523 STAGING PET-CT LENGTH AND SURVIVAL IN PATIENTS UNDERGOING RESECTIONS FOR ESOPHAGEAL ADENOCARCINOMA

Esophagectomy is associated with considerable morbidity and mortality and a significant reduction in quality of life. Early identification of patients at high-risk of early recurrence and death would allow a more informed discussion about the benefits of surgery. Previous studies have shown that histological tumour length may be an independent predictor of survival. In this study we have determined whether tumour length at diagnosis can predict survival after esophagectomy. Methods From a single-centre prospective clinical database (2012 to 2018), we obtained data on tumour characteristics and 18F-FDG PET-CT (PET-CT) measurement of tumour length. The primary endpoint was overall survival (OS).We performed multivariate modelling using semi-parametric Cox models, and additionally explored flexible parametric modelling using fractional polynomials to explore non-linear relationships. Relationships between tumour length and known prognosticators were assessed using standard statistical techniques. Results We included 300 patients with esophageal adenocarcinoma and pre-operative PET-CT imaging. Tumour length was measurable on PET-CT in 91% of patients (274) (median 4.7 cm, range 1.3–12). 77% of patients received neo-adjuvant therapy. One and five-year overall survival rates were 79% and 44%, respectively. There was no relationship between survival and tumour length. One year survival for patients with tumours greater than 8 cm was 67% compared with 82% for tumours less than 8 cm although this was not statistically significant (p = 0.86). Tumour length was associated with tumour stage but not resection margin positivity or number of positive lymph nodes. Conclusion Tumour length as measured by PET-CT at diagnosis does not predict survival in patients undergoing esophagectomy for esophageal adenocarcinoma. This data supports the notion that tumour length by itself should not be used as a means of stratifying treatment.

Clinical application value of the prognostic nutritional index for predicting survival in patients with oesophageal squamous cell carcinoma undergoing chemoradiotherapy or radiotherapy

Background : The prognostic nutrition index (PNI) has been shown to have prognostic value for several common cancers. The study aim was to explore the clinical application value of the PNI for prognosis of patients with oesophageal squamous cell carcinoma (ESCC) treated with radical chemoradiotherapy (CRT) or radiotherapy (RT). Methods : Overall, 193 patients with ESCC who received radiotherapy with or without chemotherapy at Sichuan Cancer Hospital from March 20, 2012 to December 25, 2017 were retrospectively analysed. Based on serum measurements before treatment, the PNI at ESCC recurrence was calculated as albumin (g/L) + 5 × total lymphocyte count. The Kaplan–Meier method and Cox proportional regression model were used to analyse the relationship between PNI and overall survival (OS). Results : The average pretreatment PNI of 193 ESCC patients was 49.01 ± 4.68. The optimal cutoff value of PNI was 47.975, and the patients were divided into a low-PNI group (<47.975) and a high-PNI group (≥47.975). PNI was related to tumour length, T-stage and synchronous chemotherapy in ESCC patients (P < 0.05). The median OS for the entire group was 22.37 months. The median OS of patients in the high-PNI group and low-PNI group were 32.63 months and 15.4 months, respectively, the 3-year survival rates were 47.5% and 32.2% and the 5-year survival rates were 37.7% and 16.8%, respectively, (all P = 0.001). Univariate analysis showed that PNI, tumour length, T-stage and synchronous chemotherapy were related to the prognosis of ESCC patients (P < 0.05). Multivariate analysis showed that tumour length (P = 0.019), synchronous chemotherapy (P = 0.009) and PNI (P = 0.003) were independent prognostic factors affecting the prognosis of patients in ESCC treated with RT or CRT. Conclusions: The calculation of PNI value is simple, reliable and repeatable and can improve the accuracy of a patient’s prognosis. Confirmation of these results by a large-sample prospective study is desirable.

Tumour length as an independent prognostic factor in resectable oesophageal carcinoma

Introduction Oesophageal longitudinal tumour length has been investigated as a prognostic indicator for disease recurrence and overall survival in resectable oesophageal carcinoma. However, there is conflicting evidence regarding its use in clinical practice. This study aims to assess the prognostic significance of histological tumour length in potentially curative oesophageal resections for cancer. Materials and methods Patients with locally advanced oesophageal carcinoma (squamous or adenocarcinoma) were identified in a single centre between July 2000 and December 2016. Patient demographics, tumour characteristics and survival outcomes were assimilated. Unifactorial and multifactorial analysis was performed to assess tumour length correlation with oncological outcomes. Results A total of 281 patients were included; 226 (80.4%) male and 55 (19.6%) female, with a median age of 66 years; 39 patients (13.9%) developed local recurrence and 104 (37%) distant metastases. Disease progression rate was 44.8% with a median progression-free survival of 21 months and median overall survival of 30 months. Median tumour length was 3cm (interquartile range 2–4.5cm). Multivariate analysis demonstrated longer tumours to be significantly associated with a higher rate of local recurrence (p=0.028), metastases (p=0.016), disease progression (p=0.001) and shorter progression-free survival (p=0.001). Discussion This study demonstrates histological tumour length as an independent prognostic factor for local recurrence, metastases, disease progression and progression-free survival. Further larger multicentre studies are required to define the role of longitudinal tumour length as a marker to identify patients who are at higher risk of poor oncological outcomes following surgery.

The use of the paediatric gastroscope to deploy self-expanding metal stents in patients with cancer of the oesophagus at Dr. George Mukhari Academic Hospital

Background: Oesophageal carcinoma continues to be a major cause of cancer related deaths worldwide. Metal stents are an established treatment option for palliation of dysphagia. These stents are classically deployed using endoscopy with fluoroscopic control. An alternative technique is using the paediatric endoscope.Methods: The study is a retrospective review of all cases of esophageal stenting at Dr George Mukhari Academic Hospital, Pretoria, South Africa were included. A prospectively maintained database Olympus Endobase® is used in the endoscopy suite. All cases between March 2015- February 2018, where the oesophagus was stented were reviewed. Cases where the paediatric scope was used were analysed further. Data captured from the database included demographics, tumour length, the presence of trahceoesophageal fistula.Results: A total of 233 patients were stented, the paediatric scope was used in 217. The procedure was successfully completed in 84,7% of the patients. Repeat stenting was required in 20 patients. The mean age was 57 years (32-97). Average length of the stricture 9,6cm (5-15cm). The reasons for palliation were patient unfit for surgery (n=159), associated TOF (n=15), unspecified (n=38). The reasons for repeat stenting were stent migration (n=5), tumour overgrowth (n=10) and blocked stent (n=5). Complications were recorded in 1 case where an iatrogenic perforation was caused which was successfully stented. In the 33 cases that failed the reason for failure was inability of the scope to negotiate the stricture. These cases were subsequently completed successfully using a guidewire with fluoroscopy. There was no periprocedural mortality.Conclusions: It is safe and feasible to use the paediatric endoscope to stent tumours of the oesophagus. If the procedure is successful it prevents the exposure of the staff and the patient to radiation. It ensures reliable placement of the guidewire into the stomach as well as confirming appropriate positioning of the stent.

Prognostic significance of the endoluminal ultrasound defined lymph node metastasis count in esophageal cancer

4558 Background: TNM histopathological staging system for esophageal cancer is controversial, and will soon be revised to account for the relative burden of the number of lymph node metastases. The aim of this study was to assess the prognostic significance of endoluminal ultrasound (EUS) defined lymph node metastasis count (eLNMC) in patients with esophageal cancer. Methods: Two hundred and sixty-seven consecutive patients (median age 63 yr, 187 m) underwent EUS followed by stage directed multidisciplinary treatment [183 esophagectomy (92 neoadjuvant chemotherapy), 79 definitive chemoradiotherapy, and 5 palliative therapy]. The eLMNC was subdivided into four groups (0, 1, 2 to 4, >4) and the primary measure of outcome was survival. Results: Survival was related to EUS T stage (p<0.0001), EUS N stage (p<0.0001), EUS tumour length (p<0.0001), and the eLNMC (p<0.0001). Multivariable analysis revealed EUS tumour length (HR 1.071, 95% CI 1.008 to 1.138, p=0.027) and eLNMC (HR 1.302, 95% CI 1.133 to 1.496, p<0.0001) to be significantly and independently associated with survival. Median and 2 year survival for patients with 0, 1, 2 to 4, and >4 lymph node metastases were: 44 months and 71%; 36 months and 59%; 24 months and 50%; and 17 months and 32% respectively. Conclusions: The eLNMC was an important and significant prognostic indicator in patients with esophageal cancer, which should in future be reported and used to revise the perceived radiological stage, in order to inform stage directed multimodal therapy. No significant financial relationships to disclose.