Risk Models Based On Populations In High-Risk Areas of Oesophageal Cancer In China For Improving The Oesophageal Cancer Diagnosis Rate

Background: To improve the diagnostic efficiency of early oesophageal cancer, it is of great significance to develop an effective risk prediction model. This study aimed to identify a high-risk population with oesophageal squamous cell carcinoma (ESCC) based on a population screening model.Methods: From 120 target townships randomly selected from 150 villages selected in Nanchong City, Sichuan Province, China, from Jan 2016 to Sep 2019, a total of 6409 subjects were screened. Each patient underwent standard endoscopy and narrow band imaging (NBI) and iodine staining indicator biopsies to evaluate oesophageal cancer and precancerous lesions. Before endoscopy, the subjects completed a questionnaire about ESCC risk factors. Variables were evaluated by univariate analysis, and variables significantly related to ESCC were extracted by using a logistic regression model. We used the Akaike information criterion to develop the final model structure and the coding form of variables with multiple metrics. We developed two sets of models to define severe dysplasia and above (SDA) and moderate dysplasia and above (MDA) as prognostic events, respectively. Results: The areas under the receiver operating characteristic curve (AUROC) were0.896 (95%CI, 0.888-0.903) and 0.825 (95% CI, 0.816-0.835) for our SDA and MDA models, respectively. MDA-related and SDA-related factors included age, sex, cigarette smoking, alcohol drinking, pharyngeal foreign body sensation, swallowing obstruction, pain behind the sternum, and discomfort behind the breastbone.Conclusions: we developed an easy-to-use model to identify individuals with high risk of dysplasia or oesophageal cancer in high-risk areas of oesophageal cancer in China.

294 LONG TERM OUTCOMES OF THORACOSCOPIC-ASSISTED OESOPHAGECTOMY FOR EARLY OESOPHAGEAL CANCER

Oesophageal cancer is the 9th most common cancer in Scotland, yet is ranked 5th for cancer mortality. This is in part due to most new patients presenting with locally-advanced or metastatic disease. Early disease is often found during Barrett's surveillance or serendipitously. There is a paucity of literature describing the outcomes of patients who undergo resection for early disease in Europe, particularly morbidity, actual five-year survival rate, recurrence patterns and ultimate causes of death. Methods Data for fifty consecutive patients from the Royal Infirmary Edinburgh (RIE) with cN0 disease who underwent thoracoscopically-assisted McKeown (three-stage) oesophagectomy between 2005 and 2013 were recorded in a prospectively-maintained database. 20/50 were in a formal endoscopic surveillance program for Barrett’s oesophagus. Endoscopic ultrasound (EUS) became widely used at RIE in 2007 with the introduction of an endoscopic mucosal resection service, with 39/40 patients operated on since 2007 undergoing pre-operative EUS. Results Median age was 67 (range 46–81) with 34 males and 16 females. 44 had ≤pT1b, while 48 patients were pN0 (median node yield of 12). There were 4 anastomotic leaks, 4 recurrent laryngeal nerve palsies and 2 tracheo-oesophageal fistulas. There was one in-hospital death secondary to intra-operative and post-operative myocardial infarctions. As of January 2020, 16/50 patients had died, with a median survival of 9 years; five year survival was approximately 85%. 5 patients died of metastatic disease (1.3 to 6.8 years post-resection). 10 patients died of other causes, the most common being alcoholic liver disease (n = 3). Conclusion Patients in this case series received high quality surgery and peri-operative care, and survival rates were high. This dataset demonstrates that a holistic approach to healthcare is vitally important in the long-term care of such a cohort, because most deaths were not related to their cancer. This should be kept in mind when counselling patients with early disease and when liaising with their primary care provider.

P137 OUTCOME OF PATIENTS UNDERGOING ENDOSCOPIC MUCOSAL RESECTION FOR CANCER OF THE OESOPHAGUS FROM A SINGLE CENTRE

Aim To evaluate the outcomes patients undergoing endoscopic mucosal resection (EMR) as a therapeutic and or diagnostic treatment for oesophageal cancer. Background Management of early oesophageal cancer usually involves major surgery (oesophagostomy) which has a reported morbidity of 50% and mortality of 3%. EMR is increasingly used as a treatment for patients with early (T1 N0) oesophageal cancer. It may also be employed as a diagnostic tool in those where previous biopsies have been insufficient in proving a cancer. Methods A retrospective review of patients who underwent EMR with a curative intent for cancer of the oesophagus or oesophago-gastric junction (OGJ) at a single centre between October 2006 and February 2019 was conducted. Patients were included in the study if the EMR sample was positive for T1a or T1b cancer. Results Overall 144 patients were identified who underwent 276 therapeutic or diagnostic procedures. 141 patients were diagnosed with adenocarcinoma and 3 patients with squamous cell cancer (SCC). T1a stage was confirmed for 120 patients with adenocarcinoma and one with SCC. 21 patients with adenocarcinoma and 2 with SCC were staged as T1b. 78 patients underwent EMR as their sole treatment for cancer- three year cancer related survival was 89% and 5 year 69%. A further 49 patients progressed to having surgery (gastrectomy (2), trans-thoracic oesophagectomy (47). Six (12%) were node positive. There was no mortality associated with EMR, however bleeding requiring intervention or readmission was observed after 29 procedures (11%) and perforation was seen after 3 procedures (1.1%). Conclusion EMR is a safe procedure in the treatment of early oesophageal or OG junctional cancer. However survival may not be as high as expected in patients similarly staged but undergoing more radical treatment.

P115 TRANSITION FROM OESOPHAGECTOMY TO ENDOSCOPIC THERAPY FOR EARLY OESOPHAGEAL CANCER – A SINGLE CENTRE EXPERIENCE OF 251 CONSECUTIVE CASES

Aim To compare Oesophagectomy and Endoscopic mucosal resection (EMR) short and long term outcomes of patients treated for early oesophageal cancer over a transition period in a single institution. Background and Methods Introduction of Endoscopic eradication therapy (EET) techniques in 2012 provided an alternative to oesophagectomy for high grade dysplasia (HGD) and early cancer. Historically the gold-standard treatment had been oesophagectomy, which is associated with significant post-operative morbidity and prolonged recovery, but offers a high chance of cure with additional benefit of regional lymphadenectomy. A single centre, contemporaneously maintained database of consecutive patients diagnosed with early oesophageal cancer and treated at a tertiary referral centre during 2000-2018 was analysed. Patients were discussed at MDT; histology was confirmed by 2 expert pathologists. Oesophagectomy was not preceded by neoadjuvant chemotherapy. Primary outcomes are overall and disease specific survival, secondary outcomes including hospital stay, complications and overall cost. Results 113 patients underwent oesophagectomy and 138 underwent EMR +/- further EET. Mean age for oesophagectomy 64.6 vs. EMR 71.6 years (p=<.0001). Mean follow up for oesophagectomy was 5.6 vs 2.4 years after EET. The proportion of T1 tumours was (HGD 25% vs 39%, T1a 17% vs 34%, T1b 43% vs 16%, p<0.001), poor differentiation (23% vs 5%, p<0.001), lymphovascular invasion (19% vs 4%, p<0.001) and Inpatient hospital stay (median 14 vs 1.5 days EMR; p=<.0001) was significantly higher in oesophagectomy group. In-hospital and 30 day mortality was 0%. Surgical group suffered more complications (Clavien-dindo ≥ 3) 26% vs. EMR 1%, p=<.0001. Cancer recurrence after oesophagectomy was 18% (local 4%, systemic 9%, mixed 5%) vs. 5% following EET (local). Overall survival showed no difference between both groups (HR 1.157 95%CI 0.62-2.16). Stage matched survival in HGD; T1a and T1b sub-groups didn´t significantly differ. Conclusion In a large consecutive series of patients treated during a transition period, overall survival was similar in both groups. Surgery was associated with prolonged recovery and significant post-operative morbidity. EMR should be available for HGD and early cancer patients as gold standard of care although patients with adverse prognostic features may still benefit from oesophagectomy.

Hypopharyngeal cancer associated with synchronous oesophageal cancer: risk factors and benefits of image-enhanced endoscopic screening

Objectives:To explore the risk factors associated with the occurrence of synchronous oesophageal cancer in patients with hypopharyngeal cancer, and to investigate the roles of image-enhanced endoscopic screening in the prediction and diagnosis of early oesophageal cancer.Methods:The clinical characteristics of patients with hypopharyngeal cancer (n = 160) were analysed. All patients underwent laryngoscopic and gastroscopic examination using image-enhanced endoscopic techniques before treatment.Results:Of 160 hypopharyngeal cancer patients, 43 (27 per cent) had synchronous oesophageal cancer. Heavy drinking (odds ratio = 4.787, p = 0.029) and local invasion of three or more anatomical sites (odds ratio = 14.391, p = 0.000) were independent risk factors for synchronous oesophageal cancer. Narrow-band imaging laryngoscopy could detect more invaded anatomical sites than ordinary white light endoscopy (t = 8.532, p = 0.000). More early oesophageal cancer cases were detected with Lugol chromoendoscopy than with non-Lugol iodine staining examination (χ2 = 4.925, p = 0.026).Conclusion:Synchronous oesophageal cancer is common in patients with hypopharyngeal cancer. The heavy drinking patients with hypopharyngeal cancer should undergo intensive monitoring. Image-enhanced endoscopic screening is helpful in the prediction and early detection of second primary oesophageal cancer.