-surgery to 90 days post-surgery; average sleep recovery time was up to 20 days, and 50.58% of patients had sleep disturbances 90 days post-surgery.Conclusions: Early postoperative pain management after esophagectomy should be considered. Characteristics and intervention strategies of postoperative fatigue, distress, and disturbed sleep in esophageal cancer patients warranty further studies.The study was registered on ChiCTR.org.cn Web site (ChiCTR2000040780, date 12/10/2020).

Comparison of definitive chemoradiotherapy and esophagectomy for stage I esophageal squamous cell carcinoma.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 67-67
Author(s):  
S. Yamamoto ◽  
R. Ishihara ◽  
M. Motoori ◽  
Y. Kawaguchi ◽  
Y. Takeuchi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Local Recurrence ◽  
Esophageal Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Stage I ◽  
High Local Recurrence Rate

67 Background: Chemoradiotherapy (CRT) of esophageal cancer has been proposed as an alternative to esophagectomy given the favourable survival rate and mild toxicity. However, no comparative study is reported between esophagectomy and CRT in stage I esophageal squamous cell carcinoma. Methods: A total of 54 patients treated by definitive CRT and 116 patients treated by esophagectomy at out institution between February 1995 and August 2008 were included in the analysis. Overall survival and recurrence rates were evaluated. Results: Of 170 patients who had clinical stage I esophageal squamous cell carcinoma and treated by definitive CRT or esophagectomy, 169 patients (99%) were completely followed up. CRT mainly consisted of two cycles of cisplatin and fluorouracil with concurrent radiotherapy of 60 Gy in 30 fractions. Median (range) observation period was 67 (10–171) months in SURG group and 30 (4–77) months in CRT group. In CRT group grade 3 or grade 4 hematological or non-hematological adverse effects were seen in 24 (44.4%) patients. 1-year and 3-year overall survival rates were 97.4% and 85.5% in the SURG group and 98.1% and 88.7% in the CRT group (P = 0.78). By using Cox proportional hazards modelling, overall survival was comparable between the 2 groups after adjusting for age, sex, and size of cancer. Hazard ratio of CRT for overall survival was 0.95 (95% CI: 0.37-2.47). The incidence or local recurrence including metachronous esophageal cancer was significantly higher in the CRT group than the SURG group (P < 0.0001). All recurrences were intramucosal carcinomas and all of them were cured after the salvage treatment mainly using endoscopy. Conclusions: Overall survival rate of CRT was comparable with esophagectomy despite high local recurrence rate. Local recurrent carcinoma is endoscopically treatable in all patients without influence on overall survival. CRT appears to be a reasonable alternative to esophagectomy in patients with stage I esophageal cancer. No significant financial relationships to disclose.

FA06.02: OPTIMAL EXTENT OF LYMPH NODE DISSECTION FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 11-12
Author(s):  
Long-Qi Chen ◽  
Yu-Shang Yang
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
Lymph Node ◽  
Esophageal Squamous Cell Carcinoma ◽  
Lymph Nodes ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Positive Lymph Node ◽  
Node Negative ◽  
Kaplan Meier

Abstract Background The possible presence of occult tumor dissemination is the rationale of radical systematic lymphadenectomy. Theoretically, the more extent of lymphadenectomy, the more similar survival outcomes between node-negative and node-positive patients. Accordingly, there will be a certain number of examined lymph nodes (NELN) for patients with only one tumor-positive lymph node that can equal their survival with the node-negative patients, and this cut-off point should be define the minimal requirement for an adequate extent of lymphadenectomy. The aim of this report was to determine the optimal number of examined lymph nodes (NELN) dissection for esophageal squamous cell carcinoma (ESCC) by this novel method. Methods We retrospectively reviewed 589 ESCC patients from June 2011 and July 2012. Among them, 372 patients were pathologically confirmed with node-negative (N 0 + ), and 217 patients with only one tumor-positive lymph node (N 1 + ). Comparison of overall survival were performed using the Kaplan-Meier method. Cox regression hazard model was used for multivariate analysis to assess the independent influence of NELN on overall survival. Results The median survival for N 0 + and N 1 + patients was 32 versus 23 months (HR 1.61; 95% CI 22.86- 29.148; P = 0.000). Survival analyses revealed that the NELN positively correlated with overall survival (OS) both for patients with N 0- (P = 0.024) and N 1 + (P = 0.046), and an independent prognostic predictor only for N 0 + patients (hazard ratio 0.984; P = 0.032). When the cut-off point of NELN was set as a value less than 18, stratum analysis within the Kaplan–Meier method showed that NELN did not affect the results that N 1 + patients have a worse overall survival as compared with N 0 + patients (P < 0.05). However, stratum analysis showed that no significant difference in OS was observed between N 1 + and N 0 + patients when the NELN was greater than 18. Conclusion The NELN should be considered a mandatory requirement for improving the OS of ESCC patients. The minimum of 18 lymph nodes removed for ESCC is rational and should be complied with. Disclosure All authors have declared no conflicts of interest.

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