Nationwide quality indicator survey on the current practice of esophageal cancer management in Japan: report from the guideline committee for the 6th edition of the Japanese Esophageal Cancer Practice Guidelines.

This study aims to analyze the prevalence trend of esophageal cancer in Japan and China to provide suggestions for the prevention and treatment of esophageal cancer. The results showed that the incidence rate for the years 2010-2018 significantly decreased with an APC of 5.66%, and the mortality rate from 2010 to 2015 had an APC of -5.87% in China. However, the incidence rate of Japanese women showed an upward trend, with an APC of 4.09% from 2010 to 2019. The mortality rate of esophageal cancer in Japan showed a downward trend, with an APC of -2.96% from 2010 to 2021. From 2010 to 2018, Chinese esophageal squamous cell carcinoma accounted for the highest proportion, accounting for 85.96%, with the largest distribution in the middle, accounting for 47.25%. Patients are mostly diagnosed at stage III, and the relative survival rate from 2012 to 2015 was 30.3%. Japan also has the highest proportion of squamous cell carcinoma, and the lesions are also mostly located in the middle segment. While Japanese esophageal cancer patients are mostly diagnosed at stage I, and the relative survival rate was 41.5% in Japan from 2009 to 2011. The results of this article indicate that the current prevalence of esophageal cancer in China and Japan is generally declining, and the quality of life of patients is gradually improving, but effective screening and prevention strategies are still needed to reduce the burden of this disease.

AIM: It is assess benefit prophylactic selective unilateral cervical lymph node (LN) dissection with total thyroidectomy for patients who have papillary thyroid carcinoma (PTC) and negative cervical lymph nodes metastasis and determination recommended risk factors for such surgery. METHODS: This was a prospective study, 60 patients with PTC investigated by Fine needle aspiration, ultrasonography to support diagnosis patients with PTC, and negative lymph node metastasis. Nineteen patients are excluded from the entire 60 patients; remaining 41 patients are submitted to a total thyroidectomy and prophylactic selective one side ipsilateral lateral and central lymph nodes dissection (level II, III, IV, and V). Then, follow-up 2 years for all patients, postoperatively, for detection PTC recurrence. RESULTS: The result shows that from the total 41 patients, two groups are positive and negative lymph nodes metastasis 24.4% (10) and 75.6% (31), respectively, positive lymph nodes metastasis is presented more in male 7 (70%) with significant difference (p = 0.03) and age groups <55 years old 6 (60%) with insignificant association (p = 0.413). Thyroid nodular size (>1 cm) and multiple nodules presented more in positive lymph nodes metastasis with significant difference in both. Multivariate binary logistic regression, sex, thyroid multinodularity, and thyroid nodule size were insignificant relationship of prediction of lymph nodes metastasis. CONCLUSION: Prophylactic cervical LN dissection with total thyroidectomy for patients with PTC and negative cervical lymph nodes metastasis has beneficial role in preventing recurrence of PTC. Risk factors such as male gender, thyroid multinodularity (multiple nodule), and their size (>1 cm) have role in increasing chance of occurrence of cervical LN metastasis.

PCN8 Real World Treatment Patterns, Healthcare Resource Utilization (HCRU), Economic Outcomes and Survival Associated with Esophageal Cancer in JAPAN

Esophagectomy with three-field lymph node dissection is common, but the effects of cervical lymph node dissection on overall survival in patients with thoracic esophageal cancer remain controversial. Recently, we performed thoracoscopic esophagectomy and superior mediastinum and paracervical esophageal lymph nodes could have been effectively dissected from the thoracic cavity. This study assessed the risks and benefits of prophylactic supraclavicular lymph node dissection in patients who underwent thoracoscopic esophagectomy. This retrospective study included 294 patients who underwent thoracoscopic esophagectomy at Kobe University Hospital and Hyogo Cancer Center between April 2010 and December 2015. Patients in the two-field (paracervical esophageal lymph nodes were dissected from the thoracic cavity) and three-field lymph node dissection groups were matched using propensity score matching. We compared overall survival and the incidence of postoperative complications in the matched cohort and assessed the estimated efficacy of additional lymphadenectomy for supraclavicular lymph node recurrence in the entire cohort. In the matched cohort, overall survival was not significantly different between the two groups, but the incidence of recurrent laryngeal nerve palsy was significantly higher in the 3FL group than in the 2FL group. In the entire cohort, 162 patients underwent a two-field lymph node dissection; 11 experienced supraclavicular nodal recurrence. We performed additional supraclavicular lymph node dissection in three patients without systemic metastasis, all of whom are alive without any other recurrence. Prophylactic cervical lymph nodes dissection in thoracoscopic esophagectomy does not improve long-term survival but does increase the risk of postoperative complications.

A well-established feature of papillary thyroid carcinoma (PTC) is it propensity to metastasize to cervical lymph nodes in the central and lateral compartments. Currently, there is no nonor minimally invasive method that is completely reliable for detecting all of the metastases that are present. Therefore, some have advocated prophylactic cervical lymph node dissection as part of the operative procedure for PTC. There is no unanimity, however, on the efficacy and safety of prophylactic cervical lymph node dissection for this tumor. At the recent National Thyroid Cancer Workshop II,* two distinguished surgeons, Dr. Gerard M. Doherty from the University of Michigan and Dr. David L. Steward at the University of Cincinnati, were invited to debate the pros and cons of prophylactic cervical lymph node dissection. More specifically, Dr. Doherty was asked to take the positive view and Dr. Steward the contrary view concerning prophylactic central compartment (Level VI) dissection (CLND). By definition, this is a total compartment dissection that is performed when there is no preoperative or intraoperative evidence of cervical lymph-node metastases. Each participant was asked to marshal the case for one side and not necessarily reflect their personal views. To help them prepare, they were given the following hypothetical case to consider. A 22-year-old woman is referred by her endocrinologist for surgical management of an asymptomatic 2-cm PTC diagnosed 1 week before. There is no family history of thyroid cancer, and she has had no exposure to radiation. Her thyroidstimulating hormone (TSH) level is 1.7 (IU=mL. Repeat neck ultrasonography reveals a single 2-cm right lobe thyroid nodule with a hazy border and no lateral or central neck lymph-node abnormalities. The question posed to the debaters is: What are the pros and cons of prophylactic level VI lymph-node dissection for this patient? After the workshop, these surgeons, who are recognized authorities on the surgical management of thyroid cancer, were asked to prepare written commentary based on their presentations. What follows are two concise, carefully articulated, literature-based reviews that support each side of the debate.

We assessed trends and international comparisons of net survival for patients with esophageal cancer using data from Japanese regional population-based cancer registries participating in the CONCORD-3 study. The analysis included 63 631 patients aged 15-99years diagnosed with esophageal cancer during 2000-14, with follow-up completed either 5years after diagnosis or by 31 December 2014. Five-year net survival was estimated using the Pohar Perme estimator, by sex, anatomical subsite, calendar period of diagnosis, and extent of disease. Survival estimates were age-standardized using the International Cancer Survival Standard weights. During 2000-14, the age-standardized 5-year net survival for esophageal cancer improved from 27.7% (95% CI: 26.4%-29.0%) in 2000-04 to 36.0% (34.8%-37.3%) in 2010-14. This increase corresponded with a higher proportion of patients with localized disease. In 2010-14, survival was notably higher among women, at 42.6% (39.7%-45.5%), than among men, at 36.0% (34.8%-37.3%), and among patients aged 45-54years at 39.7% (35.5%-44.0%), 55-64years at 38.9% (37.0%-40.8%), and 65-74years at 39.4% (37.8%-41.1%). Survival remained lower among the oldest patients, aged 75-99years, at 29.0% (27.0%-31.0%). By anatomical subsite, survival was highest for the "abdominal, or lower third" segment of the esophagus, followed by the "thoracic, or middle third," while the "cervical, or upper third" showed the lowest survival. Survival for esophageal cancer in Japan has improved, largely attributable to early detection. Variations by sex, age, and subsite were evident. Detailed analyses using population-based registry data will provide evidence to aid the development of effective cancer control strategies.

Although esophagectomy is the standard treatment for resectable esophageal cancer, chemoradiotherapy or radiotherapy alone is also selected for some cases. However, there have been very few detailed studies conducted on a large scale on the efficacy of these treatments in Japan. Of the patients enrolled in the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society for the 2015-2017 surveys (patients treated between 2009 and 2011), the data of 388 patients treated by definitive radiotherapy alone (RTx) and 1964 patients treated by definitive chemoradiotherapy (CRTx) were analyzed. The median age of the patients was 78years in the RTx group and 69years in the CRTx group; thus, the proportion of elderly patients was significantly higher in the RTx group than in the CRTx group (p < 0.0001). With regard to the rates of treatment by the two modalities according to the depth of invasion, extent of lymph node metastasis, and disease stage, the treatment rate by CRTx increased more significantly than that by RTx as the disease progressed (p < 0.0001). With regard to the distribution of the total irradiation dose, 11.4% and 2.3% of patients in the RTx and CRTx groups, respectively, received a dose of 67Gy or more; thus, the RTx group received significantly higher total irradiation doses (p < 0.0001). In the RTx group, the 5-year overall survival rate was 23.2%, and the rates in patients with cStage 0-I, II, III, and IV disease were 41.8%,18.5%, 9.3%, and 13.9%, respectively. In the patients of the RTx group showing complete response (CR), the 5-year overall survival rate was 46.6% and the rates in patients with cStage 0-I, II, III, and IV disease were 54.8%, 39.6%, 32.4%, and 38.9%, respectively. In the CRTx group, the 5-year overall survival rate was 30.6% and the rates in patients with cStage 0-I, II, III, and IV disease were 57.8%, 47.8%, 23.4%, and 13.0%, respectively. In the patients of the CRTx group showing CR, the 5-year overall survival rate was 59.2% and the rates in patients with cStage 0-I, II, III, and IV disease were 67.9%, 59.5%, 56.5%, and 39.6%, respectively. This study revealed the current status of treatment of esophageal cancer in Japan, and we think that we have been able to establish the grounds for explaining to patients with esophageal cancer and their families the treatment decisions made for them in daily clinical practice.

Covering the Cover

We reviewed the history of the esophageal cancer registry in Japan. The Registration Committee for Esophageal Cancer, a part of the Japan Esophageal Society, has registered cases of esophageal cancer since 1976 and published the first issue of the Comprehensive Registry of Esophageal Cancer in Japan in 1979. The Act on the Protection of Personal Information was promulgated in 2003 and began to be enforced in 2005. The esophageal cancer registry required some improvements to comply with the Act. A new registration system was considered for several years and was finally completed in 2008. Specifically, “anonymity in an unlinkable fashion” using encryption with a “hash function” was introduced. Finally, the registry resumed registering esophageal cancer cases that had been treated in 2001. Here, we briefly summarize the Comprehensive Registry of Esophageal Cancer in Japan for the years 2001–2006. A total of 28,487 cases were registered from a total of 1,352 institutions in Japan. Histological diagnoses of biopsy specimens showed that squamous cell carcinoma and adenocarcinoma accounted for 88.7–92.9 % and 2.4–3.9 % of all the cases, respectively. The 5-year survival rates of patients treated using endoscopic mucosal resection, concurrent chemoradiotherapy, radiotherapy alone, chemotherapy alone, or esophagectomy were 80.0–87.7 %, 19.3–26.4 %, 15.1–30.0 %, 1.7–8.6 %, and 42.6–50.9 %, respectively. Concerning the approach used to perform an esophagectomy, 9.9–15.9 % of the cases were performed thoracoscopically. We hope that this Comprehensive Registry of Esophageal Cancer in Japan helps to improve all aspects of the diagnosis and treatment of esophageal cancer.

BackgroundThe registration committee for esophageal cancer in the Japan Esophageal Society (JES) has collected the patients' characteristics, treatment, and outcomes of patients who underwent any treatment during 2015 in Japan.MethodsWe analyzed patients' data who had visited the participating hospitals in 2015. We collected the data using the National Clinical Database with a web-based data collection system. We used the Japanese Classification of Esophageal Cancer 10th edition by JES and the TNM classification by the Union of International Cancer Control (UICC) for cancer staging.ResultsA total of 9368 cases were registered from 355 institutions in Japan. Squamous cell carcinoma and adenocarcinoma accounted for 86.7% and 7.4%, respectively. The 5-year survival rates of patients treated by endoscopic resection, concurrent chemoradiotherapy, radiotherapy alone, and esophagectomy were 87.2%, 33.5%, 24.2%, and 59.9%, respectively. Esophagectomy was performed in 5172 cases. Minimally invasive approaches were selected for 60.6%, and 54.4% underwent thoracoscopic esophagectomy. The operative mortality (within 30 days after surgery) was 0.79% and the hospital mortality was 2.3%. The survival curves showed an excellent discriminatory ability both in the clinical and pathologic stages by the JES system. The survival of pStage IV was better than IIIC in the UICC system because pStage IV included the patients with supraclavicular lymph node metastasis (M1 LYM).ConclusionWe hope this report improves all aspects of diagnosing and treating esophageal cancer in Japan.

BackgroundThe registration committee for esophageal cancer in the Japan Esophageal Society (JES) has collected the patients' characteristics, treatment, and outcomes annually.MethodsWe analyzed the data of patients who had visited the participating hospitals in 2014. We collected the data with a web-based data collection system using the National Clinical Database. We used the Japanese Classification of Esophageal Cancer 10th edition by JES and the TNM classification 7th edition by the Union of International Cancer Control (UICC) for cancer staging.ResultsA total of 9026 cases were registered from 344 institutions in Japan. Squamous cell carcinoma and adenocarcinoma accounted for 87.9% and 7.1%, respectively. The 5-year survival rates of patients treated using endoscopic resection, concurrent chemoradiotherapy, radiotherapy alone, and esophagectomy were 87.1%, 33.7%, 25.3%, and 59.3%, respectively. Esophagectomy was performed in 5204 cases. Concerning the approach used for esophagectomy, 48.1% of the cases were treated thoracoscopically. The operative mortality (within 30 days after surgery) was 0.75%, and the hospital mortality was 2.0%. The survival curves showed an excellent discriminatory ability both in the clinical and pathologic stages by the JES system. The survival of pStage IV was better than IIIC in the UICC system, because pStage IV included the patients with supraclavicular lymph-node metastasis (M1 LYM).ConclusionWe hope that this report contributes to improving all aspects of diagnosing and treating esophageal cancer in Japan.

BackgroundIn definitive chemoradiotherapy (CRTx) for esophageal cancer, a radiotherapy (RT) dose of 50.4 Gy in 28 fractions has been the standard in many countries, while 60 Gy in 30 fractions has been frequently used in Japan. To clarify the optimal RT dose in CRTx for esophageal cancer, we compared clinical outcomes with the two doses using data from the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society (JES).MethodsOf the patients enrolled in the registry for 2015–2017 surveys (patients treated between 2009 and 2011), 996 patients who received definitive CRTx with 50.4 Gy or 60 Gy for thoracic esophageal cancer were eligible for analysis.ResultsThe complete response (CR) rates in the 50.4 Gy and 60 Gy groups were 49.1% and 46.4%, respectively (p = 0.5851). The 5-year overall survival (OS) rates in the 50.4 Gy group and 60 Gy group for stages I, II/III and IV were 64.2% and 57.2%, 35.0% and 27.0%, and 18.0% and 15.3%, respectively. Since no significant difference was found between the two groups, the 50.4 Gy group was not inferior to the 60 Gy group with regard to OS.ConclusionsThe analysis revealed that the 50.4 Gy group had a non-inferior outcome in comparison with the 60 Gy group for stages I, II/III and IV thoracic esophageal cancer. These results were obtained from a large database for the first time in Japan.

There has been no definitive evidence of chemoradiotherapy being superior to radiotherapy alone in patients aged 80years or older. The purpose of the present study was to evaluate the results of radiotherapy and chemoradiotherapy in patients aged 80years or older with esophageal cancer in the Japanese Nationwide Cancer Database. A total of 358 patients aged 80years or older who were treated with radiotherapy alone or with chemoradiotherapy for esophageal cancer between 2009 and 2011 were enrolled. The 5-year overall survival (OS) rates in patients with cStages 0-I, II, III and IV were 40.9%, 24.7%, 12.2% and 4.9%, respectively. The 5-year cause-specific survival (CSS) rates in patients aged 80years or older with cStages 0-I, cStage II, cStage III and cStage IV were 73.5%, 41.4%, 25.3% and 7.4%, respectively. In patients treated with radiotherapy alone, the 5-year OS rates for patients with cStages 0-I, II, III and IV were 36.5%, 12.0%, 5.4% and 0%, respectively. In patients treated with chemoradiotherapy, the 5-year OS rates for patients with cStages 0-I, II, III and IV were 45.0%, 36.1%, 16.4% and 7.1%, respectively. In multivariate analysis, chemoradiotherapy, early stage and squamous cell carcinoma were significantly favorable prognostic factors for OS in patients aged 80years or older (p < 0.001, p < 0.001 and p = 0.0323, respectively). We were unable to evaluate toxicities, because of lack of information in the registry. Concurrent chemotherapy with radiotherapy for esophageal cancer in patients aged 80years or older is a significantly favorable prognostic factor for OS. However, chemoradiotherapy should be carefully selected in elderly patients.

15183 Background: 5 year survival rate of esophageal cancer in Japan reported to the Japanese Society for Esophageal Diseases from 1988 to 1994 (9,143 cases) was improved to 35.5% comparing to the rate of the beginning of 1980 which remained around 20%. This result was given by the increase of early cancer cases attributed to the progress of the ability of diagnosis, the improvement of the postoperative management, and the 3 field lymph node dissection introduced from the middle of 1980. Biological malignant potential and the modality of treatment for esophageal cancer in Japan differs from those in the United States. Methods: We studied clinicopathological characteristic and treatment results of 63 esophageal cancer patients in our institute from 1999 to 2005. Results: 63 patients consisted of 47 males and 16 females with mean age of 63.4±11.4. Out of 47 patients who underwent surgical treatment, 6 and 4 patients underwent neoadjuvant chemoradiotherapy and chemotherapy, respectively. 15 patients without surgical treatment consisted of 12 patients, including one patient after endoscopical mucosal resection, undergoing chemoradiotherapy, 2 patients undergoing chemotherapy, and 3 patients undergoing radiotherapy, respectively. Most common histological type was squamous cell carcinoma (55 patients), followed by adenocarcinoma (3 patients), small cell carcinoma(3 patients), others(2 patients), and unknown(1 patients). There was 1 surgical treatment-related death. The major complications were SSI (18 patients), anastomotic leakage(7 patients) and recurrent nerve palsy (5 patients). The 2-year survival rate of patients with surgical resection was 68.1%, while the rate of the unresectable patients was 38.9%.Since 2002, we have adopted posterior mediastinal route as a prime choice, rather than retrosternal route. The median amount of blood loss, rate of complications and duration of post operative hospital stay of each routes are 650/415(ml), 65/45(%), 35/22(day), respectively. These results suggested that posterior mediastinal route showed superiority comparing to restrosternal route. Conclusions: Backed by these outcomes, we will aim to establish a logical strategy for esophageal cancer therapy which could accompany fewer complications, respect quality of life and prolong survival time. No significant financial relationships to disclose.

To clarify whether routine thoracic duct (TD) resection improves the prognosis of patients with esophageal cancer after radical esophagectomy. Although TD resection can cause nutritional disadvantage and immune suppression, it has been performed for the resection of surrounding lymph nodes. We analyzed 12,237 patients from the Comprehensive Registry of Esophageal Cancer in Japan who underwent esophagectomy between 2007 and 2012. TD resection and preservation groups were compared in terms of prognosis, perioperative outcomes, and initial recurrent patterns using strict propensity score matching. Particularly, the year of esophagectomy and history of primary cancer of other organs were added as covariates. After propensity score matching, 1638 c-Stage I-IV patients participated in each group. The 5 year overall survival and cause-specific survival rates were 57.5% and 65.6% in the TD-resected group and 55.2% and 63.4% in the TD-preserved group, respectively, without significant differences. The TD-resected group had significantly more retrieved mediastinal nodes (30 vs 21, P < 0.0001) and significantly fewer lymph node recurrence (376 vs 450, P = 0.0029) compared with the TD-preserved group. However, the total number of distant metastatic organs was significantly greater in TD-resected group than in the TD-preserved group (499 vs 421, P = 0.0024). TD resection did not improve survival in patients with esoph-ageal cancer. Despite having retrieved more lymph nodes, TD resection caused distant metastases in more organs compared to TD preservation. Hence, prophylactic TD resection should not be recommended in patients with esophageal cancer.