Diabetes mellitus and survival of esophageal cancer patients after esophagectomy: a systematic review and meta-analysis

Abstract Background The impact of volatile anesthesia (INHA) and total intravenous anaesthesia (TIVA) on the long-term survival of patients after oncology surgery is a subject of controversy. The purpose of this study was to make overall evaluation of the association between these two anesthetic techniques and long-term prognosis of oncology patients after surgery. Methods Databases were searched according to the PRISMA guidelines up to September 30, 2018. Hazard ratios (HRs) with its 95% confidence intervals (CIs) were calculated after multivariable analyses and propensity score (PS) adjustments. Eight retrospective cohort articles reporting data on overall survival (OS) and recurrence-free survival (RFS) were included. An inverse variance random effects meta-analysis was conducted. The Newcastle Scale was used to assess methodological quality and bias. Results In total, about 18922 cancer patients observed were included in the meta-analysis, of which 10433 cases were available for analysis in INHA and 8489 in TIVA group. Compared to TIVA, INHA showed a shorter OS (HR =1.27, 95% CI 1.069 to 1.516, p=0.007), with a medium heterogeneity (Q-test p=0.003, I-squared=67.6%). However, no significant differences were identified between INHA and TIVA group (HR =1.10, 95% CI 0.729 to 1.659, p=0.651) concerning RFS albeit from a limited data pool. When a subgroup analysis was performed by race, the association was more likely to be observed in the Asian studies (HR=1.46, 95%CI 1.19–1.8, p =0.00), with a much lower heterogeneity (Q-test p=0.148, I-squared=44%). When comparison was done only in breast cancer patients, no significant differences were found for OS (HR=1.625, 95%CI 0.273-9.67, p=0.594) between INHA and TIVA. Conclusion TIVA for cancer surgery might be associated with better OS compared to INHA. The effect of INHA and TIVA on OS and RFS in the perioperative setting remains uncertain, cancer-specific, and has low-level evidence at present. Randomized controlled trials are required in future work. Registry number The review protocol was registered with PROSPERO (Registration NO.CRD42018109341).

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Effect of Volatile and Intravenous Anesthesia on Long-Term Survival of Cancer Surgery Patients: A Systematic Review and Meta-Analysis

10.21203/rs.2.116/v1 ◽

2018 ◽

Author(s):

Li Gong ◽

Chao Dong ◽

Qian Cai ◽

Wen Ouyang

Keyword(s):

Cancer Patients ◽

Meta Analysis ◽

Cancer Surgery ◽

Anesthetic Techniques ◽

Breast Cancer Patients ◽

Term Survival ◽

Long Term Survival ◽

Long Term Prognosis ◽

The Impact

Abstract Background The impact of volatile anesthesia (INHA) and total intravenous anaesthesia (TIVA) on the long-term survival of patients after oncology surgery is a subject of controversy. The purpose of this study was to make overall evaluation of the association between these two anesthetic techniques and long-term prognosis of oncology patients after surgery. Methods Databases were searched according to the PRISMA guidelines up to September 30, 2018. Hazard ratios (HRs) with its 95% confidence intervals (CIs) were calculated after multivariable analyses and propensity score (PS) adjustments. Eight retrospective cohort articles reporting data on overall survival (OS) and recurrence-free survival (RFS) were included. An inverse variance random effects meta-analysis was conducted. The Newcastle Scale was used to assess methodological quality and bias. Results In total, about 18922 cancer patients observed were included in the meta-analysis, of which 10433 cases were available for analysis in INHA and 8489 in TIVA group. Compared to TIVA, INHA showed a shorter OS (HR =1.27, 95% CI 1.069 to 1.516, p=0.007), with a medium heterogeneity (Q-test p=0.003, I-squared=67.6%). However, no significant differences were identified between INHA and TIVA group (HR =1.10, 95% CI 0.729 to 1.659, p=0.651) concerning RFS albeit from a limited data pool. When a subgroup analysis was performed by race, the association was more likely to be observed in the Asian studies (HR=1.46, 95%CI 1.19–1.8, p =0.00), with a much lower heterogeneity (Q-test p=0.148, I-squared=44%). When comparison was done only in breast cancer patients, no significant differences were found for OS (HR=1.625, 95%CI 0.273-9.67, p=0.594) between INHA and TIVA. Conclusion TIVA for cancer surgery might be associated with better OS compared to INHA. The effect of INHA and TIVA on OS and RFS in the perioperative setting remains uncertain, cancer-specific, and has low-level evidence at present. Randomized controlled trials are required in future work.

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The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

Cancer Control ◽

10.1177/1073274821997430 ◽

2021 ◽

Vol 28 ◽

pp. 107327482199743

Author(s):

Ke Chen ◽

Xiao Wang ◽

Liu Yang ◽

Zheling Chen

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Survival Rate ◽

Meta Analysis ◽

Response Rates ◽

Control Group ◽

Term Survival ◽

Long Term Survival ◽

And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

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Clinical and Oncological Value of Preoperative BMI in Gastric Cancer Patients: A Single Center Experience

Gastroenterology Research and Practice ◽

10.1155/2015/810134 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Costantino Voglino ◽

Giulio Di Mare ◽

Francesco Ferrara ◽

Lorenzo De Franco ◽

Franco Roviello ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Blood Proteins ◽

Term Survival ◽

Long Term Survival ◽

Single Center Experience ◽

Group B ◽

Gastric Cancer Patients ◽

The Impact

Introduction. The impact of preoperative BMI on surgical outcomes and long-term survival of gastric cancer patients was investigated in various reports with contrasting results.Materials & Methods. A total of 378 patients who underwent a surgical resection for primary gastric cancer between 1994 and 2011 were retrospectively studied. Patients were stratified according to BMI into a normal group (<25, group A), an overweight group (25–30, group B), and an obesity group (≥30, group C). These 3 groups were compared according to clinical-pathological characteristics, surgical treatment, and long-term survival.Results. No significant correlations between BMI and TNM (2010), UICC stage (2010), Lauren’s histological type, surgical results, lymph node dissection, and postoperative morbidity and mortality were observed. Factors related to higher BMI were male genderP<0.05, diabetesP<0.001, and serum blood proteinsP<0.01. A trend to fewer lymph nodes retrieved during gastrectomy with lymphadenectomy in overweight patients (B and C groups) was observed, although not statistically significant. There was no difference in overall survival or disease-specific survival between the three groups.Conclusion. According to our data, BMI should not be considered a significant predictor of postoperative complications or long-term result in gastric cancer patients.

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723 TWO- VS. THREE-FIELD LYMPHADENECTOMY FOR ESOPHAGEAL CANCER. A SYSTEMATIC REVIEW AND META-ANALYSIS OF SHORT- AND LONG-TERM OUTCOMES.

Diseases of the Esophagus ◽

10.1093/dote/doab052.723 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Letícia Nogueira Datrino ◽

Clara Lucato Santos ◽

Guilherme Tavares ◽

Luca Schiliró Tristão ◽

Maria Carolina Andrade Serafim ◽

...

Keyword(s):

Systematic Review ◽

Esophageal Cancer ◽

Meta Analysis ◽

Operation Time ◽

Extended Lymphadenectomy ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Short And Long Term

Abstract Nowadays, there is still no consensus about the benefits of adding neck lymphadenectomy to the traditional two-fields esophagectomy. An extended lymphadenectomy could potentially increase operation time and the risks for postoperative complications. However, extended lymphadenectomy allows resection of cervical nodes at risk for metastases, potentially increasing long-term survival rates. This study aims to estimate whether cervical prophylactic lymphadenectomy for esophageal cancer influences short- and long-term outcomes through a systematic review of literature and meta-analysis. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central, and Lilacs (BVS). The inclusion criteria were: (1) studies that compare two-field vs. three-field esophagectomy; (2) adults (>18 years); (3) articles that analyze short- or long-term outcomes; and (4) clinical trials or cohort studies. The results were summarized by forest plots, with effect size (ES) or risk difference (RD) and 95% CI. Results Twenty-five articles were selected, comprising 8,954 patients. Three-field lymphadenectomy was associated to higher operation time (ES: -1.51; 95%CI -1.84, −1.18) and higher blood loss (ES: -0.24; 95%CI: −0.37, −0.11). Also, neck lymphadenectomy inputs additional risk for pulmonary complications (RD: 0.03; 95%CI: 0.01, 0.05). No difference was noted for morbidity (RD: 0.01; 95%CI: −0.01, 0.03); leak (−0.02; 95%CI: −0.07, 0.03); postoperative mortality (RD: 0.00; 95%CI: −0.00, 0.01), and hospital stay (ES: -0.05; 95%CI -0.20, 0.10). Three-field lymphadenectomy allowed higher number of retrieved lymph nodes (MD: -1.51; 95%CI -1.84, −1.18), but did not increase the overall survival (HR: 1.11; 95%CI: 0.96, 1.26). Conclusion Prophylactic neck lymphadenectomy for esophageal cancer should be performed with caution once it is associated with poorer short-term outcomes compared to traditional two-field lymphadenectomy and does not improve long-term survival. Future esophageal cancer studies should determine the subgroup of patients who could benefit from prophylactic neck lymphadenectomy in long-term outcomes.

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Bridging the gap: how do we improve long-term survival of locally-advanced esophageal cancer patients?

Journal of Thoracic Disease ◽

10.21037/jtd.2019.08.112 ◽

2019 ◽

Vol 11 (S15) ◽

pp. S1841-S1843

Author(s):

Andrew E. Giles ◽

Biniam Kidane

Keyword(s):

Esophageal Cancer ◽

Cancer Patients ◽

Locally Advanced ◽

Advanced Esophageal Cancer ◽

Term Survival ◽

Long Term Survival ◽

Locally Advanced Esophageal Cancer

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O193 ROLE OF MALNUTRITION IN 0ESOPHAGEAL SURGERY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doz092.193 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

R Alfieri ◽

M Nardi ◽

V Moretto ◽

E Pinto ◽

M Briarava ◽

...

Keyword(s):

Weight Loss ◽

Postoperative Complications ◽

Nutritional Status ◽

Term Survival ◽

Long Term Outcome ◽

Long Term Survival ◽

Oesophagogastric Junction ◽

Significant Difference ◽

The Impact

Abstract Aim To investigate whether preoperative malnutrition is associated with long term outcome and survival in patients undergoing radical oesophagectomy for oesophageal or oesophagogastric junction cancer. Background & Methods Dysphagia, weight loss, chemo-radiationtherapy frequently lead to malnutrition in patients with oesophageal or oesophagogastric junction cancer. Severe malnutrition is associated with higher risk of postoperative complications but little is known on the correlation with long term survival. We conducted a single center retrospective study on a prospectively collected database of patients undergoing oesophagectomy from 2008 and 2012 in order to evaluate the impact of preoperative malnutrition with postoperative outcome and long term survival. Preoperative malnutrition was classified as: prealbumin level less than 220 mg/dL (PL), MUST index (Malnutrition Universal Screeening Tool) >2 and weight loss >10%. Results 177 consecutive patients were considered: due to incomplete data 60 were excluded from the analysis that was performed on 117 patients. PL was reported in 52 (44%) patients, MUST index was recorded in 62 (53%), 58 (49%) patients presented more than 10% weight loss at the preoperative evaluation. PL was associated with more postoperative Clavien-Dindo 1-2 complications (p=0.048, OR 2.35 95%IC 1.001-5.50), no differences were observed in mortality, anastomotic leak, major pulmonary complications. MUST index was not correlated with postoperative complications nor mortality but resulted worse in patients treated with chemo-radiotherapy (p=0.046, OR 1.92 95%CI 1.011-3.64). Weight loss >10% was not associated with postoperative complications or mortality. Overall 7 years survival rate was 69%. and DFS was 68%. Malnourished patients did not differ from non-malnourished regarding age, sex, tumor site, tumor stage and histology. No significant difference in 7 years survival rates was observed in patients with PL <220 mg/dL ( 55 % vs 67%), neither in patients with MUST score>2 (58% vs 72%), nor in patients with weight loss >10% (53% vs 70%). Conclusions Malnutrition is more common in patients treated with chemoradiation therapy and it is associated with postoperative complications. However, both long term and disease free survival are not affected by preoperative nutritional status. Larger patient population and data on long term postoperative nutritional status will be analyzed in further studies.

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