scholarly journals The Impact of Cancer Concealment on Postoperative Esophageal Cancer Patients in Stage T3: A Propensity Scores Matching Analysis

2021 ◽  
Author(s):  
Minhao Yu ◽  
Zhiquan Long
Keyword(s):  
Esophageal Cancer ◽  
Confidence Interval ◽  
Cancer Patients ◽  
Propensity Scores ◽  
Multivariate Regression Analysis ◽  
Research Subjects ◽  
Cancer Awareness ◽  
Free Survival ◽  
Sociological Factors ◽  
The Impact

Abstract Background Esophageal cancer has a poor prognosis and high mortality rate, and the overall five-year survival rate is pretty low. In addition to medical factors, some psychological and sociological factors can also contribute to it. Methods We selected postoperative T3 esophageal cancer patients hospitalized from June 2015 to December 2016 as research subjects, and divided them into a cancer-awareness group and a cancer-concealment group. Several variables are allowed for evaluating 36-month progress-free survival of the two groups. Propensity Scores Matching analysis were used to adjust selection bias. Results There were 72 patients enrolled in the study. Sex and cancer concealment were significantly predicted poor survival while stage, pathological differentiation, education background and age were not (P = 0.017, 0.020, 0.302, 0.177, 0.068, 0.054, respectively). Cox multivariate regression analysis shows sex and cancer concealment were independent predictors of progress-free survival of esophageal cancer at postoperative T3 stage (harzard ratio = 0.264, 95% confidence interval: 0.099–0.703, P = 0.008; harzard ratio = 2.823, 95% confidence interval: 1.360–5.861, P = 0.005, respectively). Conclusions Cancer concealment is an important negative predictors of postoperative esophageal cancer patients' progress-free survival.

Prognostic significance of lymphadenectomy in patients with esophageal cancer receiving neoadjuvant chemoradiation.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 87-87
Author(s):  
Charmi Vijapura ◽  
Ravi Shridhar ◽  
Jill M. Weber ◽  
Sarah E. Hoffe ◽  
Jeremiah Lee Deneve ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Multivariate Analysis ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Disease Free Survival ◽  
Neoadjuvant Chemoradiation ◽  
Free Survival ◽  
Nodal Harvest ◽  
The Impact ◽  
Disease Free

87 Background: The optimal number of lymph nodes that should be harvested in esophageal cancer patients remains to be defined, particularly in patients that receive neoadjuvant therapies. We investigated the impact of nodal resection and survival in esophageal cancer patients treated with neoadjuvant chemoradiation (NT). Methods: Using our comprehensive esophageal cancer database we identified patients treated with NT followed by esophagectomy between 2000-2011. Clinical and pathologic data were compared using Fisher’s exact and chi-square while, Kaplan Meier estimates were used for survival analysis. Overall (OS) and disease-free survival (DFS) were compared with varying numbers of lymph nodes resected <10 and ≥10 (ST-1), <12 and ≥12 (ST-2), and <15 and ≥15 (ST-3). Multivariate analysis was analyzed by the Cox proportional hazard model. Results: We identified 358 patients treated with NT and esophagectomy with a median follow-up of 18.5 months (range, 0-116 months). There was no survival benefit demonstrated for patients with increased lymph nodes removed during their surgery (ST-1 OS p=0.400, DFS p=0.8727; ST-2 OS p=0.6833, DFS p=0.6092; ST-3 OS p=0.1798, DFS p=0.4028). Patients were further stratified by pathologic response to NT and nodal harvest. There were no differences in OS or DFS in patients with increased nodal harvest when analyzed by complete (pCR) (ST-1 OS p=0.7278, DFS p=0.3602; ST-2 OS p=0.6182, DFS p=0.3592; ST-3 OS p=0.4489, DFS p=0.6976), partial (pPR) (ST-1 OS p=0.3762, DFS p=0.5061; ST-2 OS p=0.8036, DFS p=0.6497; ST-3 OS p=0.0890, DFS p=0.3364), or non response (pNR) (ST-1 OS p=0.6825, DFS p=0.7161; ST-2 OS p=0.7084, DFS p=0.8351; ST-3 OS p=0.5002, DFS p=0.7314) to NT. Multivariate analysis demonstrated that age (p=0.028), t-stage (p=0.006), pPR (p=0.025), and pNR (p<0.0005) to NT were all independent predictors of mortality. Conclusions: In our experience, the number of lymph nodes resected was not predictive for overall or disease free survival in esophageal cancer patients treated with NT. In addition, extended lymph node resection did not improve survival for those with residual disease.

scholarly journals The Optimal Time of Applying Enteral Immunonutrition in Esophageal Cancer Patients Receiving Esophagectomy: A Network Meta-Analysis of Randomized Clinical Trials

2021 ◽  
Author(s):  
Xu Tian ◽  
Yan-Fei Jin ◽  
Zhao-Li Zhang ◽  
Hui Chen ◽  
Wei-Qing Chen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Infectious Complications ◽  
Cochrane Library ◽  
Optimal Time ◽  
Registration Number ◽  
Meta Analyses ◽  
The Impact

Abstract Background: Enteral immunonutrition (EIN) has been extensively applied in cancer patients, however its role in esophageal cancer (EC) patients receiving esophagectomy remains unclear. We performed this network meta-analysis to investigate the impact of EIN on patients undergoing surgery for EC and further determine the optimal time of applying EIN.Methods: We searched PubMed, EMBASE, Cochrane library, and China National Knowledgement Infrastructure (CNKI) to identify eligible studies. Categorical data was expressed as the odds ratio with 95% confidence interval (CI), and continuous data was expressed as mean difference (MD) with 95% CI. Pair-wise and network meta-analysis was performed to evaluate the impact of EIN on clinical outcomes using RevMan 5.3 and ADDIS V.1.16.8 softwares. The surface under the cumulative ranking curve (SUCRA) was calculated to rank all nutritional regimes.Results: Total 14 studies involving 1071 patients were included. Pair-wise meta-analysis indicated no difference between EIN regardless of the application time and standard EN (SEN), however subgroup analyses found that postoperative EIN was associated with decreased incidence of total infectious complications (OR=0.47; 95%CI=0.26 to 0.84; p=0.01) and pneumonia (OR=0.47; 95%CI=0.25 to 0.90; p=0.02) and shortened LOH (MD=-1.01; 95%CI=-1.44 to -0.57; p<0.001) compared to SEN, which were all supported by network meta-analyses. Ranking probability analysis further indicated that postoperative EIN has the highest probability of being the optimal option in terms of these three outcomes.Conclusions: Postoperative EIN should be preferentially utilized in EC patients undergoing esophagectomy because it has optimal potential of decreasing the risk of total infectious complications and pneumonia and shortening LOH.OSF registration number: 10.17605/OSF.IO/KJ9UY.

Abstract TP209: Effect of Chemotherapy on Stroke Risk in Cancer Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takaya Kitano ◽  
Tsutomu Sasaki ◽  
Yasufumi Gon ◽  
Kenichi Todo ◽  
Shuhei Okazaki ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Propensity Scores ◽  
Stroke Risk ◽  
Cox Regression ◽  
Treatment Plan ◽  
University Hospital ◽  
Chemotherapy Group ◽  
Kaplan Meier ◽  
Increased Risk ◽  
The Impact

Introduction: Chemotherapy may be a cause of cancer-associated stroke, but whether it increases stroke risk remains uncertain. We aimed to clarify the impact of chemotherapy on stroke risk in cancer patients. Methods: We investigated 27,932 patients enrolled in a hospital-based cancer registry at Osaka University Hospital between 2007 and 2015. The registry collects clinical data, including cancer status (site and stage), on all patients treated for cancer. Of them, 19,006 patients with complete data were included. A validated algorithm was used to identify stroke events within 2 years of cancer diagnosis. Patients were divided based on whether their initial treatment plan included chemotherapy. The association between chemotherapy and stroke was analyzed using the Kaplan-Meier method and stratified Cox regression. Results: Of the 19,006 patients, 5,887 (31%) patients were in the chemotherapy group. Non-targeted chemotherapy was used in 5,371 patients. Stroke occurred in 44 patients (0.75%) in the chemotherapy group and 51 patients (0.39%) in the no-chemotherapy group. Kaplan-Meier curve analysis showed that patients in the chemotherapy group had a higher stroke risk than patients in the no-chemotherapy group (HR 1.84; 95% CI 1.23-2.75; Figure [A]). However, this difference was insignificant after adjustment for cancer status using inverse probability of treatment weighting with propensity scores (HR 1.20; 95% CI 0.76-1.91; Figure [B]). Similarly, in the stratified Cox regression model, chemotherapy was not associated with stroke after adjustment for cancer status (HR 1.26; 95% CI 0.78-2.03). These findings were consistent with analysis wherein the effect of chemotherapy was treated as a time-dependent covariate (HR 1.02; 95% CI 0.55-1.88). Conclusions: In this population, the elevated stroke risk in cancer patients who received chemotherapy was presumably due to advanced cancer stage; chemotherapy was not associated with the increased risk of stroke.

scholarly journals Efficacy of immune checkpoint inhibitors and age in cancer patients

Immunotherapy ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 587-603 ◽  
Author(s):  
Xuan-zhang Huang ◽  
Peng Gao ◽  
Yong-xi Song ◽  
Jing-xu Sun ◽  
Xiao-wan Chen ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Progression Free Survival ◽  
Comparable Efficacy ◽  
Control Groups ◽  
Free Survival ◽  
Meta Regression Analysis ◽  
The Impact

Aim: To evaluate the impact of age on the efficacy of immune checkpoint inhibitors (ICI) in cancer patients. Materials & methods: The primary outcomes included overall survival (OS) and progression-free survival (PFS). Subgroup, meta-regression analysis and within-trial interaction HR were conducted. Results: A total of 34 studies containing 20,511 cancer patients were included. ICI could improve the OS and PFS in patient aged <65 and ≥65 years. Patients aged <75 years treated with ICI also had favorable OS and PFS compared with the control groups. Conclusion: ICI has comparable efficacy in cancer patients aged <65 and ≥65 years. Cancer patients aged ≥75 years need more attention in the future clinical trials.

P23 MALNUTRITION INDICES AS PROGNOSTIC FACTORS FOR POSTOPERATIVE COMPLICATIONS IN ESOPHAGEAL CANCER PATIENTS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Lidoriki Irene ◽  
Schizas Dimitrios ◽  
Mpaili Efstratia ◽  
Mpoura Maria ◽  
Hasemaki Natasha ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factors ◽  
High Risk ◽  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Cancer Patients ◽  
Preoperative Assessment ◽  
Low Risk ◽  
Major Complications ◽  
The Impact

Abstract Aim To investigate the impact of malnutrition on postoperative complications in esophageal cancer patients. Background and Methods Malnutrition is common in esophageal cancer patients due to the debilitating nature of their disease. Several methods of nutritional assessment have emerged as significant prognostic factors for short-and long-term outcomes in patients operated for esophageal cancer. The study sample consisted of 85 patients with esophageal (n=11) and gastroesophageal junction (n=74) cancer who were admitted for surgery in the First Department of Surgery, Laikon General Hospital, Athens, Greece, between September 2015 and March 2019. Out of them, 65 patients underwent esophagectomy, while 20 patients underwent total gastrectomy. The assessment of nutritional status included the Geriatric Nutritional Risk Index (GNRI), the Patient Generated Subjective Global Assessment (PG-SGA) and sarcopenia. GNRI was based on preoperative values of patients’ serum albumin and body weight. The preoperative assessment of sarcopenia was based on Skeletal Muscle Index (SMI) derived from analysis of CT scans using SliceOmatic® Software version 4.3 (Tomovision, Montreal, Canada). Postoperative complications were graded according to Clavien-Dindo classification. Minor complications included categories I-II, whereas major complications included categories III-V. Results Thirty nine patients (47.6%) developed postoperative complications. More specifically, 21 patients (24.7%) developed minor complications and 18 patients (21.2%) developed major complications, while anastomotic leakage occurred in 10 patients (11.8%). Eighty patients (94.1%) had a high-risk GNRI (<92), while 5 patients (5.9%) had a low-risk GNRI (≥92). Forty four patients (51.8%) were diagnosed with sarcopenia. The mean PG-SGA score was 8.82 ± 5.57. Patients with a high-risk GNRI demonstrated significantly higher rate of overall complications compared to low-risk GNRI patients (100% vs 44.2%, p<0.05 respectively). Moreover, the rate of anastomotic leakage was significantly higher in the sarcopenia group than in the non-sarcopenia group (29% vs 3.4%, p<0.05). Nonetheless, PG-SGA was not significantly associated with postoperative outcomes. Conclusion Higher-risk scores on the GNRI are associated with an increased risk for developing postoperative complications, while sarcopenia is associated with higher risk for anastomotic leakage among esophageal cancer patients. Preoperative assessment of GNRI and sarcopenia should be performed in all patients in order to detect patients who are at greater risk of postoperative morbidity.

The impact of the Charlson comorbidity index on the prognosis of esophageal cancer patients who underwent esophagectomy with curative intent

Surgery Today ◽  
2018 ◽  
Vol 48 (6) ◽  
pp. 632-639 ◽  
Author(s):  
Kotaro Yamashita ◽  
Masayuki Watanabe ◽  
Shinji Mine ◽  
Ian Fukudome ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Charlson Comorbidity Index ◽  
Curative Intent ◽  
Comorbidity Index ◽  
The Impact

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

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Xi Zheng ◽  
Xingsheng Ma ◽  
Han-Yu Deng ◽  
Panpan Zha ◽  
Jie Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Esophageal Cancer ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Outcome Data ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
The Impact

SUMMARY Diabetes mellitus (DM) is one of the most common comorbidities in esophageal cancer patients who undergo esophagectomy. It is well established that DM has an unfavorable impact on short-term outcomes of patients with surgically treated esophageal cancer; however, whether DM has any impact on long-term survival of these patients remains unclear. We performed the first meta-analysis to investigate the impact of DM on survival of surgically treated esophageal cancer patients. We searched the following databases systematically to retrieve relevant studies on January 2, 2019: PubMed, Embase, and Web of Science. The main outcome data consisting of 3- and 5-year overall survival (OS) rates and hazard ratios (HRs) of OS were extracted to compare survival between patients with and without DM. We finally included for meta-analysis a total of eight cohort studies involving 5,044 esophageal cancer patients who underwent esophagectomy. We found no significant difference between 3-year (risk ratio [RR] = 0.94, 95% CI: 0.73–1.21; P = 0.65) and 5-year (RR = 0.92, 95% CI: 0.80–1.08; P = 0.31) OS rates between patients with and without DM after esophagectomy. Moreover, DM was not found to be an independent predictor of OS for these patients (HR = 1.10, 95% CI: 0.65–1.84; P = 0.72). Our study suggests that DM appears to have no significant impact on long-term survival of esophageal cancer patients who undergo esophagectomy. To improve the prognosis of these patients, it may be more important to control glycemic level in patients with DM who undergo esophagectomy. However, further high-quality studies with appropriate adjustment for confounding factors are needed to verify this conclusion.

PS02.106: THE IMPACT OF HISTOPATHOLOGICAL LYMPH NODE METASTASES AFTER PREOPERATIVE CHEMO-RADIOTHERAPY ON THE PROGNOSIS IN ESOPHAGEAL CANCER PATIENTS

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 151-151
Author(s):  
Kentaro Murakami
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Adjuvant Therapy ◽  
Cancer Patients ◽  
Lymph Node Metastases ◽  
Conflicts Of Interest ◽  
Locally Advanced ◽  
The United States ◽  
Node Metastases ◽  
The Impact

Abstract Background Esophageal cancer does not have a good prognosis despite being resectable. A recent randomized controlled trial (the Dutch CROSS study) showed the superiority of preoperative chemo-radiotherapy over surgery alone with regard to the five-year survival. At present, this therapeutic approach is regarded as the standard care in the United States and Europe. However, the prognosis in cases where part of the tumor remains is poor, so additional adjuvant therapy is required. The impact of the histopathological lymph node metastases status after preoperative chemo-radiotherapy on the prognosis is unknown, and is which patients require additional adjuvant therapy to manage lymph node metastases. Methods Esophageal cancer patients with more than five lymph node metastases or lymph node metastases spreading into three fields have a poor prognosis, despite their tumor being resectable. We therefore performed neoadjuvant chemo-radiotherapy in these patients in 1998 (NACRT group). We also performed chemo-radiotherapy for initially unresectable locally advanced esophageal cancer invading adjacent organs and curative surgery for the above-mentioned patients in whom the invasion had disappeared after chemo-radiotherapy (conversion group). The chemo-radiotherapy regimen was the same for both groups and consisted of radiotherapy 40 Gy/20 fr and chemotherapy with 5-FU (500 mg/m2 days 0–4) and CDDP (15 mg/m2 days 1–5). We then examined the impact of the histopathological lymph node metastasis status after preoperative chemo-radiotherapy on the prognosis in our institute. Results Patients with three or more histopathological lymph node metastases had a significantly poorer prognosis than those with fewer metastases in both groups. In the NACRT group, the 5-year survival rate was 35.5% vs. 36.1% (number of lymph node metastases 0 vs. ≥ 1; P = 0.889), 34.0% vs. 36.7% (0–1 vs. ≥ 2; P = 0.678), and 47.1% vs. 0% (0–2 vs. ≥ 3; P = 0.003). In conversion group, it was 40.4% vs. 43.6% (number of lymph node metastases 0 vs. ≥ 1; P = 0.841), 45.6% vs. 33.6% (0–1 vs. ≥ 2; P = 0.106), and 49.5% vs. 20.0% (0–2 vs. ≥ 3; P = 0.025). Conclusion Patients with three or more histopathological lymph node metastases after preoperative chemo-radiotherapy had a significantly poorer prognosis than those with fewer metastases and required additional adjuvant therapy. Disclosure All authors have declared no conflicts of interest.

Sign in / Sign up

Export Citation Format

Share Document