111 CLINICAL IMPORTANCE OF MEAN CORPUSCULAR VOLUME AS A PROGNOSTIC MARKER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Naoya Yoshida ◽  
Kazuto Harada ◽  
Ryuma Tokunaga ◽  
Kojiro Eto ◽  
Masaaki Iwatsuki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Importance ◽  
Predictive Marker ◽  
Survival Outcome ◽  
Short Term ◽  
Radical Esophagectomy ◽  
Multiple Primary Malignancies ◽  
Clinical Background ◽  
Standard Value

Abstract   High MCV is suggested to be relevant to the incidence and prognosis of several malignancies. However, few studies investigating the correlation between MCV and survival outcome of esophageal cancer have been conducted. Methods This study included 570 patients with esophageal cancer who underwent radical esophagectomy between April 2005 and December 2017. Patients were divided into two groups according to the standard value of pretreatment MCV: normal (83–99 fL) and high (>99 fL) groups. Clinical backgrounds, short-term outcomes, and prognostic outcomes post-esophagectomy were retrospectively compared between the groups. Results Of all patients, 410 (71.9%) had normal MCV, and 160 (28.1%) had high MCV. High MCV was significantly associated with lower body mass index, higher frequency of habitual alcohol and tobacco use, and higher incidence of multiple primary malignancies other than esophageal cancer. High MCV also correlated with higher incidence of postoperative morbidity of the Clavien–Dindo classification ≥II and pulmonary morbidity. Overall survival was significantly worse in patients with high MCV. Multivariate analysis suggested that high MCV was an independent risk factor for worse survival outcome (hazard ratio, 1.54; 95% confidence interval, 1.098–2.151; p = 0.012). Conclusion Patients with high MCV have various disadvantages in clinical background that can adversely affect both short-term and long-term outcomes after esophagectomy. MCV can become a predictive marker to estimate survival outcome after esophagectomy for esophageal cancer.

Effect of Thrombocytopenia on Short-term and Long-term Outcomes after Esophagectomy for Esophageal Cancer

2018 ◽  
Vol 69 (6) ◽  
pp. 327-334
Author(s):  
Takashi Matsumoto ◽  
Naoya Yoshida ◽  
Yoshifumi Baba ◽  
Yohei Nagai ◽  
Hideo Baba
Keyword(s):  
Esophageal Cancer ◽  
Long Term Outcomes ◽  
Short Term

An oncology clinical trial design with randomization adaptive to both short- and long-term responses

2017 ◽  
Vol 28 (7) ◽  
pp. 2015-2031 ◽  
Author(s):  
Hao Liu ◽  
Xiao Lin ◽  
Xuelin Huang
Keyword(s):  
Trial Design ◽  
Clinical Trial Design ◽  
Therapeutic Benefit ◽  
Survival Outcome ◽  
Operating Characteristics ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Term Response

In oncology clinical trials, both short-term response and long-term survival are important. We propose an urn-based adaptive randomization design to incorporate both of these two outcomes. While short-term response can update the randomization probability quickly to benefit the trial participants, long-term survival outcome can also change the randomization to favor the treatment arm with definitive therapeutic benefit. Using generalized Friedman’s urn, we derive an explicit formula for the limiting distribution of the number of subjects assigned to each arm. With prior or hypothetical knowledge on treatment effects, this formula can be used to guide the selection of parameters for the proposed design to achieve desirable patient number ratios between different treatment arms, and thus optimize the operating characteristics of the trial design. Simulation studies show that the proposed design successfully assign more patients to the treatment arms with either better short-term tumor response or long-term survival outcome or both.

PS02.238: POSTOPERATIVE PROGNOSTIC NUTRITIONAL INDEX CAN PREDICT A LONG-TERM PROGNOSIS OF ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 189-190
Author(s):  
Jun Takahashi ◽  
Masaaki Saito ◽  
Tamotsu Obitsu ◽  
Daisuke Ishioka ◽  
Hirokazu Kiyozaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Prognostic Nutritional Index ◽  
Pathological Stage ◽  
Radical Esophagectomy ◽  
Esophagus Cancer ◽  
Nutritional Index ◽  
Long Term Prognosis ◽  
Advanced Pathological Stage

Abstract Background Recent reports indicate the nutritional and immune status often affect the long-term prognosis of patients with cancer. The preoperative prognostic nutritional index(PNI) is used as an evaluation of the perioperative nutritional status, and it is reported that the PNI level correlates with postoperative results. However, only a handful of reports have discussed the predictive prognostic potential of postoperative PNI. The aim of this study is to clarify the correlation of postoperative PNI level and long-term prognosis of patients with esophagus cancer who underwent esophagectomy. Methods A total of 29 patients with esophageal cancer who received neoadjuvant chemotherapy followed by radical esophagectomy from January 2011 to December 2014 were retrospectively reviewed. The calculation of PNI level is as follows: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (/mm3). The postoperative PNI level was measured three months after radical esophagectomy. The patients were stratified by postoperative PNI level by two groups using calculated cutoff level (PNI = 43.9) by receiver operating characteristic curve. The correlation of 3-year disease-free survival (DFS) and postoperative PNI level was evaluated. Results Of the total, 25 were male and 4 were female. The median age of patients was 68 years (31–79 years). Overall, patients received 1–2 cycles of preoperative chemotherapy with 5-FU and cisplatin. Of these 29 patients, 9 (31.0%) responded to chemotherapy (8 patients had a partial response and 1 had a complete response). The median postoperative PNI level was 47.2 (38.0–58.9). Univariate analyses showed that 3-year DFS was worse in patients with low postoperative PNI level (P = 0.017), advanced pathological stage (P = 0.029) and younger age (< 70 years) (P = 0.02). Multivariate analyses showed that low postoperative PNI level[hazard ratio (HR) 0.224, 95% confidence interval (CI) 0.060–0.83, P = 0.026] and advanced pathological stage (HR 3.197, 95% CI 1.13–9.06, P = 0.029) were independent predictors of 3-year DFS. Conclusion Our findings suggest that the postoperative PNI level may be a useful marker to predict a prognosis of patients with esophagus cancer. Nutrition intervention for undernourished patients after surgery may improve prognosis of patients with esophagus cancer. Disclosure All authors have declared no conflicts of interest.

W1664 A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Only Surgically Treated Esophageal Cancer

2010 ◽  
Vol 138 (5) ◽  
pp. S-899
Author(s):  
Yogesh K. Vashist ◽  
Johannes Metze ◽  
Asad Kutup ◽  
Maximilian Bockhorn ◽  
Florian Gebauer ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Risk Score ◽  
Short Term ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Patient Age and Survival After Surgery for Esophageal Cancer

2020 ◽  
Vol 28 (1) ◽  
pp. 159-166 ◽  
Author(s):  
Jesper Lagergren ◽  
Matteo Bottai ◽  
Giola Santoni
Keyword(s):  
Esophageal Cancer ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Flexible Parametric Model ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Disease Specific Mortality ◽  
Disease Specific

Abstract Background Esophagectomy for esophageal cancer is associated with a substantial risk of life-threatening complications and a limited long-term survival. This study aimed to clarify the controversial questions of how age influences short-term and long-term survival. Methods This population-based cohort study included almost all patients who underwent curatively intended esophagectomy for esophageal cancer in Sweden in 1987–2010, with follow-up through 2016. The exposure was age, analyzed both as a continuous and categorical variable. The probability of mortality was computed using a novel flexible parametric model approach. The reported probabilities are proper measures of the risk of dying, and the related odds ratios (OR) are therefore more suitable measures of association than hazard ratios. The outcomes were 90-day all-cause mortality, 5-year all-cause mortality, and 5-year disease-specific mortality. A novel flexible parametric model was used to derive the instantaneous probability of dying and the related OR along with 95% confidence intervals (CIs), adjusted for sex, education, comorbidity, tumor histology, pathological tumor stage, and resection margin status. Results Among 1737 included patients, the median age was 65.6 years. When analyzed as a continuous variable, older age was associated with slightly higher odds of 90-day all-cause mortality (OR 1.05, 95% CI 1.02–1.07), 5-year all-cause mortality (OR 1.02, 95% CI 1.01–1.03), and 5-year disease-specific mortality (OR 1.01, 95% CI 1.01–1.02). Compared with patients aged < 70 years, those aged 70–74 years had no increased risk of any mortality outcome, while patients aged ≥ 75 years had higher odds of 90-day mortality (OR 2.85, 95% CI 1.68–4.84), 5-year all-cause mortality (OR 1.56, 95% CI 1.27–1.92), and 5-year disease-specific mortality (OR 1.38, 95% CI 1.09–1.76). Conclusions Patient age 75 years or older at esophagectomy for esophageal cancer appears to be an independent risk factor for higher short-term mortality and lower long-term survival.

RA10.04: POSTOPERATIVE PNEUMONIA IS ASSOCIATED WITH SHORT-TERM AND LONG-TERM MORTALITY OF DEFINITIVE CHEMORADIOTHERAPY FOLLOWED BY SALVAGE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 43-43
Author(s):  
Masashi Takeuchi ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factors ◽  
Prediction Model ◽  
Salvage Surgery ◽  
Postoperative Pneumonia ◽  
Short Term ◽  
Definitive Chemoradiotherapy ◽  
Invasive Approach ◽  
Salvage Esophagectomy

Abstract Background Although definitive chemoradiotherapy (CRT) with salvage esophagectomy has improved overall survival (OS) for esophageal cancer, it is a more invasive approach than neoadjuvant CRT followed by surgery or surgery alone, and causes high mortality after surgery. The purpose of this study was to investigate the short and long-term outcomes of salvage esophagectomy, to determine their prognostic factors, and to create a prediction model for OS using a classification and regression tree (CART). Methods Ninety patients who had undergone CRT followed by esophagectomy for thoracic esophageal cancer at Keio University Hospital, Tokyo, Japan, between June 1994 and August 2014 were identified for this study. We divided the 90 patients into two groups—the salvage group and the neoadjuvant group—according to the dose of irradiation of CRT. Forty-four patients who underwent CRT with radiation dose less than 50 Gy, followed by planned esophagectomy, were allocated to the neoadjuvant group. Forty-six patients with salvage esophagectomy for locally recurrent or residual cancer after definitive CRT (greater than 50 Gy) were allocated to the salvage group. Results Patients from the salvage group tended to have a lower OS (median survival: Salvage, 25 months vs neoadjuvant, 50 months, P = 0.149). In the salvage group, pneumonia and age were identified as factors predictive of in-hospital mortality. OS was significantly lower in patients with postoperative pneumonia and female gender. We set the prediction model for OS in the salvage group using survival CART. The group of R1/2 resection aged ≥ 56.5 years and the group suffering from postoperative pneumonia were the groups at highest risk; the area under the curve was 0.72. Conclusion The present study demonstrates the short-term and long-term prognostic factors of salvage esophagectomy after definitive CRT for esophageal cancer. Achieving improvement in OS after salvage surgery requires increased R0 resection rates and decreased pulmonary complications. Both informed decision making in the adoption of salvage surgery and specific plans to reduce pneumonia through means such as pulmonary rehabilitation are required. Disclosure All authors have declared no conflicts of interest.

scholarly journals Short-term outcomes of robotic radical esophagectomy for esophageal cancer by a nontransthoracic approach compared with conventional transthoracic surgery

2015 ◽  
Vol 29 (5) ◽  
pp. 429-434 ◽  
Author(s):  
K. Mori ◽  
Y. Yamagata ◽  
S. Aikou ◽  
M. Nishida ◽  
T. Kiyokawa ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Short Term ◽  
Radical Esophagectomy

scholarly journals Clinical importance of long-term antidepressant treatment

2001 ◽  
Vol 179 (S42) ◽  
pp. s4-s8 ◽  
Author(s):  
Robert M. A. Hirschfeld
Keyword(s):  
Antidepressant Treatment ◽  
Clinical Importance ◽  
Maintenance Phase ◽  
Term Treatment ◽  
Antidepressant Therapy ◽  
Short Term ◽  
Short Term Treatment ◽  
Treatment Of Depression ◽  
Patients At Risk

BackgroundDepression, which only a few decades ago was considered to be a short-term illness requiring short-term treatment, is now recognised as a recurrent, sometimes chronic, long-term illness.AimsTo highlight the clinical importance of long-term antidepressant therapy in the treatment of depression.MethodThe current literature was reviewed to examine the relationship between duration of antidepressant therapy and efficacy.ResultsApproximately one-third to a half of patients successfully stabilised in acute-phase treatment will relapse if medication is not sustained throughout the continuation period. Only 10–15% will relapse if medication is continued. For maintenance-phase therapy, approximately 60% of patients at risk will experience a recurrent episode of depression within I year if untreated, whereas those who continue in treatment will have a recurrence rate of between 10% and 30%.ConclusionsRisk of relapse and recurrence of depression can be significantly reduced if adequate continuation and maintenance therapy durations are achieved.

scholarly journals Selecting esophageal cancer patients for lymphadenectomy after neoadjuvant chemoradiotherapy: a modeling study

2020 ◽  
Vol 2 (1) ◽  
pp. e000027
Author(s):  
Mirre Scholte ◽  
Didi JJM de Gouw ◽  
Bastiaan R Klarenbeek ◽  
Janneke PC Grutters ◽  
Camiel Rosman ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Success Rate ◽  
Cancer Patients ◽  
Treatment Success ◽  
Neoadjuvant Chemoradiotherapy ◽  
Sensitivity Analyses ◽  
Short Term ◽  
Life Years

ObjectivesTwo-thirds of patients do not harbor lymph node (LN) metastases after neoadjuvant chemoradiotherapy (nCRT). Our aim was to explore under which circumstances a selective lymph node dissection (LND) strategy, which selects patients for LND based on the restaging results after nCRT, has added value compared with standard LND in esophageal cancer.DesignA decision tree with state-transition model was developed. Input data on short-term and long-term consequences were derived from literature. Sensitivity analyses were conducted to assess promising scenarios and uncertainty.SettingDutch healthcare system.ParticipantsHypothetical cohort of esophageal cancer patients who have already received nCRT and are scheduled for esophagectomy.InterventionsA standard LND cohort was compared with a cohort of patients that received selective LND based on the restaging results after nCRT.Main outcome measuresQuality-adjusted life years (QALYs), residual LN metastases and LND-related complications.ResultsSelective LND could have short-term benefits, that is, a decrease in the number of performed LNDs and LND-related complications. However, this may not outweigh a slight increase in residual LN metastases which negatively impacts QALYs in the long-term. To accomplish equal QALYs as with standard LND, a new surgical strategy should have the same or higher treatment success rate as standard LND, that is, should show equal or less recurrences due to residual LN metastases.ConclusionsThe reduction in LND-related complications that is accomplished by selecting patients for LND based on restaging results after nCRT seems not to outweigh a QALY loss in the long-term due to residual LN metastases. Despite the short-term advantages of selective LND, this strategy can only match long-term QALYs of standard LND when its success rate equals the success rate of standard LND.

697 ESOPHAGECTOMY ANASTOMOTIC LEAKS DECREASE LONG TERM SURVIVAL AFTER SURGERY FOR ESOPHAGEAL CANCER: MOVING FROM RESCUE TO PREVENTION.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Survival Rates ◽  
Standard Of Care ◽  
Innovative Technology ◽  
Anastomotic Leaks ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
The Difference

Abstract   Multimodal therapy including esophagectomy is the standard of care for esophageal cancer with a view to achieve long-term survival. Leaks from esophageal anastomoses are associated with major short-term morbidity and mortality. The aim of this study was to analyse our anastomotic leaks following esophagectomy for cancer, their effect on short-term mortality and any effect on long term survival. Methods All patients undergoing esophagectomy for esophageal cancer over 10 years from 2011 to 2020 in our centre were selected for this study from a prospectively maintained database. Patients with leaks were identified by reviewing their case records, electronic records, endoscopy and radiological results. All leaks including non-clinical radiological leaks were included in the study. Overall survival was calculated from date of surgery to death or otherwise censored. Statistical analysis was carried out using SPSS. Results 104 consecutive patients were identified of whom 10 patients (9.6%) had anastomotic leaks. 8 of these patients (80%) were rescued and were well enough to be discharged home. The median survival of patients with leaks was 11.6 months compared to 52.9 months for patients without leaks. The 3-year survival was 30% in patients with leaks compared to 59.9% (p = 0.23, Fisher’s exact) in patients without leaks. The Kaplan Meier survival analysis curves are shown here and the difference in survival was very close to being statistically significant with p = 0.089 (Log Rank) and p = 0.056 (Breslow). Conclusion Esophageal anastomotic leak rates are still exceedingly high at 10%. The rescue rate of 80% is significantly better compared to previous decades. Despite the high rescue rate, these patients have extremely poor long-term survival rates. The future should aim for innovative technology and strategies to eliminate esophageal anastomotic leaks for optimal short- and long-term outcomes.

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