|
1
|
Lakkanna A, Gopalam V, Rajender G, Manna S. Squamous Cell Carcinoma of the Esophagus in an Adolescent: A Case Report. Cureus 2024; 16:e68660. [PMID: 39371837 PMCID: PMC11452017 DOI: 10.7759/cureus.68660] [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] [Accepted: 09/04/2024] [Indexed: 10/08/2024] Open
Abstract
Esophageal cancer is more common with increasing age and rarely seen below the age of 45. The current case report is a case of squamous cell carcinoma of the esophagus in a 17-year-old male patient who presented with progressive dysphagia and significant weight loss. Contrast-enhanced computed tomography (CECT) neck, chest, and abdomen showed a lesion involving the middle and lower third of the esophagus with contiguous involvement of the gastroesophageal junction (GEJ), extending from D7 to D11 vertebral segments and completely occluding the lumen. He was managed with chemoradiation, in which three cycles of chemotherapy (Carboplatin 220 mg and Paclitaxel 80 mg) were given, followed by 18 fractions of 40Gy radiotherapy. After this period of chemoradiation, he developed weakness and breathlessness; he was not able to ambulate and became completely bedridden. He underwent a feeding jejunostomy for nutrition, then neoadjuvant chemoradiotherapy (NACRT) and oncological resection with thoracoscopy-assisted transhiatal esophagectomy. The patient had bubbles in the intercostal tube drain while doing incentive spirometry and basal crepitations, so on the next day, a gastric Conray was done, which showed a suspected contrast leak into bilateral lung fields. CECT neck, chest, and abdomen confirmed the minor leak and was managed conservatively. The abdominal wound developed erythema on the seventh day and was opened showing a small amount of sanguinopurulent discharge, for which daily dressing was done along with antibiotic cefuroxime. On the seventh and eighth days, the patient experienced hoarseness in their voice, a condition managed with supportive care. The patient was successfully discharged after completing all management protocols. The report clearly highlights the need to suspect malignancy in young adults presenting with dysphagia.
Collapse
Affiliation(s)
- Aayush Lakkanna
- General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Vivek Gopalam
- Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Guguloth Rajender
- General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Souvik Manna
- Community Medicine, Employee's State Insurance Corporation (ESIC) Medical College and Hospital, Alwar, IND
| |
Collapse
|
|
2
|
Chen L, Jin T, Fang Y, Wu G, Yuan Y. Comparison of postoperative survival between early-onset and late-onset adenocarcinoma of esophagogastric junction: a population-based study. J Gastroenterol Hepatol 2024; 39:1073-1081. [PMID: 38353050 DOI: 10.1111/jgh.16514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/07/2024] [Accepted: 01/28/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND AND AIM The prognosis of early-onset adenocarcinoma of esophagogastric junction (AEG) remains unclear. This research aimed at comparing the prognosis between early-onset and late-onset AEGs. METHODS We extracted eligible patients with surgically resected, pathologically confirmed, nonmetastatic AEG from the Surveillance, Epidemiology, and End Results database from 2004 to 2015. The cutoff age of early-onset AEG was set at ≤50 years old. Univariate and multivariate Cox analysis as well as competing risk model were adopted for comparing overall survival (OS) and cancer-specific survival (CSS) between early-onset and late-onset AEGs. In addition, multiple imputation and propensity score matching (PSM) were also carried out for sensitivity analysis. RESULTS In total, 4610 eligible AEG patients were collected in this study, including 610 early-onset AEGs and 4000 late-onset AEGs. Kaplan-Meier curves revealed significantly better survival in early-onset AEGs than late-onset AEGs. After interpolating missing data by multiple imputation, multivariate Cox regression analysis similarly showed better OS and CSS in early-onset AEGs. By using PSM analysis at a ratio of 1:1, we matched 610 early-onset AEG patients with 610 late-onset AEG patients. After PSM, univariate Cox regression model still revealed favorable prognosis in early-onset AEGs. Similar results were confirmed by performing PSM analysis at a ratio of 1:2 and 1:3. In addition, competing risk model demonstrated significantly lower cancer-specific death in early-onset AEGs compared to late-onset AEGs before and after matching. CONCLUSION By applying several effective sensitivity analyses, we reported significantly favorable OS and CSS in early-onset AEGs compared to late-onset AEGs.
Collapse
Affiliation(s)
- Liubo Chen
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Tian Jin
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yimin Fang
- Department of Colorectal Surgery and Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Gaoqi Wu
- Institute of Immunology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Ying Yuan
- Department of Medical Oncology, Key Laboratory of Cancer Prevention and Intervention, Ministry of Education, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China
| |
Collapse
|
|
3
|
Lai H, Zheng J, Zhou G, Li Y. Clinical characteristics and prognostic outcomes for adenocarcinoma of esophagogastric junction in early-onset patients: a population-based appraisal. J Cancer Res Clin Oncol 2023; 149:14941-14952. [PMID: 37606763 DOI: 10.1007/s00432-023-05210-2] [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: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Malignancies of the upper gastrointestinal tract are rare in early-onset patients outside the hereditary genetic disorders. There are few reports describing adenocarcinoma of the esophagogastric junction (AEG) in extremely early-onset patients aged under 50 years old. The aim of this study was to describe the clinicopathological features and prognosis of adenocarcinoma of esophagogastric junction (AEG) in early-onset patients among three successive periods: 1975-1989 (period 1), 1990-2004 (period 2), and 2005-2017 (period 3). METHODS Between 1975 and 2017, data were extracted from the Surveillance, Epidemiology, and End Results database, and 18,278 patients with AEG were enrolled. Three age groups of patients were identified: < 50, 50-69, and ≥ 70 years of age. Clinicopathological characteristics and prognostic outcomes were reviewed and compared among three groups over three periods (1975-89, 1990-04, and 2005-2017). Multivariate Cox regression analysis was performed to adjust for covariate effects related to both overall survival (OS) and cancer-specific survival (CSS). RESULTS Among three age groups, early-onset patients were more likely to present with higher tumor grade, advanced nodal, and distant metastatic disease at diagnosis than other groups (p < 0.01 for both). In comparison to the older group, a higher proportion of patients in the early-onset group received chemotherapy and radiation treatment. After adjusting for covariates, early-onset patients had a better CSS and OS than elderly patients. CONCLUSIONS Early-onset AEG patients were more likely than other age groups to present with advanced disease upon diagnosis. However, the prognosis of early-onset patients was better than their older counterparts after adjustment for covariates. The dissimilarities in tolerance to treatment among early-onset, middle-aged, and elderly patients could be the reason for this difference.
Collapse
Affiliation(s)
- Hongkun Lai
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Jiabin Zheng
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China
| | - Guinan Zhou
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Yong Li
- Department of Gastrointestinal Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, Guangdong, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, People's Republic of China.
| |
Collapse
|
|
4
|
Jankarashvili N, Melkadze T, Tchiabrishvili M, Mariamidze A, Arveladze G. Advanced Esophageal Squamous Cell Carcinoma in Young Female Patient With Durable Complete Response on Treatment. Cureus 2021; 13:e15255. [PMID: 34188993 PMCID: PMC8231733 DOI: 10.7759/cureus.15255] [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: 11/23/2022] Open
Abstract
Esophageal carcinoma is the seventh most common cancer and the sixth most lethal cancer worldwide. There are two main histological types of esophageal carcinoma: adenocarcinoma (AC) and squamous cell carcinoma (SCC). Both histological types are more common in males than females. Menopause is an independent risk factor for esophageal cancer while usage of hormonal therapy (estrogen plus progesterone) is associated with a lower risk of esophageal SCC in postmenopausal women. Gender differences have an impact on SCC incidence, however, it is unclear if gender has a prognostic value for survival. The present case report describes a young woman who developed SCC of the esophagus. The disease was diagnosed in the locally advanced stage. Definitive chemo-radiotherapy induced complete response. These findings might suggest that in young women esophageal SCC may have a better prognosis.
Collapse
Affiliation(s)
- Natalia Jankarashvili
- Department of Radiation Oncology, Academician Fridon Todua Medical Center, Tbilisi, GEO
| | - Tamar Melkadze
- Department of Clinical Oncology, Academician Fridon Todua Medical Center, Tbilisi, GEO
| | - Mariam Tchiabrishvili
- Department of Radiation Oncology, Academician Fridon Todua Medical Center, Tbilisi, GEO
| | - Armaz Mariamidze
- Department of Pathology, Pathology Research Center, Tbilisi, GEO
| | - Giorgi Arveladze
- Department of Radiation Oncology, David Tvildiani Medical University, Tbilisi, GEO
| |
Collapse
|
|
5
|
Guo YN, Tian DP, Gong QY, Huang H, Yang P, Chen SB, Billan S, He JY, Huang HH, Xiong P, Lin WT, Guo D, Marom M, Gil Z, Su M. Perineural Invasion is a Better Prognostic Indicator than Lymphovascular Invasion and a Potential Adjuvant Therapy Indicator for pN0M0 Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2020; 27:4371-4381. [PMID: 32519146 DOI: 10.1245/s10434-020-08667-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) at pN0M0 can be more locally aggressive and disseminated than those with lymph node and distant metastasis. Perineural invasion (PNI) is reported as a poor prognostic factor in cancer and is thought to be related to regional tumor spread and metastasis. However, its clinicopathological role and meaning for treatment in pN0M0 ESCC are unknown. PATIENTS AND METHODS We applied scoring methods of PNI and lymphatic and vascular invasion (LI, VI) based on immunohistochemistry staining on tumor tissues of pN0M0 ESCC patients. ROC analyses, Kaplan-Meier analyses, Cox regression, and χ2 test were performed for survival analysis, comparison of PNI with LI and VI, and exploration of the relevance between PNI and other clinicopathological features. RESULTS Presence of PNI was significantly associated with poor survival in pN0M0 patients, whereas LI and VI were not predictive of outcome (P > 0.05). Neural invasion index (NII), defined as the ratio of the number of tumor-invaded nerves to the total number of nerves per tumor microsection, was the most consistent measure of PNI (P = 0.006, HR = 6.892, 1.731-27.428). Postoperative radiotherapy significantly improved survival in high-NII patients (P = 0.035, HR = 0.390, 0.163-0.936). CONCLUSIONS PNI is an important risk factor for the outcome of pN0M0 ESCC patients. NII can be used for risk assessment and to tailor adjuvant radiotherapy in this population.
Collapse
Affiliation(s)
- Yuan-Ning Guo
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Dong-Ping Tian
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Qing-Yun Gong
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Hao Huang
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Peng Yang
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Shao-Bin Chen
- Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Salem Billan
- The Radiation Oncology Institute, The Head and Neck Center, Rambam Healthcare Campus, Haifa, Israel
| | - Jia-Yu He
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Hai-Hua Huang
- Department of Pathology, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Pan Xiong
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Wen-Ting Lin
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Dan Guo
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China
| | - Moshe Marom
- Guangdong Dynavolt Renewable Energy Technology, Shantou, China
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, The Head and Neck Center, Department of Otolaryngology Head and Neck Surgery, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Min Su
- Department of Pathology and Institute of Clinical Pathology, Shantou University Medical College, Shantou, China.
| |
Collapse
|
|
6
|
Graham-Wisener L, Hanna J, Collins L, Dempster M. Psychological adjustment in patients post-curative treatment for oesophageal cancer: a longitudinal interview study. Psychol Health 2019; 34:901-921. [PMID: 30939933 DOI: 10.1080/08870446.2019.1579910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Oesophageal cancer is an increasingly prevalent disease with a demanding post-curative treatment recovery period and sustained longer-term effects. Although post-curative treatment is a key transitionary period, the process of psychological adjustment for the individual is under-researched which limits the evidence base to inform supportive care. The aim of this study was to understand the process of adjustment for oesophageal cancer patients post-curative treatment, in particular the beliefs participants hold regarding their condition and how these are appraised against their experience. Design: Serial interviews were undertaken with six oesophageal cancer patients who have recently completed curative treatment, at baseline and at 6-month follow-up using interpretative phenomenological analysis. Results: The findings demonstrate an effortful process of adjustment, including recognising and accepting a changed self, fostering control beliefs over the course of the illness and physical sequelae, searching for meaning, developing illness coherence and moving away from self-blame. Conclusions: This study is the first to utilise a longitudinal qualitative design in oesophageal cancer, and provides an understanding of post-treatment adjustment over time for this clinical population through which to inform clinical practice and service development.
Collapse
Affiliation(s)
- Lisa Graham-Wisener
- a School of Psychology, Queen's University Belfast , Belfast , Northern Ireland
| | - Julie Hanna
- b Belfast Health and Social Care Trust , Belfast City Hospital , Belfast , Northern Ireland
| | - Louise Collins
- b Belfast Health and Social Care Trust , Belfast City Hospital , Belfast , Northern Ireland
| | - Martin Dempster
- a School of Psychology, Queen's University Belfast , Belfast , Northern Ireland
| |
Collapse
|
|
7
|
Kasagi Y, Morita M, Otsu H, Kawano H, Ando K, Hiyoshi Y, Ito S, Miyamoto Y, Saeki H, Oki E, Maehara Y. Clinicopathological characteristics of esophageal squamous cell carcinoma in patients younger than 50 years. Ann Surg Oncol 2014; 22:311-5. [PMID: 24962939 DOI: 10.1245/s10434-014-3856-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE This study clarifies age differences in clinicopathologic characteristics and risk factor exposure of patients who have undergone esophagectomy for esophageal cancer (EC). METHODS Clinical results of esophagectomy were compared between 22 patients younger than 50 years of age (Group I) and 327 patients older than 50 years of age (Group II) with esophageal squamous cell carcinoma. RESULTS The two groups did not significantly differ in clinicopathological characteristics, including prognosis. Postoperative pulmonary complication incidence rates were 4.2 % (Group I) and 14.4 % (Group II). In Group I, the incidence of multiple ECs was 36.4 %, and association with head and neck cancer was 31.8 %, which were significantly higher than in Group II (13.4 %, p = 0.021; and 9.2 %, p = 0.015, respectively). Furthermore, the patients in Group I with multiple cancers were almost all heavy smokers and/or users of alcohol. CONCLUSIONS These results suggest that multiple upper aerodigestive tract cancers are associated with heavy exposure to risk factors in patients younger than 50 years of age.
Collapse
Affiliation(s)
- Yuta Kasagi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
8
|
Pavlidis TE, Pavlidis ET. Role of stenting in the palliation of gastroesophageal junction cancer: A brief review. World J Gastrointest Surg 2014; 6:38-41. [PMID: 24672648 PMCID: PMC3964413 DOI: 10.4240/wjgs.v6.i3.38] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/21/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal junction cancer has an increasing incidence in western countries. It is inoperable when first manifested in more than 50% of cases. So, palliation is the only therapeutic option for the advanced disease to relieve dysphagia and its consequences in weakened patients with an estimated mean survival under 6 mo. This article has tried to identify trends focusing on current information about the best palliative treatment, with an emphasis on the role of stenting. Self-expanding stent placement, either metal or plastic, is the main management option. However, this anatomical location creates some particular problems for stent safety and effectiveness which may be overcome by properly designed novel stents. The stents ensure a good quality of life and must be preferred over other alternative methods of loco-regional modalities, i.e., external radiation, laser thermal or photodynamic therapy. Although stent placement is generally a simple, safe and effective method, there are sometimes complications, increasing the morbidity and mortality rate. Bypass operative procedures have now been abandoned as a first choice. The stomach instead of the colon must be used for a bypass operation when it is needed. Chemotherapy, despite the toxicity, and intraluminal radiation (brachytherapy) have a well-defined role.
Collapse
|
|
9
|
van Nistelrooij AMJ, van Steenbergen LN, Spaander MCW, Tilanus HW, van Lanschot JJB, Lemmens VEPP, Wijnhoven BPL. Treatment and outcome of young patients with esophageal cancer in the Netherlands. J Surg Oncol 2013; 109:561-6. [PMID: 24338660 DOI: 10.1002/jso.23533] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/20/2013] [Indexed: 01/15/2023]
Abstract
BACKGROUND Esophageal cancer is increasingly recognized in younger patients. We compared clinicopathological characteristics, treatment, and survival of patients aged ≤50 years with patients aged >50 years diagnosed with esophageal cancer in the Netherlands. METHODS From the nationwide Netherlands Cancer Registry we identified all patients diagnosed with esophageal cancer between January 2000 and January 2011. Proportions were compared using the χ(2) test for categorical variables. Overall and relative survival was calculated. RESULTS Eleven percent of the patients (n = 1,466) were aged ≤50 years and adenocarcinoma was the most common tumor type (73.6%). Grade of tumor differentiation was comparable between both age groups (P = 0.460) as well as T-stage (P = 0.058). Younger patients presented more often with positive lymph nodes (70.1% vs. 66.4%, P = 0.010) and distant metastasis (50.5% vs. 44.7%, P < 0.001) but had surgery more often as compared to older patients: 40.6% versus 37.9%, P = 0.047. There was no significant difference in the 5-year relative survival between both age groups: 18.1% versus 17.2%, P > 0.05. A subgroup analysis among patients diagnosed with adenocarcinoma revealed similar results. CONCLUSIONS Young patients with esophageal cancer present with more advanced disease stage and received more often treatment. However, they show comparable relative survival rates with their older counterparts.
Collapse
|
|
10
|
van Nistelrooij AMJ, Andrinopoulou ER, van Lanschot JJB, Tilanus HW, Wijnhoven BPL. Influence of young age on outcome after esophagectomy for cancer. World J Surg 2013; 36:2612-21. [PMID: 22814593 DOI: 10.1007/s00268-012-1718-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The incidence of esophageal cancer has risen among all age groups. Controversy exists about the clinical presentation and prognosis of young patients. The aim of this study was to compare the clinicopathologic characteristics and outcomes after surgery between patients with esophageal cancer who were <50 years of age and those ≥50 years of age. METHODS Patients diagnosed with esophageal carcinoma who underwent esophagectomy between January 1990 and December 2010 in a single institution were selected from a prospective database. Patients aged <50 years at diagnosis (n = 163) were compared with those ≥50 years (n = 1151) with respect to clinicopathologic stage and oncologic outcome. RESULTS Younger patients had less co-morbidity (p < 0.001). There were no significantly differences in tumor localization, histology, differentiation, or TNM stage in the two groups. In both groups, 37 % of the patients underwent neoadjuvant chemo(radio)therapy. One or more nonsurgical complications developed in 53 % of the older group versus 42 % in the younger group (p = 0.012). In-hospital mortality was 6.3 % for patients ≥50 years compared to 1.8 % for younger patients (p = 0.021). The 5 year overall survival was significantly better for the younger patients than for those ≥50 years (41 vs. 31 %, p < 0.001), but median disease-specific and disease-free survival did not differ between the groups (37 vs. 30 months, p = 0.140 and 49 vs. 28 months, p = 0.079, respectively). Multivariate analysis identified moderate, poorly, and undifferentiated tumors; tumor-positive resection margins (pR1-2); and TNM stage IIB-IV as independent predictors of disease-specific survival. CONCLUSIONS A considerable proportion (12 %) of patients diagnosed with resectable esophageal carcinoma were <50 years. Phenotypic tumor characteristics and disease-specific survival were comparable for the two age groups.
Collapse
Affiliation(s)
- Anna M J van Nistelrooij
- Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|