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Huang J, Chen C, Shen YM, Luo YF, Sun ZM, Chen J, Xu SJ, Lin JH, Chen SC. Preoperative immune prognostic index predicts the prognosis and postoperative adjuvant chemotherapy benefits of esophageal squamous cell carcinoma after minimally invasive esophagectomy. BMC Gastroenterol 2025; 25:344. [PMID: 40340583 PMCID: PMC12060512 DOI: 10.1186/s12876-025-03959-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 04/29/2025] [Indexed: 05/10/2025] Open
Abstract
BACKGROUND The utility of the immune prognostic index (IPI) for esophageal squamous cell carcinoma (ESCC) has yet to be established after minimally invasive esophagectomy (MIE). The purpose of this study was to investigate the value of IPI in predicting the prognosis and postoperative adjuvant chemotherapy (AC) benefits of ESCC patients. METHODS Between January 2011 and December 2018, 613 ESCC patients underwent MIE at our center and were divided into two groups: low IPI and high IPI.Log-rank tests were used to compare the overall survival (OS) and disease-free survival (DFS) of patients in different groups based on Kaplan-Meier survival analysis. Differences in clinical characteristics between groups were eliminated by propensity score matching (PSM) analysis. To identify independent risk factors influencing OS and DFS, the Cox proportional risk model was used. RESULTS In comparison to the high IPI group, the low IPI group had a better 5-year OS and DFS in both the entire and matched cohorts (P < 0.05). IPI was found to be an independent prognostic factor for OS and DFS in a multivariate analysis of the entire cohort and the matched cohort (P < 0.05). In subgroup analyses of most clinicopathological factors, high IPI was associated with a higher risk of death or recurrence in the matched cohorts. When combined with 8th TNM staging, the 5-year OS and DFS of stage II or III patients with low IPI in the AC group were not different from those in the non-AC group (P > 0.05), and AC of stage III patients with high IPI significantly prolonged 5-year OS and DFS (OS: 37.4% vs 26.2%, P = 0.018; DFS: 33.6% vs 19.8%, P = 0.042). CONCLUSION Preoperative IPI is a promising predictor of ESCC after MIE. For stage III ESCC patients with high IPI, AC can significantly reduce the risk of death or recurrence.
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Affiliation(s)
- Jin Huang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Chao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Yan-Ming Shen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Yun-Fan Luo
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Zhao-Min Sun
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Jie Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Shao-Jun Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
| | - Ji-Hong Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
| | - Shu-Chen Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, No.29 Xin Quan Road, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
- Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
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Bangolo A, Nagesh VK, Simonson G, Thapa A, Ram A, Santhakumari NJ, Chamroukh R, Varughese VJ, Nareeba S, Menon A, Sridharan K, Chacko AA, Mansour C, Elias D, Singh GR, Rambaransingh A, Mendez LR, Levy C, Kianifar Aguilar I, Hamad I, Sharma U, Salcedo J, Tran HHV, Haq A, Geleto TB, Jean K, Periel L, Bravin S, Weissman S. The Impact of Tumor Stage and Histopathology on Survival Outcomes in Esophageal Cancer Patients over the Past Decade. Med Sci (Basel) 2024; 12:70. [PMID: 39728419 PMCID: PMC11676677 DOI: 10.3390/medsci12040070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/04/2024] [Accepted: 12/05/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Esophageal cancer (EC) is the sixth leading cause of cancer-related mortality worldwide, continuing to be a significant public health concern. The purpose of this study is to assess the impact of staging and histopathology of EC on associated mortality. The study also aims to further investigate clinical characteristics, prognostic factors, and survival outcomes in patients diagnosed with EC between 2010 and 2017. Furthermore, we analyzed the interaction between tumor histology and staging and the risk of mortality. METHODS A total of 24,011 patients diagnosed with EC between 2010 and 2017 in the United States were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic parameters, tumor stage, and histologic subtypes were analyzed and associated overall mortality (OM) and cancer-specific mortality (CSM) were measured across all subgroups. Covariates reaching the level of statistical significance, demonstrable by a p-value equal to or less than 0.01, were incorporated into a multivariate Cox proportional hazards model. A hazard ratio greater than 1 was indicative of an increased risk of mortality in the presence of the variable under discussion. Additionally, the study explores the interaction between histology and tumor stage on outcomes. RESULTS The majority of patients were male (80.13%) and non-Hispanic white (77.87%), with a predominant age at diagnosis of between 60 and 79 years (59.86%). Adenocarcinoma was the most common tumor subtype (68.17%), and most patients were diagnosed at a distant stage (41.29%). Multivariate analysis revealed higher mortality risks for males, older patients, unmarried individuals, and those with advanced-stage tumors. Higher income, receiving radiation or chemotherapy, and undergoing surgery were associated with lower mortality. Tumor subtype significantly influenced mortality, with squamous cell carcinoma and neuroendocrine tumors showing higher hazard ratios compared to adenocarcinoma. Adenocarcinoma is linked to a poorer prognosis at advanced stages, whereas the opposite trend is observed for SCC. CONCLUSIONS The study identifies significant demographic and clinicopathologic factors influencing mortality in esophageal cancer patients, highlighting the importance of early diagnosis and treatment intervention. Future research should focus on tailored treatment strategies to improve survival outcomes in high-risk groups and to understand the interaction between tumor histology and tumor stage.
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Affiliation(s)
- Ayrton Bangolo
- Department of Hematology and Oncology, John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ 07601, USA;
| | - Vignesh Krishnan Nagesh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Grace Simonson
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Abhishek Thapa
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Arun Ram
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Nithin Jayan Santhakumari
- Department of Internal Medicine, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Rayan Chamroukh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | | | - Shallot Nareeba
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Aiswarya Menon
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Kousik Sridharan
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Angel Ann Chacko
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Charlene Mansour
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Daniel Elias
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Gurinder R. Singh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Aaron Rambaransingh
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Luis Roman Mendez
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Charlotte Levy
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Izage Kianifar Aguilar
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Ibrahim Hamad
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Urveesh Sharma
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Jose Salcedo
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Hadrian Hoang-Vu Tran
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Abdullah Haq
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Tahir B. Geleto
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Kaysha Jean
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Luis Periel
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Sara Bravin
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
| | - Simcha Weissman
- Department of Internal Medicine, Hackensack Palisades Medical Center, North Bergen, NJ 07047, USA (A.M.); (A.A.C.); (C.M.); (D.E.); (I.K.A.); (L.P.); (S.W.)
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Zeng Y, Li J, Ye J, Han G, Luo W, Wu C, Qin S, Gu W, Zhao S, Zhao Y, Xia B, Zhu Z, Du X, Liu Y, Liu J, Li H, Wang J, Guo J, Yu W, Zhang Q, Wang C, Fang W, Li Z, Fu X, Cai X. Postoperative tumor bed radiation versus T-shaped field radiation in the treatment of locally advanced thoracic esophageal squamous cell carcinoma: a phase IIb multicenter randomized controlled trial. BMC Med 2024; 22:522. [PMID: 39511550 PMCID: PMC11545895 DOI: 10.1186/s12916-024-03727-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 10/24/2024] [Indexed: 11/15/2024] Open
Abstract
BACKGROUND Postoperative radiotherapy (PORT) is crucial for patients with thoracic locally advanced esophageal squamous cell carcinoma (LA-ESCC, pT3-4aN0-3M0) following esophagectomy. However, the appropriate radiation volume has not been well established. This study aimed to determine the optimal PORT volume for LA-ESCC patients. METHODS LA-ESCC patients post-esophagectomy were randomly assigned to either the large-field irradiation (LFI, primary lesion and lymph node tumor bed plus elective nodal irradiation) group or the small-field irradiation (SFI, primary lesion and lymph node tumor bed alone) group. Stratification was based on T stage and the number of lymph node metastases. The primary endpoint was disease-free survival (DFS), while the secondary endpoints included overall survival (OS), adverse events, and patterns of initial failure. RESULTS A total of 401 patients were randomly assigned to the intention-to-treat analysis(LFI group, n = 210; SFI group, n = 191). The median DFS of patients in the LFI group was 47.9 months and 48.1 months in the SFI group (HR = 0.87, 95%CI, 0.65 to 1.16; p = 0.32). The estimated one-year and three-year OS rates were 89.2% and 63.2% for patients in the LFI group, compared to 86.6% and 60.7% for the SFI group, respectively. The difference of OS between the two groups was not significant (HR = 0.86, 95%CI, 0.63 to 1.16; p = 0.35). Fewer patients in the LFI group experienced locoregional recurrence compared to the SFI group (12.9% vs 20.4%, p = 0.013). Additionally, locoregional recurrence-free survival of the LFI group was significantly longer than that of SFI group (HR = 0.54, 95%CI, 0.34-0.87; p = 0.01). The most common toxicity was grade 2 esophagitis, observed in 22.9% of the LFI group and 16.8% of the SFI group. Grade 3 adverse events occurred in 6.7% of the LFI group and 2.6% of the SFI group. No grade 4 or 5 toxicities were observed. Adverse events did not significantly differ between the two groups. CONCLUSIONS Postoperative radiotherapy, with the specified radiation volume shows encouraging survival outcomes that are comparable to those of neoadjuvant chemoradiotherapy in patients with thoracic LA-ESCC. Both postoperative irradiation fields were found to be feasible and safe.
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Affiliation(s)
- Ya Zeng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jingjun Ye
- Department of Radiation Oncology, Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Gaohua Han
- Department of Radiation Oncology, Taizhou City People's Hospital, Taizhou, China
| | - Wenguang Luo
- Department of Radiation Oncology, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Chaoyang Wu
- Department of Radiation Oncology, Zhenjiang First People's Hospital, Zhenjiang, China
| | - Songbing Qin
- Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wendong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Suzhou, China
| | - Shengguang Zhao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yufei Zhao
- Department of Radiation Oncology, The First Affiliated Hospital of USTC West District Anguish Provincial Cancer Hospital, Hefei, China
| | - Bing Xia
- Department of Radiation Oncology, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou Cancer Hospital, Hangzhou, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xianghui Du
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Science/Institute of Cancer and Basic Medicine, Chinese Academy of Science, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Yuan Liu
- Department of Statistics, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongxuan Li
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaming Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jindong Guo
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Yu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changlu Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Li
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
| | - Xuwei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
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Zeng Y, Su X, Zhou T, Jia J, Liu J, Yu W, Zhang Q, Song X, Fu X, Cai X. Propensity-matched study on locally advanced esophageal cancer: surgery versus post-operative radiotherapy. Radiat Oncol 2024; 19:130. [PMID: 39334405 PMCID: PMC11428459 DOI: 10.1186/s13014-024-02528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND This study aims to delineate the long-term outcomes and recurrence patterns of locally advanced thoracic esophageal squamous cell carcinoma (TESCC) patients managed with or without postoperative radiotherapy (PORT). METHODS A retrospective cohort from two academic centers, encompassing patients who initially underwent esophagectomy and were pathologically staged T3-4, was analyzed. Survival outcomes were constructed using Kaplan-Meier method, with survival significance was evaluated using the log-rank test. Propensity score matching (PSM) was utilized to balance potential selection bias. RESULTS Among the 506 patients, 251 underwent surgery alone and 255 received radiotherapy following radical surgery. With a median follow-up of 49.1 months, PORT significantly improved 5-year overall survival (53.8% vs. 25.3%; p < 0.001) and 5-year disease-free survival rates (45.3% vs. 8.5%; p < 0.001) compared to surgery alone. These differences in survival outcomes persisted even after PSM (p < 0.001 for both). Treatment failure was significantly less frequent in the PORT group (46.7%) compared to the surgery-only group (90.0%; p < 0.001), with corresponding reductions in locoregional recurrence (9.4% vs. 54.1%; p < 0.001). This underscores the significant association between PORT and disease control. CONCLUSION The absence of neoadjuvant chemoradiotherapy highlights the importance of PORT in improving survival and reducing recurrence in advanced T3-4 TESCC patients. This study underscores the importance of PORT as a salvage treatment for locally advanced TESCC patients without neoadjuvant chemoradiotherapy.
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Affiliation(s)
- Ya Zeng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Xi Su
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Tongfang Zhou
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Jingyi Jia
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Jun Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Wen Yu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Qin Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Xinyun Song
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China.
| | - Xuwei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, 241 West Huaihai Road, Shanghai, 200030, China.
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Tang JM, Huang SJ, Chen QB, Wu HS, Qiao GB. Optimal extent of lymphadenectomy improves prognosis and guides adjuvant chemotherapy in esophageal cancer: A propensity score-matched analysis. World J Gastrointest Surg 2024; 16:1537-1547. [PMID: 38983355 PMCID: PMC11230019 DOI: 10.4240/wjgs.v16.i6.1537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/29/2024] [Accepted: 05/16/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND The optimal extent of lymphadenectomy in esophageal squamous cell carcinoma (ESCC) patients remained debatable. AIM To explore the ideal number of cleared lymph nodes in ESCC patients undergoing upfront surgery. METHODS In this retrospective, propensity score-matched study, we included 1042 ESCC patients who underwent esophagectomy from November 2008 and October 2019. Patients who underwent neoadjuvant therapy were excluded. We collected patients' clinicopathological features and information regarding lymph nodes, including the total number of resected lymph nodes (NRLN), and pathologically diagnosed positive lymph nodes (RPLN). SPSS and R software were used for statistical analysis. RESULTS Among the included 1042 patients, two cohorts: ≤ 21 (n = 664) and > 21 NRLN (n = 378) were identified. The final prognostic model included four variables: T stage, N, venous thrombus, and the number of removed lymph nodes. Among them, NRLN > 21 was determined as an independent prognosticator after surgery for esophageal cancer (hazards regression = 0.66, 95% confidence interval: 0.50-0.87, P = 0.004). A nomogram was created based on the regression coefficients of the variables in the final model. In the training cohort, the predictive model displayed an uncorrected five-year overall survival C-index of 0.659, with a bootstrap-corrected C-index of 0.654. In the subgroup analysis, adjuvant chemotherapy was beneficial in the subgroup with NRLN > 21 and RPLN ≤ 0.16 and NRLN ≤ 21 and RPLN > 0.16. CONCLUSION NRLN > 21 was an independent prognostic factor after ESCC surgery. The combination of NRLN and RPLN may provide a reference for adjuvant chemotherapy use in potential beneficiaries.
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Affiliation(s)
- Ji-Ming Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
| | - Shu-Jie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
| | - Qi-Bin Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
| | - Han-Sheng Wu
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Gui-Bin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangzhou 510080, Guangdong Province, China
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Du R, Fan S, Yang D, Wang X, Hou X, Zeng C, Guo D, Tian R, Jiang L, Dong X, Yu R, Yu H, Zhu S, Li J, Shi A. Exploration of lymph node recurrence patterns and delineation guidelines of radiation field in middle thoracic oesophageal carcinomas after radical surgery: a real-world study. BMC Cancer 2024; 24:596. [PMID: 38755542 PMCID: PMC11097414 DOI: 10.1186/s12885-024-12297-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Oesophageal squamous cell carcinoma is one of the most commonly diagnosed carcinomas in China, and postoperative radiotherapy plays an important role in improving the prognosis of patients. Carcinomas in different locations of the oesophagus could have different patterns of lymph node metastasis after surgery. METHODS In this multicentric retrospective study, we enrolled patients with middle thoracic oesophageal squamous cell carcinomas from 3 cancer centres, and none of the patients underwent radiotherapy before or after surgery. We analysed the lymph node recurrence rates in different stations to explore the postoperative lymphatic recurrence pattern. RESULTS From January 1st, 2014, to December 31st, 2019, 132 patients met the criteria, and were included in this study. The lymphatic recurrence rate was 62.1%. Pathological stage (P = 0.032) and lymphadenectomy method (P = 0.006) were significant predictive factors of lymph node recurrence. The recurrence rates in the supraclavicular, upper and lower paratracheal stations of lymph nodes were 32.6%, 28.8% and 16.7%, respectively, showing a high incidence. The recurrence rate of the subcarinal node station was 9.8%, while 8.3% (upper, middle and lower) thoracic para-oesophageal nodes had recurrences. CONCLUSIONS We recommend including the supraclavicular, upper and lower paratracheal stations of lymph nodes in the postoperative radiation field in middle thoracic oesophageal carcinomas. Subcarinal station is also potentially high-risk, while whether to include thoracic para-oesophageal or abdominal nodes needs careful consideration.
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Affiliation(s)
- Rongxu Du
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Songqing Fan
- Oncology Division I, China Pingmei Shenma Medical Group General Hospital, Kuanggongzhong Rd.1, Xinhua District, Pingdingshan Henan, 450052, China
| | - Dan Yang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xiaobin Wang
- Department of Radiation Oncology, Hebei Cancer Hospital, The Fourth Hospital of Hebei Medical University, JianKang Rd.12, Shijiazhuang Hebei, 050011, China
| | - Xia Hou
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China
| | - Cheng Zeng
- Department of Radiation Oncology, Central Theater General Hospital, Wuluo Rd. 627, Wuchang District, Wuhan Hubei, 430061, China
| | - Dan Guo
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China
| | - Rongrong Tian
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China
| | - Leilei Jiang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Xin Dong
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Rong Yu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Huiming Yu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Shuchai Zhu
- Department of Radiation Oncology, Hebei Cancer Hospital, The Fourth Hospital of Hebei Medical University, JianKang Rd.12, Shijiazhuang Hebei, 050011, China.
| | - Jie Li
- Department of Radiation Oncology, Shanxi Provincial Cancer Hospital, No.3 Workers New Village, Xinghualing District, Taiyuan, Shanxi, 030013, China.
| | - Anhui Shi
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Gao H, Wang Y, Jiang Z, Shi G, Hu S, Ai J, Wang Z, Wei Y. Association of survival with adjuvant radiotherapy for pN0 esophageal cancer. Aging (Albany NY) 2023; 15:3158-3170. [PMID: 37184977 DOI: 10.18632/aging.204677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/15/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION This study was conducted to elucidate the link between adjuvant radiotherapy and survival in pathologic node-negative (pN0) esophageal cancer patients with upfront esophagectomy. METHODS From 2000 to 2016, patients with pN0 esophageal cancer who underwent upfront esophagectomy were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The association of high-risk covariates with survival after adjuvant radiotherapy was evaluated using propensity score matching and multivariate analysis. RESULTS We identified 3197 patients, 321 (10.0%) underwent postoperative radiotherapy and 2876 (90.0%) underwent esophagectomy alone. In the unmatched cohort, postoperative radiotherapy was associated with a statistically significant but modest absolute decrease in survival outcomes (P < 0.001). In the matched cohort, the survival differences disappeared. Additionally, adjuvant radiotherapy was linked to a 5-year overall survival (OS) benefit for patients with the pT3-4N0 disease (34.8% vs. 27.7%; P = 0.008). Adjuvant radiotherapy for pT3-4N0 disease with tumor length ≥3 cm, adenocarcinoma, and evaluated lymph node count <12 was shown to independently function as a risk factor for improved OS, as per a multivariate analysis (P < 0.01). CONCLUSIONS This population-based trial showed that high-risk patients with pT3-4N0 esophageal cancer had better OS following upfront esophagectomy followed by radiotherapy therapy. This discovery may have major significance in the use of adjuvant radiotherapy following upfront esophagectomy in patients with pN0 esophageal cancer.
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Affiliation(s)
- Huijiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuanyong Wang
- Department of Thoracic Surgery, Tangdu Hospital of Air Force Military Medical University, Xi’an, China
| | - Zhihui Jiang
- Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Guodong Shi
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shiyu Hu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiangshan Ai
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhaofeng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yucheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Kang M, Wang Y, Yang M, Wang X, Zhu L, Zhang M. Prognostic nomogram and risk factors for predicting survival in patients with pT2N0M0 esophageal squamous carcinoma. Sci Rep 2023; 13:4931. [PMID: 36967413 PMCID: PMC10040408 DOI: 10.1038/s41598-023-32171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
This study analyzed the impact of factors affecting overall survival in patients with pT2N0M0 esophageal squamous carcinoma (ESCC) and developed a nomogram to predict overall survival (OS). We reviewed the clinical data of 413 patients with pathological T2N0M0 ESCC after radical esophagectomy in two hospitals. Data from one institution was used as the training cohort. A nomogram was established using Cox proportional hazard regression for identifying the prognostic factors affecting for OS in ESCC patients. The area under the curve (AUC), calibration curves and decision curve analysis (DCA) were used to evaluate prognostic efficacy, which was validated in an independent validation cohort. In the training cohort (N = 304), the median OS was 69.33 months, and the 3-, 5- and 10-year OS rates were 76.80%, 67.00% and 56.90%, respectively. The median OS of the validation cohort (N = 109) was 73.50 months, and the 3-, 5- and 10-year OS rates were 77.00%, 67.80% and 55.60%, respectively. According to Cox univariate and multivariate analyses, sex, age, tumor length and the number of resected lymph nodes were identified as predictors of OS. We developed nomograms and performed internal and external validation. The time-dependent receiver operating characteristic (ROC) curve and area under the curve (AUC) value, calibration curve and decision curve analysis (DCA) showed good prediction ability of the nomogram. The developed nomogram can effectively predict OS after esophagectomy in patients with pT2N0M0 ESCC.
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Affiliation(s)
- Mei Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
| | - Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
| | - Mingwei Yang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
| | - Xiumei Wang
- Department of Oncology, The Third People's Hospital of Hefei, No. 204, Wangjiang East Road, Baohe District, Hefei, 230022, Anhui, People's Republic of China
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
| | - Mei Zhang
- Department of Integrated Traditional and Western Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China.
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Ai D, Chen Y, Liu Q, Deng J, Zhang X, Zhang J, Chu L, Shen J, Ma L, Zhang Y, Chen H, Miao L, Zhao K, Xiang J. Extensive clinical target volume in postoperative chemoradiotherapy for esophageal squamous cell carcinoma: a phase II clinical trial (ESO-Shanghai 9). Radiat Oncol 2023; 18:26. [PMID: 36750858 PMCID: PMC9903423 DOI: 10.1186/s13014-023-02211-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/20/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To compare the efficacy and safety of postoperative extensive target volume irradiation with elevated radiation dose and concurrent chemotherapy with radiotherapy only for the postoperative treatment of esophageal squamous cell carcinoma. METHODS This trial was a single-arm phase II trial. Patients who underwent a radical transthoracic resection with negative margins within 3 months and histologically confirmed esophageal squamous cell carcinoma (pT3-4N0M0 or pTxN + M0, AJCC 7th) were eligible for this study. Postoperative radiotherapy was performed at a total dose of 45 Gy in 25 fractions with clinical target volumes of the tumor bed, anastomosis, bilateral supraclavicular, mediastinal, left gastric and celiac trunk lymph node areas. Five cycles of weekly TC (paclitaxel 50 mg/m2, d1, carboplatin AUC = 2, d1) were given as concurrent chemotherapy. The primary endpoint was the 2-year local control rate, and the secondary endpoints were overall survival, disease free survival, local-regional recurrence free survival, distant metastasis free survival and adverse events. All endpoints were compared with those in ESO-Shanghai 8 study with postoperative radiotherapy alone (40 Gy/20Fx). RESULTS A total of 70 patients were enrolled from 2016 to 2018. The 2-year local control rate was 87.9% (95% CI: 83.3-92.3) in this study, which achieved the hypothesized 2-year local control rate of at least 83%. Overall survival, disease free survival, local-regional recurrence free survival and distant metastasis free survival in this study were also longer than those in previous ESO-Shanghai 8 study while most toxicities were increased and two patients in this study died of radiation pneumonitis. CONCLUSIONS Postoperative extensive target volume irradiation with elevated radiation dose and concurrent chemotherapy was effective. Treatment related toxicity was increased due to higher treatment intensity. Trial registration clinicaltrials.gov: NCT02916511.
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Affiliation(s)
- Dashan Ai
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Yun Chen
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Qi Liu
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Jiaying Deng
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Xiaofei Zhang
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Junhua Zhang
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Li Chu
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Jingyi Shen
- grid.452404.30000 0004 1808 0942Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Longfei Ma
- grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China ,grid.452404.30000 0004 1808 0942Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China
| | - Yawei Zhang
- grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China ,grid.452404.30000 0004 1808 0942Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China
| | - Haiquan Chen
- grid.8547.e0000 0001 0125 2443Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China ,grid.452404.30000 0004 1808 0942Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China
| | - Longsheng Miao
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, 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.
| | - Jiaqing Xiang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China. .,Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
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Han W, Chang X, Zhang W, Yang J, Yu S, Deng W, Ni W, Zhou Z, Chen D, Feng Q, Liang J, Hui Z, Wang L, Gao S, Lin Y, Chen X, Chen J, Xiao Z. Effect of Adjuvant Radiation Dose on Survival in Patients with Esophageal Squamous Cell Carcinoma. Cancers (Basel) 2022; 14:5879. [PMID: 36497360 PMCID: PMC9736548 DOI: 10.3390/cancers14235879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background: For patients with esophageal squamous cell carcinoma (ESCC) treated with surgery alone, the incidence of local-regional recurrence remains unfavorable. Postoperative radiotherapy (PORT) has been associated with increased local-regional recurrence-free survival (LRFS), although its application is limited by concerns of PORT-related toxicities. Methods: Among 3591 patients with ESCC analyzed in this study, 2765 patients with T3-4N0 and T1-4N1-3 lesions and specific local-regional status information were analyzed in a subsequent analysis of adjuvant radiation dose (aRTD) effect. Application of the restricted cubic spline regression model revealed a non-linear relationship between aRTD and survival/radiotoxicity. Linear regression analysis (LRA) was performed to evaluate correlations between LRFS and overall survival (OS)/ disease-free survival (DFS). Results: For patients staged T1−2N0, T1−2N1−3, T3−4N0, and T3−4N1−3, 5-year OS in PORT and non-PORT groups were 77.38% vs. 72.91%, p = 0.919, 52.35% vs. 46.60%, p = 0.032, 73.41% vs. 61.19%, p = 0.005 and 38.30% vs. 25.97%, p < 0.001. With aRTD escalation, hazard ratios (HRs) of OS/DFS declined until aRTD exceeded 50Gy, then increased, whereas that of LRFS declined until aRTD exceeded 50 Gy, then remained steady. HR of treatment-related mortality was stable until aRTD exceeded 50 Gy, then increased. LRA revealed strong correlations between LRFS and OS/DFS (r = 0.984 and r = 0.952, respectively). An absolute 1% advancement in LRFS resulted in 0.32% and 0.34% improvements in OS and DFS. Conclusions: An aRTD of 50Gy was well-tolerated, with favorable survival resulting from PORT-related LRFS improvement in patients staged T3−4N0 or T1-4N1−3. Further stratification analyses based on tumor burden would help determine potential PORT-beneficiaries.
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Affiliation(s)
- Weiming Han
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiao Chang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wencheng Zhang
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jingsong Yang
- Department of Radiation Oncology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Shufei Yu
- Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wei Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Wenjie Ni
- Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Ninth School of Clinical Medicine, Beijing 100038, China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhouguang Hui
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Lvhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu Lin
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Xiaohui Chen
- Department of Thoracic Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Junqiang Chen
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Hu SY, Gao HJ, Jiang ZH, Shi GD, Wang HF, Ai JS, Wei YC. A Recurrence Predictive Model for Node-negative Esophageal Squamous Cell Carcinoma After Upfront Esophagectomy. Semin Thorac Cardiovasc Surg 2022; 36:102-111. [PMID: 36089122 DOI: 10.1053/j.semtcvs.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/11/2022]
Abstract
The prognosis for pathologically node-negative (pN0) esophageal squamous cell carcinoma (ESCC) with surgery alone remains poor. We aimed to develop a model for a more precise prediction of recurrence, which will allow personalized management for pN0 ESCC after upfront complete resection. Clinical and pathological records of patients with completely resected pT1-3N0M0 ESCC were retrospectively analyzed between January 2014 and December 2019. A nomogram for the prediction of recurrence was established based on the Cox regression analysis and evaluated by C-index, AUC, and calibration curves. The model was further validated using bootstrap resampling and k-fold cross-validation and compared with the 8th edition of the AJCC TNM staging system using Td-ROC, NRI, IDI, and DCA. Two-hundred-and seventy cases were included in this study. The median follow-up was 45 months. Distant and/or loco-regional recurrences were noted in 89 (33.0%) patients. The predictive model revealed pT-category, differentiation, perineural invasion, examined lymph nodes (ELN), and prognostic nutritional index (PNI) as independent risk factors for recurrence, with a c-index of 0.725 in the bootstrapping cohort. Td-ROC, NRI, and IDI showed a better predictive ability than the AJCC 8th TNM staging system. Based on this model, patients in the low-risk group had a significantly lower recurrence incidence than those in the high-risk group (p < .001). The predictive model developed in this study may facilitate the precise prediction of recurrences for pN0 ESCC after upfront surgery. Stratifying management of those patients might bring significantly better survival benefits.
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Affiliation(s)
- Shi-Yu Hu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui-Jiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhi-Hui Jiang
- Department of General Surgery, Qingdao women and Children's Hospital, Qingdao, China
| | - Guo-Dong Shi
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hua-Feng Wang
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jiang-Shan Ai
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Du R, Fan S, Wang X, Hou X, Zeng C, Guo D, Tian R, Yang D, Jiang L, Dong X, Yu R, Yu H, Li D, Zhu S, Li J, Shi A. Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study. Radiat Oncol 2022; 17:47. [PMID: 35248100 PMCID: PMC8898421 DOI: 10.1186/s13014-022-01987-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background To study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squamous cell esophageal carcinomas. Methods We enrolled patients who underwent radical esophagectomy, without radiation before or after surgery, at 3 cancer hospitals. Patients were classified into groups according to tumor locations. We included patients with tumors in the lower thoracic segment and analyzed the postoperative lymph node recurrence mode. A cutoff value of 10% was used to differentiate high-risk lymph node drainage areas from others. Results We enrolled 1905 patients in the whole study series, including 652 thoracic esophageal carcinomas that met our inclusion criteria; there were 241 cases of lower thoracic esophageal carcinomas. 1st, 2nd, 4th, 7th, 8th groups of lymph nodes, according to the 8th edition of the AJCC classification, displayed as high-risk recurrence areas, representing 17.8%, 23.9%, 11.7%, 10.9% and 12.2% of lymph node recurrence. Stage III-IV tumors located in the lower segment of the thoracic esophagus showed a tendency to recur in the left gastric nodes (7.9%) and celiac nodes (10.6%). Conclusions According to our results, we recommended including the 4th, 7th and 8th groups of lymph nodes in the radiation field, and for patients with stage III-IV disease, the 17th and 20th groups of nodes should be irradiated during postoperative treatment. Whether including 1st/2nd groups in preventive irradiation needed more proofs.
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Zhou Z, Huang S, Ben X, Zhuang W, Hong L, Xie Z, Zhang D, Xie L, Zhou H, Tang J, Chen G, Wu H, Qiao G. A novel prognostic model: which group of esophageal squamous cell carcinoma patients could benefit from adjuvant chemotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:182. [PMID: 35280404 PMCID: PMC8908144 DOI: 10.21037/atm-22-46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to establish a reliable model for predicting the overall survival (OS) of esophageal squamous cell carcinoma (ESCC) patients and identifying the potential beneficiaries of adjuvant chemotherapy after esophagectomy. METHODS This retrospective study included 819 ESCC patients who underwent esophagectomy as the training cohort. We constructed a prognostic model named GTLN2. Both internal and external validation tests were performed. Potential beneficiaries were defined as ESCC patients who obtained a significantly longer OS after adjuvant chemotherapy. Propensity score matching (PSM) was utilized in the subgroup analysis to screen ESCC beneficiaries of adjuvant chemotherapy. RESULTS We enrolled a total of 819 cT1b-3 patients in the training cohort. Multiple prognostic factors were associated with adjuvant chemotherapy. Using uni-/multivariate analysis, histological grade (G), tumor invasion depth (T), regional lymph node metastasis (N), and the number of cleared lymph nodes (NCLNs) were identified as independent prognostic factors. Then, we developed the GTLN2 model based on these predictors and validated it using internal calculations [the 1-, 3- and 5-year area under the curves (AUCs) were 0.692, 0.685 and 0.680, respectively; P<0.001] and external cohorts (the 1-, 3-, and 5-year AUCs were 0.651, 0.619 and 0.650, respectively; P<0.001). ESCC patients were categorized into high- and low-risk groups based on their assigned risk scores. After 1:1 patient pairing was performed by PSM in the high-risk group, better OS was noted in patients receiving adjuvant chemotherapy (P=0.024). CONCLUSIONS Differentiating high- and low-risk patient groups via a novel mathematical prediction model allows physicians to identify patients in need of adjuvant chemotherapy accurately.
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Affiliation(s)
- Zihao Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shujie Huang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Xiaosong Ben
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weitao Zhuang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Liangli Hong
- Department of Pathology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zefeng Xie
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Dongkun Zhang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Liang Xie
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haiyu Zhou
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiming Tang
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gang Chen
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hansheng Wu
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Guibin Qiao
- Department of Thoracic Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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14
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Gong H, Li B. Guidelines for Radiotherapy of Esophageal Carcinoma (2020 Edition). PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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15
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Ni W, Yu S, Xiao Z, Zhou Z, Chen D, Feng Q, Liang J, Lv J, Gao S, Mao Y, Xue Q, Sun K, Liu X, Fang D, Li J, Wang D, Zhao J, Gao Y. Postoperative Adjuvant Therapy Versus Surgery Alone for Stage IIB-III Esophageal Squamous Cell Carcinoma: A Phase III Randomized Controlled Trial. Oncologist 2021; 26:e2151-e2160. [PMID: 34309117 DOI: 10.1002/onco.13914] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/13/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Retrospective studies have shown that adjuvant treatment improves survival of patients with stage IIB-III esophageal squamous cell carcinoma, but there is no evidence from prospective trials so far. MATERIALS AND METHODS Patients with pathological stage IIB-III esophageal squamous cell carcinoma were randomly assigned to receive surgery alone (SA), postoperative radiotherapy (PORT), or postoperative concurrent chemoradiotherapy (POCRT). PORT patients received 54 Gy in 27 fractions; the POCRT group received 50.4 Gy in 28 fractions, plus concurrent chemotherapy with paclitaxel (135-150 mg/m2 ) and cisplatin or nedaplatin (50-75 mg/m2 ) every 28 days. The primary endpoint was disease-free survival (DFS), and the secondary endpoint was overall survival (OS). RESULTS A total of 172 patients were enrolled (SA, n = 54; PORT, n = 54; POCRT, n = 64). The 3-year DFS was significantly better in PORT/POCRT patients than in SA patients (53.8% vs. 36.7%; p = .020); the 3-year OS was also better in PORT/POCRT patients (63.9% vs. 48.0%; p = .025). The 3-year DFS for SA, PORT, and POCRT patients were 36.7%, 50.0%, 57.3%, respectively (p = .048). The 3-year OS for SA, PORT, and POCRT patients were 48.0%, 60.8%, 66.5%, respectively (p = .048). CONCLUSION PORT/POCRT (especially POCRT) may significantly improve DFS and OS in stage IIB-III esophageal squamous cell carcinoma. IMPLICATIONS FOR PRACTICE The results of this phase III study indicated that postoperative radiotherapy/postoperative concurrent chemoradiotherapy (PORT/POCRT) could significantly improve disease-free survival and overall survival in stage IIB-III esophageal squamous cell carcinoma compared with surgery alone with acceptable toxicities. In-field and out-of-field recurrences were comparable between the POCRT and PORT groups, which demonstrates the rationality and safety of the radiation field used in this study. The postoperative regimens in this trial might be accepted as standard treatment options for pathological stage IIB-III esophageal cancer. Larger sample size prospective randomized trials to identify the value are warranted.
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Affiliation(s)
- Wenjie Ni
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.,Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Shufei Yu
- Department of Radiotherapy, Beijing Chao-yang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Zongmei Zhou
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dongfu Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qinfu Feng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jun Liang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jima Lv
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kelin Sun
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xiangyang Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dekang Fang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Dali Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yushun Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Pucher PH, Wijnhoven BPL, Underwood TJ, Reynolds JV, Davies AR. Thinking through the multimodal treatment of localized oesophageal cancer: the point of view of the surgeon. Curr Opin Oncol 2021; 33:353-361. [PMID: 33966001 DOI: 10.1097/cco.0000000000000751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW This review examines current developments and controversies in the multimodal management of oesophageal cancer, with an emphasis on surgical dilemmas and outcomes from the surgeon's perspective. RECENT FINDINGS Despite the advancement of oncological neoadjuvant treatments, there is still no consensus on what regimen is superior. The majority of patients may still fail to respond to neoadjuvant therapy and suffer potential harm without any survival advantage as a result. In patients who do not respond, adjuvant therapy is still often recommended after surgery despite any evidence for its benefit. We examine the implications of different regimens and treatment approaches for both squamous cell cancer and adenocarcinoma of the oesophagus. SUMMARY The efficacy of neoadjuvant treatment is highly variable and likely relates to variability of tumour biology. Ongoing work to identify responders, or optimize treatment on an individual patient, should increase the efficacy of multimodal therapy and improve patient outcomes.
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Affiliation(s)
- Philip H Pucher
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London
- Department of Surgery, Portsmouth University Hospitals NHS Trust, Portsmouth, UK
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus MC-Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Timothy J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - John V Reynolds
- Department of Surgery, National Oesophageal and Gastric Center, St. James's Hospital and Trinity College, Dublin, Ireland
| | - Andrew R Davies
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London
- King's College London, London, UK
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Otake R, Okamura A, Yamashita K, Imamura Y, Kanamori J, Kozuki R, Takahashi K, Toihata T, Yamamoto N, Asari T, Mine S, Watanabe M. Efficacy of postoperative radiotherapy in esophageal squamous cell carcinoma patients with positive circumferential resection margin. Esophagus 2021; 18:288-295. [PMID: 33108536 DOI: 10.1007/s10388-020-00790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 10/15/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The significance of postoperative radiotherapy for residual disease after esophageal cancer surgery remains controversial. The purpose of this study was to elucidate the efficacy of postoperative radiotherapy in esophageal squamous cell carcinoma (ESCC) patients with positive circumferential resection margin (CRM). METHODS We retrospectively analyzed data from 1190 patients who underwent esophagectomy for ESCC at our hospital from 2005 to 2018, of whom 61 (5.1%) patients were diagnosed with positive CRM of ESCC. Overall survival (OS), progression-specific survival (PSS), local progression-specific survival (LPSS), and clinicopathological factors were compared between patients with and without postoperative radiotherapy. The efficacy of additional radiotherapy on patient outcomes was evaluated. RESULTS Among the 61 patients analyzed, 29 (47.5%) underwent radiotherapy (RT group) and 32 (52.5%) did not (NRT group). In the RT group, 22 patients (75.9%) received radiotherapy and 7 patients (24.1%) received chemoradiotherapy. The RT group included younger patients, a greater number of upper-esophageal tumors, and a greater rate of R2 resections than the NRT group. The LPSS and PSS of the RT group were significantly better than those of the NRT group (P = 0.007, P < 0.001, respectively). In multivariate analysis, postoperative radiotherapy was an independent factor for LPSS [P < 0.001; hazard ratio (HR) 0.17; 95% confidence interval (CI) 0.06-0.46] and PSS (P < 0.001; HR 0.31; 95% CI 0.16-0.60). CONCLUSIONS Postoperative radiotherapy contributed to the control of residual tumor and was significantly associated with better LPSS and PSS among patients with positive CRM after esophagectomy for ESCC.
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Affiliation(s)
- Reiko Otake
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Jun Kanamori
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Ryotaro Kozuki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Keita Takahashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Tasuku Toihata
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Noriko Yamamoto
- Department of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takao Asari
- Department of Radiotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
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Shao Y, Chen D, Ye L, Wang XM, Wu QC, Zhang C. Survival benefit of perioperative chemotherapy for T1-3N0M0 stage esophageal cancer: a SEER database analysis. J Thorac Dis 2021; 13:995-1004. [PMID: 33717572 PMCID: PMC7947537 DOI: 10.21037/jtd-20-2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The effect of perioperative chemotherapy on patients with lymph node-negative esophageal cancer (EC) is controversial. This study explored which EC patients, staged under the T1-3N0M0, would benefit from perioperative chemotherapy. Methods Data on patients with diagnosed primary EC were retrieved from Surveillance, Epidemiology and End Results (SEER) database. Propensity score-matched (PSM) method was performed to balance baseline covariates. Multivariate Cox regression analysis and Kaplan-Meier curve were used to assess potential survival difference between patients undergoing surgery plus perioperative chemotherapy (SA + CT) and those undergoing surgery alone (SA). Results In a total of 2,711 EC patients (T1–3N0M0), 166 patients underwent SA + CT and 2,545 patients received SA. In the multivariable analysis, T stage was significantly related to prognosis of EC patients before and after matching. Subgroup analysis showed that perioperative chemotherapy was associated with poor cancer-specific survival (CSS) for stage T1 patients. There was no effect of perioperative chemotherapy on overall survival (OS) or CSS for T2 patients, whereas a remarkable improvement in OS and CSS was observed for T3 patients. Survival analysis showed that T3 stage EC patients obtained survival benefit from SA + CT. Prognosis in the SA group was significantly better than in the SA + CT group for T1 patients. However, T2 patients showed no significant increase in survival after undergoing SA + CT compared with SA. Conclusions T3 patients benefit more from SA + CT. However, perioperative chemotherapy does not present survival benefit to T1–2 patients, and it is an adverse prognostic factor for T1 patients.
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Affiliation(s)
- Yue Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liu Ye
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Mei Wang
- Department of Pathology, Chongqing Medical University, Chongqing, China
| | - Qing-Chen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Postoperative Adjuvant Therapy for Patients with pN+ Esophageal Squamous Cell Carcinoma. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8571438. [PMID: 33553432 PMCID: PMC7847342 DOI: 10.1155/2021/8571438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/24/2020] [Accepted: 01/09/2021] [Indexed: 12/25/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is the most common pathological type of esophageal cancer in China. However, patient survival time after surgery remains unsatisfactory, especially in those who are pN+. This retrospective study determined the value of postoperative adjuvant therapy for patients with pN+ ESCC. From Jan 2008 to Sep 2011, 453 pN+ ESCC patients who underwent R0 resection and survived for at least 1 month were retrospectively enrolled. All patients received surgery. Some patients received surgery alone (SA, n = 131), and others received postoperative chemotherapy (POCT, n = 222), radiotherapy (PORT, n = 57), or sequential chemoradiotherapy (POCRT, n = 43). The follow-up ended on 1 Dec 2019. The 5-year overall survival (OS), disease-free survival (DFS), and locoregional recurrence (LR) were significantly worse in the SA group (15.2%, 13.1%, and 71.6%, all p < 0.05) than in the POCT group (28.0%, 20.8%, and 66.5%), the PORT group (27.4%, 24.4%, and 46.9%), and the POCRT group (42.8%, 35.5%, and 43.0%). Furthermore, compared with the SA group, the median OS and DFS were significantly longer in the POCT, PORT, and POCRT groups (all p < 0.05). PORT and POCRT (but not POCT) also significantly reduced the LR (p < 0.01). Multivariate Cox analysis showed that each type of postoperative therapy was independently associated with improvements in OS, DFS, and LR. Postoperative adjuvant therapy—either POCT, PORT, or POCRT—significantly improved OS and DFS in patients with pN+ ESCC after R0 surgery. PORT and PORCT significantly reduced LR in these patients.
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20
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Lin MQ, Li JL, Zhang ZK, Chen XH, Ma JY, Dai YQ, Huang SY, Hu YB, Li JC. Delayed postoperative radiotherapy might improve the long-term prognosis of locally advanced esophageal squamous cell carcinoma. Transl Oncol 2021; 14:100956. [PMID: 33227662 PMCID: PMC7689552 DOI: 10.1016/j.tranon.2020.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE There is no consensus on the optimal timing of postoperative radiotherapy (PORT) for locally advanced esophageal squamous cell carcinoma (ESCC). We aimed to determine whether the timing of PORT affects the long-term prognosis of ESCC, and plotted nomograms to predict survival. METHODS We retrospectively analyzed 351 ESCC patients who underwent radical surgery and PORT. Receiver operating characteristic curves were used to estimate the optimal cutoff point of the time interval between surgery and PORT. Cox proportional hazards regression was used to identify prognostic predictors. Overall survival (OS) and progression-free survival (PFS) were predicted using nomograms. RESULTS The median follow-up was 53 months (range: 3-179 months). Compared to early PORT, PORT at >48 days after surgery was associated with better OS (adjusted hazard ratio [HR]: 1.406, p = 0.037) and PFS (adjusted HR: 1.475, p = 0.018). In the chemotherapy subgroup, incorporation of chemotherapy timing into the analysis suggested that 2-4 chemotherapy cycles followed by PORT was the optimal treatment schedule as compared to 0-1 chemotherapy cycle followed by PORT and concurrent chemoradiotherapy (5-year PFS: 65.9% vs. 51.0% vs. 50.1%; p = 0.049). The nomograms for OS and PFS were superior to the TNM classification (concordance indices: 0.721 vs. 0.626 and 0.716 vs. 0.610, respectively). CONCLUSIONS Delayed PORT (>48 days) provides better survival benefit than early PORT among ESCC patients. PORT following 2-4 chemotherapy cycles might lead to the best survival rate. The nomogram plotted in this study effectively predicted survival and may help guide treatment.
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Affiliation(s)
- Ming-Qiang Lin
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jin-Luan Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Zong-Kai Zhang
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen 361003, China.
| | - Xiao-Hui Chen
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jia-Yu Ma
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Ya-Qing Dai
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen 361003, China.
| | - Shu-Yun Huang
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Yi-Bin Hu
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jian-Cheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
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Wang Y, Wang F. Postoperative Radiotherapy for Thoracic Esophageal Carcinoma with Upfront R0 Esophagectomy. Cancer Manag Res 2020; 12:13023-13032. [PMID: 33376396 PMCID: PMC7755334 DOI: 10.2147/cmar.s286074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/10/2020] [Indexed: 12/11/2022] Open
Abstract
Multidisciplinary therapies can improve the survival of patients with locally advanced esophageal carcinoma. However, the determination of the optimal modality is still a controversial subject. Many randomized controlled trials in the late 20th century showed that there was no survival benefit when postoperative radiotherapy was added to surgery for esophageal carcinoma. As a result, the treatment modality shifted thereafter to neoadjuvant therapies. Even so, these trials are criticized for many limitations and an increasing number of studies (mainly nonrandomized controlled trials) has indicated that postoperative radiotherapy/chemoradiotherapy can improve the survival of patients with a poor prognosis after R0 esophagectomy. Additionally, a large number of patients with locally advanced esophageal carcinoma still choose upfront surgery in the clinical practice due to many reasons. Therefore, postoperative radiotherapy seems to be a feasible treatment for these patients with a poor prognosis, particularly in the new era of conformal radiotherapy. Here, we review published studies on postoperative radiotherapy/chemoradiotherapy, and we discuss the clinical issues related to postoperative radiotherapy, such as the indication, target volume, total radiation dosage, time interval and complications of postoperative radiotherapy with or without chemotherapy, to make recommendations of postoperative radiotherapy for both current practice and future research in esophageal carcinoma.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Deng W, Yang Z, Dong X, Yu R, Wang W. Conditional survival in patients with esophageal or gastroesophageal junction cancer after receiving various treatment modalities. Cancer Med 2020; 10:659-674. [PMID: 33314798 PMCID: PMC7877350 DOI: 10.1002/cam4.3651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/31/2023] Open
Abstract
Background To estimate the adjusted conditional overall survival (COS) in patients with esophageal cancer after receiving various treatment modalities via a national population‐based database, and to investigate the possible time‐dependent effects. Materials and Methods Eligible patients diagnosed with esophageal cancer between 2000 and 2016 were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. The Kaplan‐Meier method was used to calculate conventional survival time. The inverse probability of treatment weighting method was used to estimate the adjusted COS in patients receiving different treatment modalities. Landmark analysis was employed to investigate the possible time‐dependent effects of different treatment modalities in patients who had survived a certain period of time. Results A total of 25,232 patients were included in the final analysis. The conventional 5‐year overall survival was 19.3%. The 5‐year adjusted COS increased most for the first 3 years, and increased slightly afterwards. In patients with regional esophageal or gastroesophageal junction cancer, stage‐specific analysis showed that surgery only and preoperative radiation therapy benefited most for patients with localized disease, preoperative radiation therapy plus surgery benefited regional, and preoperative radiation therapy plus surgery benefited distant disease, with the 5‐year adjusted COS given patients had survived 3 years being 67.0% (95% CI 65.2%–68.7%), 59.9% (95% CI 58.3%–61.5%), 58.4% (95% CI 56.3%–60.5%), and 61.8% (95% CI 59.5%–64.1%), respectively. In time‐dependent analysis, the benefits of surgery only in localized cases were prominent within 48 months after diagnosis. Preoperative radiation therapy showed long‐lasting benefits in patients with regional disease. In patients with distant disease, all treatment modalities showed similar and short‐term effects. Conclusions The adjusted COS in patients with esophageal cancer increased as time accrued after receiving various treatment modalities. The time‐dependent effects in specific tumor stage provided a dynamic view on optimization of treatment strategies.
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Affiliation(s)
- Wei Deng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhao Yang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xin Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Rong Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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Zheng B, Chen M, Chen C, Xiao J, Cai B, Zhang S, Liang M, Zeng T, Chen H, Wu W, Xu G, Zheng W, Zhu Y, Chen C. Adjuvant chemoradiotherapy for patients with pathologic node-positive esophageal cancer following radical resection is associated with improved survival. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1633. [PMID: 33490145 PMCID: PMC7812226 DOI: 10.21037/atm-20-4893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Depending on the pathological stage, patients with esophageal squamous cell carcinoma (ESCC) can experience poor prognosis after surgery. This study was designed to analyze the effect of various treatments on prognosis in pathologic node-positive esophageal cancer patients who undergo radical surgery. Methods We evaluated 210 pathologic stage IIb–IIIc patients (pT1-4aN + M0) who had undergone esophagectomy for thoracic ESCC from January 2013 to October 2015 at our institute. Surgery alone was applied in 65 patients, postoperative chemotherapy alone was applied in 112 patients, and postoperative adjuvant chemoradiotherapy was applied in 33 patients. Kaplan-Meier and Cox regression analysis were used to compare overall survival (OS) and disease-free survival (DFS). A nomogram was constructed to visualize the multivariate Cox regression analysis model. Results The median follow-up period was 49.4 months. The 3- and 5-year OS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 55.4%, 61.6%, and 75.8%, and 30.1%, 44.0%, and 63.0% respectively. The 3- and 5-year DFS rates of the patients in the surgery group, postoperative chemotherapy group, postoperative chemoradiotherapy group were 44.6%, 52.7%, and 72.7%, and 20.0%, 24.1%, and 39.4%, respectively. Both the OS and DFS of the patients in the postoperative chemoradiotherapy group were better than those of the patients in the surgery and postoperative chemotherapy group. Among them, the OS of the postoperative radiotherapy group was longer than that of the surgery group (P=0.011) and the postoperative chemotherapy group (P=0.190), while the DFS of postoperative chemoradiotherapy group was longer than that of the surgery group and postoperative chemotherapy group, but the difference was not statistically significant (P>0.05). Conclusions This study showed that postoperative adjuvant chemoradiotherapy could improve 3-year OS and DFS compared with treatment using surgery alone or postoperative chemotherapy alone. However, an evaluation of long-term prognosis requires a longer follow-up.
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Affiliation(s)
- Bin Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Maohui Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Cheng Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiazhou Xiao
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Bingqiang Cai
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Shuliang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Mingqiang Liang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Taidui Zeng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Hao Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Weidong Wu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Guobing Xu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Wei Zheng
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Yong Zhu
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, China
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Wu L, Zhang Z, Li S, Ke L, Yu J, Meng X. Timing of Adjuvant Chemoradiation in pT1-3N1-2 or pT4aN1 Esophageal Squamous Cell Carcinoma After R0 Esophagectomy. Cancer Manag Res 2020; 12:10573-10585. [PMID: 33149667 PMCID: PMC7603416 DOI: 10.2147/cmar.s276426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/03/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Postoperative adjuvant radiation therapy (RT) and chemotherapy (aCRT) have been supposed to improve prognosis and outcomes in patients with node-positive thoracic esophageal squamous cell carcinoma (TESCC). Our aim was to analyze the impacts of interval between surgery and aCRT on prognosis, determining the optimal time interval. METHODS We retrospectively reviewed 520 patients with TESCC between 2007 and 2015 treated with aCRT following radical esophagectomy without neoadjuvant chemotherapy and RT. These patients underwent RT (50-60 Gy) combined with 2-6 cycles chemotherapy after surgery. The time intervals were from 17 days to 145 days and divided into three groups: short interval group (≤28 days, S-Int group), medial interval group (≥29 and ≤ 56 days, M-Int group) and long interval group (≥57 days, L-Int group). RESULTS Median follow-up was 35.6 months and the 3-, 5-year survival rates and median survival were 49.5%, 36.6% and 35.9 months. The duration of postoperative interval was a predictor of survival outcomes. The median survival and 5-year survival rates in S-Int, M-Int and L-Int groups were 23.6 (32.1%), 44.2 (43.3%) and 32.0 (31.5%) months (P=0.007). The difference was statistically significant between the M-Int and S-Int or L-Int group but was not between the S-Int and L-Int group. Besides, toxic reactions including early, late and adverse events (grade ≥3) in M-Int group were significantly less than S-Int and show no significant differences with L-Int group. CONCLUSION The optimal time interval was from 29 days to 56 days (5-8 weeks) both in terms of survival outcomes and toxic reactions.
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Affiliation(s)
- Leilei Wu
- Department of Radiation Oncology, School of Medicine, Shandong University, Jinan, People’s Republic of China
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Zhenshan Zhang
- Department of Radiation Oncology, School of Medicine, Shandong University, Jinan, People’s Republic of China
| | - Shuo Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Linping Ke
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People’s Republic of China
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25
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Wang Y, Ye D, Kang M, Zhu L, Pan S, Wang F. Risk Factors and Patterns of Abdominal Lymph Node Recurrence After Radical Surgery for Locally Advanced Thoracic Esophageal Squamous Cell Cancer. Cancer Manag Res 2020; 12:3959-3969. [PMID: 32547231 PMCID: PMC7263936 DOI: 10.2147/cmar.s249810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/10/2020] [Indexed: 12/24/2022] Open
Abstract
Background We aimed to identify the suitable indication and delineate the target volume based on the pattern of abdominal lymph node recurrence (ALNR) after radical surgery for guiding postoperative radiotherapy in thoracic esophageal squamous cell cancer (TESCC). Methods Clinical data of patients with locally advanced TESCC after radical surgery without perioperative anti-tumor therapies from June 2011 to June 2016 were reviewed. Logistic regression analysis was used to find out the high-risk factors of ALNR. The pattern of ALNR was analysed and a template CT in the Pinnacle treatment plan system was used to reconstruct the distribution of the sites of ALNR. Results A total of 63 (19.57%) patients with 276 lymph nodes of ALNR were identified in 322 patients. Univariate logistic regression indicated that pathological tumor location, width of tumor, T stage, N stage, TNM stage, ratio of lymph node metastasis (LNM), vessel carcinoma embolus, cancerous node, LNM in the middle and lower mediastinum, LNM in the abdominal region, ratio of LNM in the abdominal region were risk factors of ALNR. Multivariate logistic regression analysis showed that only LNM in the abdominal region was an independent risk factor. The odds ratio was 7.449 (95% CI=2.552–22.297, P<0.001). Station 16a2, station 9, station 16b1, and station 8 were the major regions of ALNR. The recurrence rates were 10.56%, 9.63%, 7.14% and 5.28% in these stations, respectively. Conclusion Positive pathological abdominal lymph nodes should be the major indication for abdominal irradiation in postoperative radiotherapy for locally advanced TESCC. We recommended that the target volume includes station 8, station 9, station 16a2 and station 16b1 and proposed a specific delineation of the clinical target volume based on the distribution of ALNR on template CT images.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
| | - Dongmei Ye
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
| | - Mei Kang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
| | - Shuhao Pan
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, People's Republic of China
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Deng W, Yang J, Ni W, Li C, Chang X, Han W, Zhou Z, Chen D, Feng Q, Liang J, Lv J, Wang X, Wang X, Deng L, Wang W, Bi N, Zhang T, Li Y, Gao S, Xue Q, Mao Y, Sun K, Liu X, Fang D, Wang D, Li J, Zhao J, Shao K, Li Z, Chen X, Han L, Wang L, He J, Xiao Z. Postoperative Radiotherapy in Pathological T2-3N0M0 Thoracic Esophageal Squamous Cell Carcinoma: Interim Report of a Prospective, Phase III, Randomized Controlled Study. Oncologist 2020; 25:e701-e708. [PMID: 32083766 PMCID: PMC7160414 DOI: 10.1634/theoncologist.2019-0276] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 12/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The role of postoperative radiotherapy in pathological T2-3N0M0 esophageal squamous cell carcinoma is unknown. We aimed to evaluate the efficacy and safety of postoperative radiotherapy in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma. MATERIALS AND METHODS Patients aged 18-72 years with pathological stage T2-3N0M0 esophageal squamous cell carcinoma after radical surgery and without neoadjuvant therapy were eligible. Patients were randomly assigned to surgery alone or to receive postoperative radiotherapy of 50.4 Gy in supraclavicular field and 56 Gy in mediastinal field in 28 fractions over 6 weeks. The primary endpoint was disease-free survival. The secondary endpoints were local-regional recurrence rate, overall survival, and radiation-related toxicities. RESULTS From October 2012 to February 2018, 167 patients were enrolled in this study. We analyzed 157 patients whose follow-up time was more than 1 year or who had died. The median follow-up time was 45.6 months. The 3-year disease-free survival rates were 75.1% (95% confidence interval [CI] 65.9-85.5) in the postoperative radiotherapy group and 58.7% (95% CI 48.2-71.5) in the surgery group (hazard ratio 0.53, 95% CI 0.30-0.94, p = .030). Local-regional recurrence rate decreased significantly in the radiotherapy group (10.0% vs. 32.5% in the surgery group, p = .001). The overall survival and distant metastasis rates were not significantly different between two groups. Grade 3 toxicity rate related to radiotherapy was 12.5%. CONCLUSION Postoperative radiotherapy significantly increased disease-free survival and decreased local regional recurrence rate in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma with acceptable toxicities in this interim analysis. Further enrollment and follow-up are warranted to validate these findings in this ongoing trial. IMPLICATIONS FOR PRACTICE The value of adjuvant radiotherapy for patients with node-negative esophageal cancer is not clear. The interim results of this phase III study indicated that postoperative radiotherapy significantly improved disease-free survival and decreased local-regional recurrence rate in patients with pathological T2-3N0M0 thoracic esophageal squamous cell carcinoma compared with surgery alone with acceptable toxicities. The distant metastasis rates and overall survival rates were not different between the two groups. Adjuvant radiotherapy should be considered for pathologic T2-3N0M0 thoracic esophageal squamous cell carcinoma. Prospective trials to identify high-risk subgroups are needed.
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Affiliation(s)
- Wei Deng
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & InstituteBeijingPeople's Republic of China
| | - Jinsong Yang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
- Department of Radiation Oncology, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanPeople's Republic of China
| | - Wenjie Ni
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Chen Li
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Xiao Chang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Weiming Han
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Zongmei Zhou
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Dongfu Chen
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Qinfu Feng
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Jun Liang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Jima Lv
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Xiaozhen Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Xin Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Lei Deng
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Wenqing Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Nan Bi
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Tao Zhang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Yexiong Li
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Yousheng Mao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Kelin Sun
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Xiangyang Liu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Dekang Fang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Dali Wang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Jian Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Kang Shao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Zhishan Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Xinjie Chen
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Lei Han
- Department of Oncology, Affiliated Hospital of Jining Medical CollegeJiningShandongPeople's Republic of China
| | - Lifang Wang
- Department of Oncology, Affiliated Hospital of Jining Medical CollegeJiningShandongPeople's Republic of China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
| | - Zefen Xiao
- Department of Radiation Oncology, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople's Republic of China
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Role of Perioperative Chemotherapy in Lymph Node-negative Esophageal Cancer After Resection: A Population-based Study With Propensity Score-matched Analysis. Am J Clin Oncol 2020; 42:924-931. [PMID: 31651453 DOI: 10.1097/coc.0000000000000624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Multimodality treatment is increasingly accepted and becoming the standard care for local advanced esophageal cancer (EC) patients. However, for early stage lymph node-negative EC patients, surgery alone is still the primary treatment approach, and the role of perioperative chemotherapy remains unclear. METHODS Patients with lymph node-negative EC were identified from the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Survival was compared by the log-rank test. Cox proportional hazards analysis was used to identify covariates associated with overall survival (OS). Propensity score-matched analysis was also performed to control for confounding. RESULTS A total of 3071 patients (T1-4N0M0) were identified, 1363 (44.4%) of which received perioperative chemotherapy. The effect of chemotherapy on OS was remarkably dependent on the T stage. For stage T1 patients, chemotherapy was inversely associated with OS (hazard ratio [HR]=1.54; 95% confidence interval [CI], 1.27-1.86), and no impact of chemotherapy on OS was found for T2 patients (HR=0.92; 95% CI, 0.712-1.18), whereas a significant improvement in OS was observed with the addition of chemotherapy for patients with stages T3 (HR=0.52; 95% CI, 0.43-0.62) and T4 (HR=0.60; 95% CI, 0.36-0.98) disease. Multivariable analysis with demonstrated that chemotherapy usage, age, sex, tumor grade, and T stage (P<0.05) were significantly associated with OS in T3-T4 patients. The results were similar in subgroup analyses stratified by confounding covariates, and the propensity score-matched analysis. CONCLUSIONS This population-based study indicates perioperative chemotherapy is associated with improved survival in stage T3-4N0M0 patients with EC, which needs to be further validated by randomized trials.
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Abstract
Esophageal cancer (EC) remains one of the most common and aggressive diseases worldwide. This review discusses some debates in the modern management of the disease. Endoscopic procedures for early cancer (T1a−b) are now embedded in routine care and the challenge will be to more accurately select patients for endoscopic resection with or without adjuvant therapy. Perioperative multimodal therapies are associated with improved survival compared to surgery alone for locally advanced esophageal cancer. However, there is no global consensus on the optimal regimen. Furthermore, histological subtype (adenocarcinomavs. squamous cell cancer) plays a role in the choice for treatment. New studies are underway to resolve some issues. The extent of the lymphadenectomy during esophagectomy remains controversial especially after neoadjuvant chemoradiation. The ideal operation balances between limiting surgical trauma and optimizing survival. Minimally invasive esophagectomy and enhanced recovery pathways are associated with decreased morbidity and faster recovery albeit there is no consensus yet what approach should be used. Finally, immune checkpoint inhibitors present promising preliminary results in the novel treatment of advanced or metastatic EC but their widespread application in clinical practice is still awaited.
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Affiliation(s)
- Tania Triantafyllou
- Department of Surgery, Hippocration General Hospital of Athens, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Bas P L Wijnhoven
- Department of Surgery, Erasmus University Medical Center, Rotterdam 3000, the Netherlands
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29
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Chen MH, Lai JI, Yeh YC. A rare case of colliding cancer of the esophagus with small cell neuroendocrine, squamous, and adenocarcinoma components. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_21_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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30
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Zeng Q, Tang C, Deng L, Li S, Liu J, Wang S, Shan H. Differential Diagnosis of COVID-19 Pneumonia in Cancer Patients Received Radiotherapy. Int J Med Sci 2020; 17:2561-2569. [PMID: 33029098 PMCID: PMC7532480 DOI: 10.7150/ijms.46133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022] Open
Abstract
Background: During the outbreak period of COVID-19 pneumonia, cancer patients have been neglected and in greater danger. Furthermore, the differential diagnosis between COVID-19 pneumonia and radiation pneumonitis in cancer patients remains a challenge. This study determined their clinical presentations and radiological features in order to early diagnose and separate COVID-19 pneumonia from radiation pneumonitis patients promptly. Methods and Findings: From January 21, 2020 to February 18, 2020, 112 patients diagnosed with suspected COVID-19 were selected consecutively. A retrospective analysis including all patients' presenting was performed. Four patients from 112 suspected individals were selected, including 2 males and 2 females with a median age of 54 years (range 39-64 years). After repeated pharyngeal swab nucleic acid tests, 1 case was confirmed and 3 cases were excluded from COVID-19 pneumonia. Despite the comparable morphologic characteristics of lung CT imaging, the location, extent, and distribution of lung lesions between COVID-19 pneumonia and radiation pneumonitis differed significantly. Conclusions: Lung CT imaging combined with clinical and laboratory findings can facilitate early diagnosis and appropriate management of COVID-19 pneumonia with a history of malignancy and radiation therapy.
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Affiliation(s)
- Qi Zeng
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, China, 519000.,Cancer Center,The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, Guangdong Province, China, 519000
| | - Caihua Tang
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, China, 519000.,Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, Guangdong Province, China, 519000
| | - Lisi Deng
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, China, 519000.,Department of infectious disease, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, Guangdong Province, China, 519000
| | - Sheng Li
- Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, Guangdong Province, China, 50060
| | - Jiani Liu
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, China, 519000.,Cancer Center,The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, Guangdong Province, China, 519000
| | - Siyang Wang
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, China, 519000.,Cancer Center,The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, Guangdong Province, China, 519000
| | - Hong Shan
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong Province, China, 519000.,Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, No. 52 Meihua East Road, Zhuhai, Guangdong Province, China, 519000
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Gao HJ, Shang XB, Gong L, Zhang HD, Ren P, Shi GD, Wei YC, Yu ZT. Adjuvant radiotherapy for patients with pathologic node-negative esophageal carcinoma: A population based propensity matching analysis. Thorac Cancer 2019; 11:243-252. [PMID: 31828980 PMCID: PMC6996980 DOI: 10.1111/1759-7714.13235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The impact of adjuvant treatment for esophageal carcinoma with tumor-negative lymph nodes after upfront radical esophagectomy is still uncertain. This study investigated the effects of postoperative radiotherapy in pT1-3N0 esophageal carcinoma after radical resection. METHOD We retrospectively identified pT1-3N0M0 esophageal carcinoma patients between 2000 and 2016 from the Surveillance, Epidemiology, and End Results database. Patients with upfront esophagectomy were categorized as having received surgery alone (SA) and surgical resection followed by adjuvant radiotherapy (SA + RT). Propensity score matching, univariate and multivariate analysis were performed to compare overall survival (OS) and cause-specific survival (CSS). RESULTS A total of 2862 patients were identified, of whom 274 received SA + RT and 2588 received SA. The median follow-up was 60.4 months (95%CI, 58.7-62.1 months). The five-year OS and CSS were better for SA group compared with SA + RT group (P < 0.001, respectively). Furthermore, after matching, the OS and CSS were still significantly better for SA patients. For T subgroup analysis, postoperative radiotherapy was an independent prognostic factor only for pT1 patients with worse OS, without survival differences for pT2 and pT3 patients. However, after multivariate cox analysis, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm (P = 0.03; 95%CI, 0.29-0.94). CONCLUSIONS Among pT1-3N0M0 esophageal carcinoma patients, postoperative radiotherapy can provide significantly better OS for pT3 patients with tumor length ≥5 cm. However, there are no survival benefits for pT1-2 patients after SA + RT procedure. This finding may have significant implications on the use of adjuvant radiation in patients with pN0 disease.
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Affiliation(s)
- Hui-Jiang Gao
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao-Bin Shang
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Hong-Dian Zhang
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Peng Ren
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Guo-Dong Shi
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhen-Tao Yu
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Deng W, Chen J, Xiao Z. ASO Author Reflections: Prognostic Stratification and the Value of Adjuvant Therapy in Thoracic Esophageal Squamous Cell Carcinoma Patients After Esophagectomy. Ann Surg Oncol 2019; 26:802-803. [PMID: 31654164 DOI: 10.1245/s10434-019-07728-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Wei Deng
- Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junqiang Chen
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China.
| | - Zefen Xiao
- Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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33
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Li T, Fu X, Xiao L, Su L, Dai Y, Yao Q, Li J. The long-term impact of tumor burden in pT3N0M0 esophageal squamous cell carcinoma: A propensity score-matched analysis. Medicine (Baltimore) 2019; 98:e17637. [PMID: 31626150 PMCID: PMC6824748 DOI: 10.1097/md.0000000000017637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study was to assess the impact of tumor burden on the survival of patients with pathologic T3N0M0 (pT3N0M0) esophageal squamous cell carcinoma (ESCC).A total of 84 patients with pathologic T3N0M0 ESCC treated with radical esophagectomy and 3-field lymphadenectomy (3-FL) from January 2008 to December 2009 in our center were analyzed. Receiver-operating characteristic (ROC) curve analysis was performed to calculate the optimal cutoff value. The Kaplan-Meier method and log-rank test were used to assess the overall survival (OS) differences between groups. A regression model was applied to identify prognostic factors for OS. Propensity score matching (PSM) was performed to adjust for the imbalance and indication biases in the 2 groups.The median follow-up time was 62 months (range, 1-84 months), and the 5-year OS rate was 62% (95% confidence interval, 52.2-71.8%). According to the ROC curve analysis, the optimal cutoff values for the maximal esophageal wall thickness, tumor length, and tumor volume were 1.3 cm, 5.9 cm, and 18.6 cc, respectively. Univariate analysis revealed that maximal esophageal wall thickness >1.3 cm (P = .014), tumor volume >18.6 cc (P < .001), and vascular invasion (P < .001) were significantly associated with OS. The multivariate Cox regression model identified tumor volume and vascular invasion as factors affecting OS. After propensity matching, patients with a tumor volume ≤18.6 cc had a better OS than those with a tumor volume >18.6 cc (5-year OS, 85% vs 50%, P = .008).Tumor volume may serve as a good prognostic factor for patients with pT3N0M0 ESCC treated with radical esophagectomy and 3-FL. Larger-scale studies are warranted to validate these findings.
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Affiliation(s)
- Tingting Li
- Department of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou
| | - Xiaobin Fu
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Lihua Xiao
- Department of Radiation Oncology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou
| | - Liyu Su
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Yaqing Dai
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Qiwei Yao
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Medical University Cancer Hospital & Fujian Cancer Hospital, Fuzhou, Fujian, China
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Yu J, Ouyang W, Li C, Shen J, Xu Y, Zhang J, Xie C. Mapping patterns of metastatic lymph nodes for postoperative radiotherapy in thoracic esophageal squamous cell carcinoma: a recommendation for clinical target volume definition. BMC Cancer 2019; 19:927. [PMID: 31533656 PMCID: PMC6749673 DOI: 10.1186/s12885-019-6065-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/19/2019] [Indexed: 12/28/2022] Open
Abstract
Background The clinical target volume (CTV) for postoperative radiotherapy for thoracic esophageal squamous cell carcinoma (TESCC) needs to be defined. The study aim was to map metastatic lymph nodes (LNMs) in a computed tomography (CT)-based atlas and delineate the postoperative radiotherapy target area. Methods Sixty-nine TESCC patients with first recurrent regional LNMs after esophagectomy were included. The LNM epicenters were registered onto corresponding anatomic axial CT images of a standard patient in the treatment position, with reference to the surrounding vascular and bony structures. The LNM sites were based on lymph node map of esophageal cancer, AJCC 8th. The lymph metastasis risk for different segments of thoracic esophagus was assessed. Results One hundred and seventy-nine LNMs were mapped onto standard axial CT images. The upper-middle mediastinum region (station 1 to 8 M) contained 97% of metastases in the upper segment of thoracic esophagus, 90% in the middle segment, and 66% in the lower one. Advanced pathological stage (≥IIIB) might be a predictive factor for upper abdominal region (UAR) relapse in lower TESCC. Lower cervical para-tracheal LNMs were within a 4.3-cm bilaterally expanded area from the midline of the body and a 2.2-cm expanded area from the anterior of vertebral body, from the superior border of the C7, to the inferior border of the first thoracic vertebra. Conclusion A modified target from the upper border of C7 to the lower border of caudal margin of the inferior pulmonary vein level could cover the high-risk area of TESCC underwent postoperative radiotherapy. UAR seems to be an elective irradiation target for lower TESCC at pathological IIIB stage and higher. Electronic supplementary material The online version of this article (10.1186/s12885-019-6065-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jing Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Wen Ouyang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Chunyang Li
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Jiuling Shen
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Yu Xu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071.,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China
| | - Junhong Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071. .,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China. .,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China, 430071. .,Hubei Key Laboratory of Tumor Biological Behaviors, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China. .,Hubei Cancer Clinical Study Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
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35
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Deng W, Zhang W, Yang J, Ni W, Yu S, Li C, Chang X, Zhou Z, Chen D, Feng Q, Chen X, Lin Y, Zhu K, Zheng X, He J, Gao S, Xue Q, Mao Y, Cheng G, Sun K, Liu X, Fang D, Chen J, Xiao Z. Nomogram to Predict Overall Survival for Thoracic Esophageal Squamous Cell Carcinoma Patients After Radical Esophagectomy. Ann Surg Oncol 2019; 26:2890-2898. [DOI: 10.1245/s10434-019-07393-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Indexed: 08/29/2023]
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McCloskey D, Shersher DD. Does a Lymph Node-Based Model Predict Clinical Value for Adjuvant Therapy in Squamous Cell Carcinoma of the Esophagus Treated With Upfront Surgery? Ann Surg Oncol 2019; 26:2313-2315. [DOI: 10.1245/s10434-019-07491-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Indexed: 11/18/2022]
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37
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Zhang X, Yang Y, Sun Y, Ye B, Guo X, Mao T, Hua R, Li B, Gu H, Liu J, Li Z. Adjuvant therapy for pathological T3N0M0 esophageal squamous cell carcinoma. J Thorac Dis 2019; 11:2512-2522. [PMID: 31372288 DOI: 10.21037/jtd.2019.05.70] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Tumors invading the depth of adventitia (T3) are the most common pathological type of esophageal squamous cell carcinoma (ESCC). For patients without lymph nodes metastasis, the role of adjuvant therapy is uncertain. This study was intended to retrospectively analyze the survival effects of postoperative adjuvant therapy in such patients. Methods A total of 200 patients with pathological T3N0M0 (pT3N0M0) ESCC from January 2012 to September 2014 were enrolled, including a surgery-alone group (Group S) of 111 patients and a surgery followed with adjuvant chemo/radiation/chemoradiation therapy group (Group S + aCRT) of 89 patients. Results There was no significant difference in preoperative basic characteristics and postoperative complications between the two groups. Among all patients, 5-year overall survival (OS) rate was 56.6% and the 5-year disease-free survival (DFS) rate was 51.1%, respectively. The 5-year OS rate was 47.2% in Group S, and 68.4% in Group S + aCRT (P=0.004). The 5-year DFS rate was 44.4% in Group S and 59.3% in Group S + aCRT (P=0.036). The 5-year OS and DFS were improved by adjuvant chemoradiotherapy in the subgroups of males, tumor located at the middle of thoracic esophagus, moderate differentiation, number of resected lymph nodes <15. Multivariate analysis showed that adjuvant chemoradiotherapy and female were associated with improved survival. Conclusions In our study, the adjuvant therapy was associated with improved survival for patients with pT3N0M0 ESCC.
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Affiliation(s)
- Xiaobin Zhang
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yu Yang
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yifeng Sun
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Bo Ye
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xufeng Guo
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Teng Mao
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Rong Hua
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Bin Li
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Haiyong Gu
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jun Liu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Zhigang Li
- Department of Thoracic & Esophageal Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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Vadhwana B, Zosimas D, Lykoudis PM, Phen HM, Martinou M, Amalesh T, Khoo D. Adjuvant radiotherapy in oesophageal cancer with positive circumferential resection margins-recurrence and survival outcomes. J Gastrointest Oncol 2019; 10:483-491. [PMID: 31183198 DOI: 10.21037/jgo.2019.01.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background The role of adjuvant radiotherapy in patients with microscopically positive circumferential resection margins (CRM), R1 specimen, in oesophageal resections for cancer with curative intent remains unclear. However, R1 specimens are associated with poorer survival outcomes. The aim was to assess the benefit of adjuvant radiotherapy on recurrence and survival in these patients. Methods Patients were identified in a single centre between July 2000 and December 2016. Patient demographics, tumour characteristics and survival outcomes were assimilated and compared between those who received adjuvant therapy and those who did not. Results Sixty-eight patients were included in the study; 57 (83.8%) male and 11 (16.2%) female with a median age of 67 years. The adjuvant radiotherapy regimen used was 40-50 Gy in 25 fractions over 5 weeks. Median follow-up was 13 months (interquartile range, 6-27 months). Twenty-five (36.8%) patients received adjuvant radiotherapy. There was no statistically significant correlation between administration of adjuvant radiotherapy and local recurrence (P=0.148), distant metastases (P=0.605), overall disease progression (P=0.561), progression-free survival (P=0.663) and overall survival (P=0.538). Conclusions This study detects no benefit to oncological outcomes with the use of adjuvant radiotherapy in patients with microscopically positive CRM. Larger randomized studies are needed to further confirm these results.
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Affiliation(s)
- Bhamini Vadhwana
- Department of General Surgery, Queens Hospital, Rom Valley Way, Romford, UK
| | - Dimitrios Zosimas
- Department of General Surgery, Queens Hospital, Rom Valley Way, Romford, UK
| | - Panagis M Lykoudis
- Division of Surgery & Interventional Science, University College London, London, UK
| | - Huan Ming Phen
- Department of General Surgery, Queens Hospital, Rom Valley Way, Romford, UK
| | - Maria Martinou
- Department of Oncology, Queens Hospital, Rom Valley Way, Romford, UK
| | | | - David Khoo
- Department of General Surgery, Queens Hospital, Rom Valley Way, Romford, UK
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Chen F, Li J, Ai N, Zhang H, Li J, Zhu Y. Influence of 3D-CRT and conformal IMRT on thyroid function of patients with cervical and upper thoracic esophageal cancer and comparison of clinical efficacy. Oncol Lett 2019; 17:3432-3438. [PMID: 30867781 PMCID: PMC6396116 DOI: 10.3892/ol.2019.9989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 01/17/2019] [Indexed: 11/20/2022] Open
Abstract
Clinical efficacy in patients with cervical and upper thoracic esophageal cancer was compared between three-dimensional conformal radiotherapy (3D-CRT) and conformal intensity-modulated radiotherapy (IMRT). Medical data of 120 esophageal cancer patients undergoing RT in the Radiology Department in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology (Xiaogan, China) from March 2015 to March 2018 were retrospectively analyzed. Patients were divided into 3D-CRT group (treated with 3D-CRT, n=60) and IMRT group (treated with IMRT, n=60). The target conformal index (CI), PTV maximum dose (Dmax), PTV Dmin and PTV Dmean in both groups were observed. Changes in double-lung V5, double-lung V20, double-lung V30 and spinal cord Dmax in both groups were also observed. The serum free triiodothyronine (FT3), free tetraiodothyronine (FT4) and thyroid-stimulating hormone (TSH) concentrations were detected via chemiluminescence assay. Moreover, the short-term efficacy and radiation injury were observed. CI in IMRT group was significantly higher than that in 3D-CRT group (P<0.001). The organ-at-risk dose parameter V20 in IMRT group was obviously lower than that in 3D-CRT group (P<0.001). Serum FT3 and FT4 concentrations in both groups before RT were significantly higher than those after RT (P<0.05), but the TSH concentration was significantly lower than that after RT (P<0.05). Serum FT3 and FT4 concentrations in IMRT group after RT were obviously higher than those in 3D-CRT group (P<0.05). The incidence rates of radiation esophagitis and radiation pneumonitis in IMRT group were remarkably lower than those in 3D-CRT group (P<0.05). IMRT can reduce the double-lung V20 in patients, improve the target conformal degree, better protect the normal tissues, cause less damage to thyroid function, and reduce radiation injury during and after RT of esophageal cancer.
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Affiliation(s)
- Fei Chen
- Department of Oncology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, P.R. China
| | - Jun Li
- Department of Oncology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, P.R. China
| | - Nian Ai
- Department of Oncology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, P.R. China
| | - Huaping Zhang
- Department of Oncology, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, P.R. China
| | - Jun Li
- Department of Oncology, The Central Hospital of Xiaogan, Xiaogan, Hubei 432000, P.R. China
| | - Yingying Zhu
- Cancer Center, Huazhong University of Science Technology Tongji Hospital, Sino-French New City Branch, Wuhan, Hubei 430100, P.R. China
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Yu J, Ouyang W, Li Y, Hu J, Xu Y, Wei Y, Liao Z, Liu Y, Zhang J, Xie C. Value of radiotherapy in addition to esophagectomy for stage II and III thoracic esophageal squamous cell carcinoma: Analysis of surveillance, epidemiology, and end results database. Cancer Med 2018; 8:21-27. [PMID: 30561117 PMCID: PMC6346254 DOI: 10.1002/cam4.1731] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022] Open
Abstract
To determine the value of radiotherapy in addition to esophagectomy for stage II and III TESCC. We searched the Surveillance, Epidemiology, and End Results (SEER) database for all cases of stage II‐III TESCC. Patients were grouped as those receiving pre‐ or postoperative radiotherapy plus esophagectomy and those receiving esophagectomy alone. Overall survival (OS) and cancer‐specific survival (CSS) were compared between the groups. Among the 3292 patients, multimodality treatments (pre‐ or postoperative radiotherapy plus surgery) were more effective than surgery alone (5‐year, OS: 17.3% vs 7.9%; P < 0.001; CSS: 51.8% vs 34.9%; P < 0.001). Among the patients receiving multimodality treatments, multivariate analyses revealed stage to be the most significant prognostic factor for OS (II vs III, HR, 0.726; P < 0.001), but the sequence of radiotherapy and surgery was only of the marginal significance (pre‐ vs postoperative, HR, 0.875; P = 0.093). Preoperative radiotherapy provided significantly better survival than postoperative radiotherapy in stage III disease (5‐year, OS: 13.0% vs 11.0%, P < 0.04; CSS: 49.2% vs 31.7%, P < 0.003), but not in stage II disease (5‐year OS: 23.5% vs 21.0%, P = 0.519; CSS: 62.0% vs 53.4%, P = 0.075). Radiotherapy in addition to esophagectomy provides better outcomes than esophagectomy alone for in stage II‐III TESCC. Preoperative radiotherapy followed by surgery appears to be the optimal treatment strategy in stage III TESCC.
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Affiliation(s)
- Jing Yu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Ouyang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yi Li
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jing Hu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Xu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yongchang Wei
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhengkai Liao
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Liu
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Junhong Zhang
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Wang Y, Zhu L, Xia W, Wu L, Wang F. The impact of adjuvant therapies on patient survival and the recurrence patterns for resected stage IIa-IVa lower thoracic oesophageal squamous cell carcinoma. World J Surg Oncol 2018; 16:216. [PMID: 30404621 PMCID: PMC6223077 DOI: 10.1186/s12957-018-1516-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/23/2018] [Indexed: 12/19/2022] Open
Abstract
Background This study evaluated the impact of adjuvant therapies on patient survival and disease recurrence patterns to identify an effective adjuvant therapy for resected lower thoracic oesophageal squamous cell carcinoma (LTESCC). Methods Clinical data of 127 patients with stage IIa-IVa LTESCC with a minimum 2-year follow-up after oesophagectomy were analysed. The survival and recurrence patterns were compared among patients who received adjuvant radiotherapy, adjuvant chemotherapy, adjuvant chemoradiotherapy, or surgery alone. Results Eighty-eight patients (69.3%) were identified as having disease recurrence. The regional lymph node recurrence rate was 57.5%, and the recurrence rates were high in the lower neck, upper mediastinum, and upper abdomen. Compared to surgery alone, adjuvant radiotherapy or chemoradiotherapy significantly decreased the recurrence rate (p < 0.05). Adjuvant chemoradiotherapy significantly improved overall survival, disease-free survival, and locoregional recurrence-free survival compared to surgery alone (p = 0.01, 0.01, and 0.00, respectively). Pathologically positive lymph nodes (PPLNs) in the lower mediastinum represented a potential risk factor for cervical recurrence (HR 2.97, 95%CI 1.19–7.39). Multivariable analysis showed that postoperative radiotherapy (HR 0.30, 95%CI 0.13–0.68) and PPLNs in the upper mediastinum (HR 3.72, 95%CI 1.30–10.67) were independent risk factors for upper mediastinal recurrence, while postoperative radiotherapy (HR 0.37, 95%CI 0.16–0.85) and PPLNs in the abdomen (HR 2.57, 95%CI 1.12–5.92) were independent risk factors for abdominal recurrence. Conclusion Adjuvant chemoradiotherapy was the most effective adjuvant therapy for resected stage IIa-IVa LTESCC. The lower neck, upper mediastinum, and upper abdomen were high-risk regions for postoperative radiotherapy. The regions of PPLNs may be important factors for individual targets.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China.
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
| | - Wanli Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, People's Republic of China
| | - Liming Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Hefei, 230022, Anhui, People's Republic of China
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Moon DH, Jeon JH, Yang HC, Kim YI, Lee JY, Kim MS, Lee JM, Lee GK. Intramural Metastasis as a Risk Factor for Recurrence in Esophageal Squamous Cell Carcinoma. Ann Thorac Surg 2018. [DOI: 10.1016/j.athoracsur.2018.02.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Zhou YQ, Ding NX, Wang LJ, Liu W, Jiang M, Lu JC. Salvage radiochemotherapy for lymph node recurrence after radical surgery of esophageal cancer. Medicine (Baltimore) 2018; 97:e9777. [PMID: 29384871 PMCID: PMC5805443 DOI: 10.1097/md.0000000000009777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To evaluate the efficacy of salvage radiochemotherapy (SRC) in patients with recurrent lymph node after radical surgery in esophageal cancer.This study enrolled 58 patients with esophageal squamous cell carcinoma who underwent SRC for lymph node recurrence after radical surgery from August 2011 to November 2015 at our hospital. Survival rates were calculated by the Kaplan-Meier method with the log-rank test. Multivariate analysis was conducted using the Cox model.The overall 1-, 3-, and 5-year survival rates after radical surgery were 94.8%, 53.0%, and 29.6%, respectively. The 1- and 3-year survival rates after SRC were 68.7% and 26.9%, respectively. The major acute toxicities were esophagitis and neutropenia, while most toxicities were grade 1 or 2. There was no unexpected increase in serious adverse events or treatment-related deaths. The results of multivariate analysis showed that time to recurrence (odds ratio [OR]: 0.25, 95% confidence interval [CI]: 0.11-0.53, P = .0004), T stage (OR: 2.75, 95%CI: 1.16-6.49, P = .021), and prophylactic radiotherapy/chemotherapy (PRC, OR: 0.39, 95%CI: 0.16-0.98, P = .045) were determinants of postoperative overall survival, and PRC was the only factor affecting the outcome of SRC (OR: 0.28, 95%CI: 0.12-0.70, P = .006).SRC is an effective treatment for recurrent lymph node after radical surgery of esophageal cancer.
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Wang Y, Zhang L, Ye D, Xia W, Jiang J, Wang X, Zhang M, Wang F. A retrospective study of pattern of recurrence after radical surgery for thoracic esophageal carcinoma with or without postoperative radiotherapy. Oncol Lett 2018; 15:4033-4039. [PMID: 29556283 DOI: 10.3892/ol.2018.7807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/11/2018] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to investigate the recurrence pattern of thoracic esophageal cancer (TEC) following radical surgery for guiding postoperative radiotherapy (PRT). Patterns of recurrence were analyzed in patients with recurrence for the first time after radical surgery at the First Affiliated Hospital of Anhui Medical University (Anhui, China) from January 2012 to December 2015. A total of 244 patients were reviewed in the study. The mean recurrence time for patients with PRT was >1 month longer than that for patients without PRT. The lymphatic, anastomotic and hematological recurrence ratios were 87.9 vs. 69.2%, 4.0 vs. 11.5% and 8.0 vs. 17.2%, respectively for patients without and with PRT. The most common recurrence regions were staion1 and station 2-4 (30.0 vs. 36.5% and 37.2% vs. 23.1%, respectively, for patients without and with PRT). The lymphatic recurrence of upper TEC was almost in station1 and station 2-4 (infield). The middle and lower TEC also had a high probability of lymphatic recurrence in station 1 and station 2-4 (totally 76.3 vs. 57.6% and 61.9 vs. 61.1%, respectively). The recurrence ratio significantly decreased in station 2-4 (infield) for middle TEC patients with PRT compared with patients without PRT (P=0.03), while no significant differences in the lymphatic recurrence ratios were observed in other regions (P>0.05). The differences of recurrence ratios in station 7, station 8 and celiac regions (infield) for lower TEC patients without and with PRT also demonstrated no statistical significance (P>0.05). The results of the present study indicated that the lower neck, supraclavicular regions and upper mediastinal regions (station 1, 2 and 4) should be included in the clinic target volume (CTV) for PRT, while lower mediastinal regions, celiac regions and anastomotic may not be included in CTV.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Li Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Dongmei Ye
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Wanli Xia
- Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Jun Jiang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Xiumei Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Mingxia Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Fan Wang
- Department of Radiation Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
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Meta-analysis of survival benefit with postoperative chemoradiotherapy in patients of lymph node positive esophageal carcinoma. Clin Transl Oncol 2017; 20:889-898. [PMID: 29143229 DOI: 10.1007/s12094-017-1803-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/09/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The effect of postoperative chemoradiotherapy (CRT) for esophageal carcinoma (EC) was investigated. Patients who can obtain benefit from this treatment modality have not yet been well identified. METHODS We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies published from January 1993 to July 2016. Research comparing surgery alone (SA) with postoperative CRT in patients with resectable EC was procured; collected articles were written in English. RESULTS Nine studies comparing of postoperative CRT versus SA (n = 1650) in patients with resectable EC met the inclusion criteria. No survival benefit was achieved for postoperative CRT compared with SA. Subgroup analysis was conducted for patients under resection with positive lymph node carcinoma; there was a significant survival benefit at 1 year [risk ratio (RR) = 0.55 95% CI: 0.37-0.82; P = 0.003], 3 years (RR = 0.71 95% CI: 0.61-0.83; P<0.0001), as well as 5 years (RR = 0.86 95% CI: 0.78-0.94; P = 0.0007). Subgroup analysis by tumor histology of squamous cell carcinoma (SCC) was also performed, but there was no significant survival benefit when postoperative CRT was compared with SA. Fail models after surgery were performed; the RR for local control rate and distant metastasis rate were 0.64 (95% CI 0.49-0.85; P = 0.002) and 0.87 (95% CI 0.67-1.15; P = 0.34), which indicates lower local recurrence rates of post-CRT than that of SA. CONCLUSION This meta-analysis demonstrated a survival benefit of postoperative CRT over SA in resectable EC patients with positive lymph nodes. Improvements of local control rates with postoperative CRT were also detected.
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Hsu PK. Do we have enough evidence for adjuvant postoperative chemoradiation in esophageal cancer? J Thorac Dis 2017; 9:1777-1779. [PMID: 28839960 DOI: 10.21037/jtd.2017.06.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan
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DaVee T, Ajani JA, Lee JH. Is endoscopic ultrasound examination necessary in the management of esophageal cancer? World J Gastroenterol 2017; 23:751-762. [PMID: 28223720 PMCID: PMC5296192 DOI: 10.3748/wjg.v23.i5.751] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/23/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023] Open
Abstract
Despite substantial efforts at early diagnosis, accurate staging and advanced treatments, esophageal cancer (EC) continues to be an ominous disease worldwide. Risk factors for esophageal carcinomas include obesity, gastroesophageal reflux disease, hard-alcohol use and tobacco smoking. Five-year survival rates have improved from 5% to 20% since the 1970s, the result of advances in diagnostic staging and treatment. As the most sensitive test for locoregional staging of EC, endoscopic ultrasound (EUS) influences the development of an optimal oncologic treatment plan for a significant minority of patients with early cancers, which appropriately balances the risks and benefits of surgery, chemotherapy and radiation. EUS is costly, and may not be available at all centers. Thus, the yield of EUS needs to be thoughtfully considered for each patient. Localized intramucosal cancers occasionally require endoscopic resection (ER) for histologic staging or treatment; EUS evaluation may detect suspicious lymph nodes prior to exposing the patient to the risks of ER. Although positron emission tomography (PET) has been increasingly utilized in staging EC, it may be unnecessary for clinical staging of early, localized EC and carries the risk of false-positive metastasis (over staging). In EC patients with evidence of advanced disease, EUS or PET may be used to define the radiotherapy field. Multimodality staging with EUS, cross-sectional imaging and histopathologic analysis of ER, remains the standard-of-care in the evaluation of early esophageal cancers. Herein, published data regarding use of EUS for intramucosal, local, regional and metastatic esophageal cancers are reviewed. An algorithm to illustrate the current use of EUS at The University of Texas MD Anderson Cancer Center is presented.
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