18FDG PET/CT-derived parameters successfully predict clinical stage and prognosis of esophageal cancer.

Abstract Background Although 18 F- FDG PET/CT is validated in baseline workup of esophageal cancer to detect distant metastases, it remains underused in assessing local staging and biology of the primary tumor. This study aimed to evaluate the association between 18 F- FDG PET/CT-derived parameters of esophageal cancer, and its clinico-pathological features and prognosis.Methods All patients (n=86) with esophageal adenocarcinoma or squamous cell cancer operated between 2005-2014 were analyzed. Linear regression was used to identify clinico-pathologic features of esophageal cancer associated with the tumor’s maximal Standardized Uptake Value (SUV max ), Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV). ROC curve analysis was performed to precise the optimal cutoff of each variable associated with a locally advanced (cT3/4) status, long-term survival and recurrence. Kaplan Meier curves and Cox regression were used for survival analyses.Results High baseline SUV max was associated with cT3/4 status and middle-third tumor location, TLG with a cT3/4 and cN+ status, whereas MTV only with active smoking. A cT3/4 status was significantly predicted by a SUV max >8.25g/mL (p<0.001), TLG>41.7 (p<0.001) and MTV>10.70 cm 3 (p<0.01) whereas a SUV max > 12.7 g/mL was associated with an early tumor recurrence and a poor disease-free survival (median 13 versus 56 months, p=0.030), particularly in squamous cell cancer.Conclusions Baseline 18 F- FDG PET/CT has a high predictive value of preoperative cT stage, as its parameters SUV max , TLG and MTV can predict a locally advanced tumor with high accuracy. A SUV max > 12.7 g/mL may herald early tumor recurrence and poor disease-free survival.

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18 F- FDG PET/CT-derived parameters predict clinical stage and prognosis of esophageal cancer.

10.21203/rs.2.18946/v2 ◽

2019 ◽

Author(s):

Styliani Mantziari ◽

Anastasia Pomoni ◽

John O Prior ◽

Michael Winiker ◽

Pierre Allemann ◽

...

Keyword(s):

Esophageal Cancer ◽

Fdg Pet ◽

Tumor Recurrence ◽

Locally Advanced ◽

Disease Free Survival ◽

Free Survival ◽

Pet Ct ◽

Early Tumor ◽

Fdg Pet Ct ◽

Disease Free

Abstract Background Although 18 F- FDG PET/CT is validated in baseline workup of esophageal cancer to detect distant metastases, it remains underused in assessing local staging and biology of the primary tumor. This study aimed to evaluate the association between 18 F- FDG PET/CT-derived parameters of esophageal cancer, and its clinico-pathological features and prognosis.Methods All patients (n=86) with esophageal adenocarcinoma or squamous cell cancer operated between 2005-2014 were analyzed. Linear regression was used to identify clinico-pathologic features of esophageal cancer associated with the tumor’s maximal Standardized Uptake Value (SUV max ), Total Lesion Glycolysis (TLG) and Metabolic Tumor Volume (MTV). ROC curve analysis was performed to precise the optimal cutoff of each variable associated with a locally advanced (cT3/4) status, long-term survival and recurrence. Kaplan Meier curves and Cox regression were used for survival analyses.Results High baseline SUV max was associated with cT3/4 status and middle-third tumor location, TLG with a cT3/4 and cN+ status, whereas MTV only with active smoking. A cT3/4 status was significantly predicted by a SUV max >8.25g/mL (p<0.001), TLG>41.7 (p<0.001) and MTV>10.70 cm 3 (p<0.01) whereas a SUV max > 12.7 g/mL was associated with an early tumor recurrence and a poor disease-free survival (median 13 versus 56 months, p=0.030), particularly in squamous cell cancer.Conclusions Baseline 18 F- FDG PET/CT has a high predictive value of preoperative cT stage, as its parameters SUV max , TLG and MTV can predict a locally advanced tumor with high accuracy. A SUV max > 12.7 g/mL may herald early tumor recurrence and poor disease-free survival.

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Hypoxic gene expression is a prognostic factor for disease free survival in a cohort of locally advanced squamous cell cancer of the uterine cervix

Acta Oncologica ◽

10.1080/0284186x.2021.1979249 ◽

2021 ◽

pp. 1-7

Author(s):

Jan Alsner ◽

Jens Overgaard ◽

Trine Tramm ◽

Jacob Christian Lindegaard

Keyword(s):

Gene Expression ◽

Prognostic Factor ◽

Squamous Cell ◽

Uterine Cervix ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Locally Advanced ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free

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Sarcopenia Is Associated with Reduced Overall and Disease-Free Survival in Patients Undergoing Esophagectomy for Locally Advanced Esophageal Cancer

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.432 ◽

2020 ◽

Vol 231 (4) ◽

pp. S292-S293

Author(s):

Connor Wakefield ◽

Andrew Arndt ◽

Nicole Geissen ◽

Sanjib Basu ◽

Justin Karush ◽

...

Keyword(s):

Esophageal Cancer ◽

Locally Advanced ◽

Disease Free Survival ◽

Advanced Esophageal Cancer ◽

Free Survival ◽

Disease Free ◽

Locally Advanced Esophageal Cancer

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Outcomes associated with T4 esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.130 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 130-130

Author(s):

K. Meredith ◽

J. Weber ◽

R. Shridhar ◽

S. E. Hoffe ◽

K. Almhanna ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Locally Advanced ◽

Survival Rates ◽

Disease Free Survival ◽

Pathologic Response ◽

Additional Patient ◽

Free Survival ◽

T4 Esophageal Cancer ◽

Disease Free

130 Background: Esophageal cancer often presents as locally advanced disease with 15% of patients having T4 tumors upon diagnosis. Esophagectomy was often reserved for palliation given the dismal survival rates and high rates of R1/R2 resections. However, neoadjuvant therapy (NT) has the potential to significantly downstage esophageal cancers and thus increase complete resection rates. We report our experience with surgically resected T4 cancers of the esophagus. Methods: Using a comprehensive esophageal cancer database, we identified patients who underwent an esophagectomy for T4 tumors between 1994 and 2008. Neoadjuvant therapy and pathologic response were recorded and denoted as complete (pCR), partial (pPR), and non-response (NR). Clinical and pathologic data were compared using Fisher's exact and chi-square when appropriate while Kaplan Meier estimates were used for survival analysis. Results: We identified 39 patients with T4 tumors who underwent esophagectomy of which 38 (97%) underwent NT. The median age was 61 (31-79) years with a median follow-up of 32 (5-97) months. There were 3 (7.9%) pCR, 17 (44.7%) pPR, and 18 (47.4%) NR. R0 resections were accomplished in 37 (94.9%). Two patients had incomplete resections. One patient had a R2 resection after NT and was deemed as NR. An additional patient had a R1 resection after NT and was a pPR with a residual 0.2 cm tumor on permanent pathology. There were 14 (35.9%) recurrences with a median time to recurrence of 19.5 (4-71) months. Complete pathologic response represented 1 (7.1%), whereas pPR and NR represented 6 (42.9%), and 7 (50%) respectively of all recurrences. The overall and disease free survival for all patients with T4 tumors was 28% and 34% respectively. Patients achieving a pCR had a 5-year overall and disease free survival of (43% and 47%), compared to pPR (30% and 21%) while there were no 5-year survivors in the NR cohort. Conclusions: T4 esophageal cancer often portends a dismal prognosis even after surgical resection. Historical incomplete resections and dismal survival rates often make surgery palliative rather then curative. However, we have demonstrated that neoadjuvant therapy and down staging of T4 tumors leads to increased R0 resections and improvements in overall and disease free survival. No significant financial relationships to disclose.

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Nigro regimen treatment of squamous cell cancer of the anus

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.14545 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 14545-14545

Author(s):

S. R. Kalmadi ◽

R. J. Pelley ◽

E. Kay ◽

J. P. Saxton ◽

R. M. Bukowski ◽

...

Keyword(s):

Anal Cancer ◽

Squamous Cell ◽

Survival Data ◽

Squamous Cell Cancer ◽

Clinical Stage ◽

Cell Cancer ◽

Cleveland Clinic ◽

Disease Free Survival ◽

Free Survival ◽

Disease Free

14545 Background: To identify prognostic factors for patients with squamous cell cancer (SCC) of the anus treated with Nigro Regimen chemo/radiation therapy. Methods: Survival data of 61 patients with SCC of the anal canal were reviewed who were treated with definitive radiochemotherapy (RCT) between 9/83 and 3/06. All patients received RCT at the Cleveland Clinic Foundation. Results: Patient characteristics were typical of other studies. Median age was 57 years (34–82), women: men (42:19), PS 0–1 (95%), smokers 52%, and clinically lymph node positive tumors 27%. T3–4 tumors were 50%, high for most series. The median follow-up time was 52 mos (7–246 mos). The median disease free survival (DFS) and overall survival (OS) have not been reached. 5-year DFS was 76% (95% C.I. 62–88%) and 5-year OS was 76% (95% C.I. 60–86%). Colostomy free survival at 5-years was 41/61 (67%). Log rank analyses showed that female sex (5-yr DFS 82 vs 55%, p=0.03), and clinical stage (5-yr DFS, stage 1 100%, stage 2 80%, stage 3a 65%, stage 3b 0%) correlated with better disease free survival. Patient age (less than 60 or greater), time of diagnosis (before 1996 or later), and smoking status did not correlate with better disease free survival. There were 14 recurrences, 7 systemic, 7 local with APR salvaging 4 patients with local relapse. There were 2 cases of treatment related hemolytic uremic syndrome, with one death. Conclusions: The Nigro regimen is successful in curing anal cancer in a significant majority of patients. We appear to have reached a therapeutic plateau and have not had any significant improvement in cure rates over the last two decades. Identification of subsets more prone to relapse is crucial, to target with more intense treatment in future trials. In the current series, male sex and advanced clinical stage correlated with poor disease free survival, when anal cancer patients were treated with the Nigro regimen RCT. Future studies should investigate whether more intensive treatment is needed in males, and patients with more advanced disease. No significant financial relationships to disclose.

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Trimodality treatment (TMT) for locally advanced esophageal cancer in Pakistan; Analysis of prognostic factors influencing survival

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15185 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15185-15185

Author(s):

A. A. Syed ◽

A. Jamshed ◽

B. Muhammad ◽

R. Azhar ◽

M. A. Yusuf ◽

...

Keyword(s):

Esophageal Cancer ◽

Tumor Regression ◽

Locally Advanced ◽

Disease Free Survival ◽

Tumor Regression Grade ◽

Advanced Esophageal Cancer ◽

Free Survival ◽

Regression Grade ◽

Disease Free ◽

Locally Advanced Esophageal Cancer

15185 Background: The prognosis of patients with locally advanced esophageal cancer is poor. TMT for locally advanced esophageal cancer is being utilized with increasing frequency. In this study, we investigate the prognostic factors influencing survival in patients with locally advanced esophageal cancer following TMT. Methods: The study included 22 patients with esophageal carcinoma treated between January 2003 and December 2005 at Shaukat Khanum Memorial Hospital and Research Centre. Median age was 49 years (range 26 - 68). There were 15 (68%) males and 7 (32%) females. All patients had EGD with biopsy and CT chest. Twelve (54.5%) had squamous cell carcinoma and 10 (45.5%) patients had adenocarcinoma. Five patients (23%) had tumour in the middle third and 17 (77%) had lower/gastroesophageal lesions. Preoperative radiation consisted of 50.4 Gy / 28 fractions with concomitant chemotherapy day 1 and 29 (Cisplatin 75 mg/m2 day 1 and infusional 5FU 1000 mg/m2 day 1–5). Esophagectomy was done at 6 - 12 weeks following chemoradiation. The pathologic down-staging was evaluated by the 5-score tumor regression grade (TRG) of Mandard. Results: Post TMT pathologic TNM stage was; Stage 0 in 8 pts (36%), stage II in 5 pts (23%) and stage III in 9 pts (41%). 13 (59%) pts had R0 and 9 (41%) pts had R1 resection. The 4-year disease free survival was 29% with a median survival of 19 months. The number of patients with TRG score 1, 2, 3, 4 and 5 were 7 (32%), 4 (18%), 5 (23%), 2 (9%) and 4 (18%) respectively. Tumor regression grade 1–2 (p=.0016) and negative circumferential margins >2 mm (p=.0019) had a positive influence on DFS. Age (< 50 vs ≥ 50 years), sex, hemoglobin at presentation (≤ 12 vs > 12 gm/dl), tumor site (middle vs lower/GE junction), pathological nodal status (node positive vs node negative) and histological subtype (squamous cell vs adenocarcinoma) did not influence survival (p= 0.92, p= 0.82, p= 0.69, p= 0.79, p= 0.41 and p= 0.32 respectively). Conclusions: TMT results in prolonged disease free survival in patients with complete response or microscopic residual foci (TRG 1–2). Positive or circumferential margins <2mm is associated with poor prognosis. No significant financial relationships to disclose.

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Impact of body mass index on postoperative complications and long-term survival in patients with esophageal squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.37 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 37-37

Author(s):

Kenichi Kamachi ◽

Soji Ozawa ◽

Tsutomu Hayashi ◽

Akihito Kazuno ◽

Eisuke Ito ◽

...

Keyword(s):

Body Mass Index ◽

Squamous Cell ◽

Squamous Cell Cancer ◽

Cell Cancer ◽

Disease Free Survival ◽

Pulmonary Complications ◽

Esophageal Squamous Cell Cancer ◽

Free Survival ◽

Disease Free

37 Background: Chachexia and undernutrition have been suggested to be risk factors for postoperative complications and survival in cancer patients. The aim of this study was to investigate whether body mass index (BMI) is related to the short-term and long-term outcomes in patients who undergo an esophagectomy for the resection of esophageal squamous cell cancer. Methods: Three hundred forty patients who underwent an esophagectomy for the resection of esophageal squamous cell cancer between 2003 and 2008 were retrospectively reviewed. The patients were divided into two groups: an L-BMI group characterized by a BMI < 18.5 kg/m2, and an N-BMI group characterized by a BMI ≥ 18.5 kg/m2. The overall and disease-free survival curves of the two BMI groups were determined using the Kaplan-Meier method and were compared using a log-rank test. A Cox proportional hazards regression analysis was used for the univariate and multivariate analyses. Results: The study included 40 patients in the L-BMI group and 300 patients in the N-BMI group. Pulmonary complications seemed to occur more frequently in the L-BMI group (P = 0.006). A histopathological assessment showed that nodal involvement was seen more frequently in the L-BMI group (P = 0.016). The 5-year overall survival rate was higher in the N-BMI group (63.6%) than in the L-BMI group (32.3%) (P < 0.001). The 5-year disease-free survival rate was also higher in the N-BMI group (64.2%) than in the L-BMI group (32.3%) (P = 0.014). In a multivariate analysis, a lower BMI, an upper tumor location, an advanced pathological T stage, and a larger number of metastatic lymph nodes were independent prognostic factors for overall survival (P < 0.05). Conclusions: Our data suggested that a lower BMI not only increased pulmonary complications but also impaired overall and disease-free survival after an esophagectomy for the resection of esophageal squamous cell cancer.

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