Advanced Stage Esophageal Cancer Research Articles

637. UPFRONT SURGERY IN ESOPHAGEAL CANCER: ACCURACY OF PREOPERATIVE CLINICAL STAGING

Abstract Background Treatment of locally limited esophageal cancer is still a frequently discussed topic. Especially, the inaccuracy of clinical staging in lymph node-negative T2-carcinomas has to be considered further in the treatment pathway. Aim of this study was to evaluate the accuracy of clinical staging in patients treated with esophagectomy without neoadjuvant treatment. Methods We conducted a retrospective multicenter analysis at the departments of surgery from two university clinics. All patients between January 2016 and December 2023, who underwent an esophagectomy because of an esophageal adenocarcinoma or squamous cell carcinoma without neoadjuvant treatment were included. Advanced tumor stage, T staging greater than T2, was defined as exclusion criteria. Results Fifty-three patients after upfront esophagectomy were included in the analysis. In 40 (75%) patients a gastroesophageal junction adenocarcinoma was diagnosed, and 13 (25%) patients were treated because of a squamous cell carcinoma of the esophagus. Clinical T staging was T1 or T2 and all lymph node stages were included. The endosonographic preoperative staging of invasion depth was accurate in 32 (60%) patients in comparison to the histopathological staging. In 7 (13%) cases the T-values were upstaged one level and in 5 (9%) cases one level downstaged after resection. The endosonographic preoperative staging of nodal spread was accurate in 32 (60%) patients. Furthermore, in 7 (13%) cases node status was upstaged and in 5 (9%) patients downstaged. Nine (17%) patients did not undergo a sufficient endosonographic staging, mainly due to prior endoscopic submucosal dissection or stenosis. In these patients, clinical lymph node staging was accurate in 4 patients. Conclusion Preoperative staging using endoscopic ultrasound and computed tomography is not accurate enough in a high number of patients, therefore we are seeking to identify other predictive factors underlying advanced stage esophageal cancer.

Correlation between morphological parameters and dosimetric parameters of the heart and spinal cord in the intermediate- and advanced-stage esophageal cancer.

Radiation therapy plays a pivotal role as the primary adjuvant treatment for esophageal cancer (EPC), emphasizing the critical importance of carefully balancing radiation doses to the target area and organs at risk in the radiotherapeutic management of esophageal cancer. This study aimed to explore the correlation between morphological parameters and dosimetric parameters of the heart and spinal cord in intermediate- and advanced-stage esophagus cancer to provide a reference for clinical treatment. A total of 105 patients with intermediate- and advanced-stage EPC, who received treatment in our hospital from 2019 to 2021, were included. The morphological parameters were calculated by imaging. Intensity-modulated radiation therapy plan was executed at Raystation4.7. The PTV-G stood for the externally expanded planning target volume (PTV) of the gross tumor volume (GTV) and PTV-C for the externally expanded volume of the clinical target volume (CTV). The prescription dose of PTV-G and PTV-C was set as 60Gy/30F and 54Gy/30F, respectively. The linear regression model was used to analyze the correlation between morphologic parameters of EPC and dosimetric parameters of the heart and spinal cord. In 105 cases, the total lung length was correlated with the spinal cord maximum dose (D2 ). The heart mean doses (Dmean ) and heart V40 (the relative volume that receives 40 Gy or more) was correlated with PTV-G volume, PTV-G length; In middle- and upper-segment EPC cases, only the total lung volume was correlated with the spinal cord Dmean , spinal cord D2 , heart Dmean , and heart V40 ; In middle-stage EPC cases, the heart Dmean was correlated with the PTV-G volume, PTV-G length. The total lung length was correlated with the spinal cord D2 ; In middle- and lower-segment EPC, only the PTV-G volume and PTV-G length were correlated with the heart Dmean . All the aforementioned values were statistically significant. Combined with the unsegmented tumor and different locations, the organ at risk dose was comprehensively considered.

Clinical T2 N0 M0 Esophageal Cancer: Identifying Predictive Factors of Upstaging

BackgroundInaccuracy of clinical staging renders management of clinical T2 N0 M0 (cT2 N0 M0) esophageal cancer difficult. When an underlying advanced-stage disease is understaged to cT2 N0 M0, patients miss the opportunity to gain the potential benefits of neoadjuvant therapy. This study aimed to identify preoperative factors that predict underlying advanced-stage esophageal cancer. MethodsFrom 2000 to 2020, 1579 patients with esophageal cancer underwent esophagectomy. Sixty patients who underwent upfront surgery for cT2 N0 M0 esophageal cancer were included in this study. The median age was 62.5 years, and 78% (n = 47) of these patients were male. Radiologic, clinical, and endoscopic factors were evaluated as preoperative markers. The Fisher exact and the Wilcoxon rank sum tests were used for categoric and continuous variables, respectively. Random forest classification was used to identify preoperative factors for predicting upstaging and downstaging. ResultsOf the 60 patients, 8 (13%) were found to have pathologic T2 N0 M0 esophageal cancer. Sixteen (27%) patients had cancer that was pathologically downstaged, and 36 (60%) had upstaged disease. Seven (19%) patients had upstaged cancer on the basis of the pathologic T stage, 14 (39%) had upstaging on the basis of the pathologic N stage, and 15 (42%) had upstaging on the basis of both T and N stages. Dysphagia (P = .003) and tumor maximum standardized uptake value (P = .048) were predictors of upstaging, with a combined predictive value of up to 75%. ConclusionsThe presence of dysphagia and of high maximum standardized uptake value (≥5) of the tumor is predictive of more advanced underlying disease for patients with cT2 N0 M0 esophageal cancer, and these patients should be considered for neoadjuvant therapy.

Immunotherapy Plus Chemoradiation Improves Overall Survival in Stage IV Esophageal Cancer: A Cohort Study

The association of immunotherapy in combination with radiation therapy (RT) or chemoradiation with the overall survival (OS) of patients diagnosed with stage IV esophageal cancer (EC) is unknown. The aim of the current study is to explore the association of immunotherapy with OS in patients with advanced stage EC who received chemotherapy, RT, or chemoradiation. We conducted a cohort study using the National Cancer Database and included patients diagnosed between 2013 and 2020 with stage IV esophageal adenocarcinoma or squamous cell carcinoma. The association of immunotherapy with OS was assessed with Cox proportional hazards regression, adjusted for age at diagnosis, race, sex, stage, histology, Charlson score, education, income, insurance, hospital type, place of living, region, distance to facility, year of diagnosis, and treatment modality. Of 18,260 patients, 2946 (17%) received immunotherapy. In the multivariable COX analysis, patients who received immunotherapy had significantly improved OS compared with no immunotherapy (hazard ratio [HR]: 0.71; 95% confidence interval [CI]: 0.67-0.75; P < .001). Chemotherapy plus immunotherapy was associated with improved OS compared to chemotherapy alone (HR: 0.69; 95% CI: 0.64-0.75; P < .001). RT plus immunotherapy was associated with improved OS compared to RT alone (HR: 0.60; 95% CI: 0.46-0.78; P < .001). Treatment with chemoradiation plus immunotherapy was associated with significantly improved OS compared with chemoradiation alone (HR 0.78; 95% CI: 0.71-0.86; P < .001). The addition of immunotherapy to chemotherapy, RT, and chemoradiation was associated with improved OS compared with chemotherapy alone, RT alone, or chemoradiation alone in patients with stage IV EC.

The association between mortality and use of Chinese herbal medicine among incident stage IV esophageal cancer patients: A retrospective cohort study with core herbs exploration.

Esophageal cancer (EC) remains a leading cause of death worldwide and in Taiwan. The prognosis of advanced-stage EC is notably poor, and the treatment options are limited. Chinese herbal medicine (CHM) has been widely used as a complementary treatment for cancer, yet the long-term effect of CHM in stage IV EC remains unclear.The multi-institutional cohort obtained from the Chang Gung research database (CGRD) was used to study the long-term outcome of CHM use among incident stage IV EC patients from 1 January 2002, to 31 December 2018. All patients were followed up to 5 years or the occurrence of death. The overall survival (OS) and disease-specific survival rates were conducted using Kaplan-Meier estimation. Overlap weighing and landmark analysis were used to eliminate confounding and immortal time biases. Furthermore, we demonstrated the core CHMs for stage IV EC by using the Chinese herbal medicine network (CMN) analysis on prescriptions.Nine hundred eighty-five stage IV EC patients were analyzed, including 74 CHM users and 911 non-CHM users. We found the use of CHM was associated with a higher 5-year overall survival rate than CHM nonusers (the cumulative probability: 19.52% versus 6.04%, log-rank test: p < 0.001, and the p < 0.001 with overlap weighting). In addition, the overall median survival time was about 7 months longer among CHM users. Moreover, the lower 1-, 3-, 5-year disease-specific survival rates were higher among CHM users. Additionally, the risk of all-cause mortality was lower among CHM users when considering accessible demographic covariates (adjusted hazard ratio: 0.59, 95%CI: 0.39, 0.89, p = 0.011). Furthermore, the CMN analysis revealed that CHMs improved health while relieving tumor burden. For example, Hedyotis diffusa Willd . was the core CHM with an anti-cancer effect, while Fritillaria thunbergii Miq and Sevilla maindronide Rochebrune were used together to relieve cancer-related gastrointestinal discomfort.The use of CHM seems safe and possibly beneficial among stage IV EC patients with a higher 5-year OS. Further clinical trials on CHM were guaranteed to explore the role of CHM in managing stage IV EC patients.

Effect of adding immunotherapy to standard of care on survival in patients with esophageal cancer: Analysis of NCDB database.

325 Background: Combined immuno-chemotherapy has been shown to be more effective than chemotherapy alone in advanced esophageal cancer. However, the association of immunotherapy and overall survival (OS) of patients with esophageal cancer, regardless of stage and combined therapy, is unknown. The objective is to explore the association of immunotherapy with OS in patients with all stage esophageal adenocarcinoma or squamous cell carcinoma who received any treatment. Subset analysis was conducted on OS for patients who received chemoradiation with and without immunotherapy. Methods: This study included 85,900 adult patients in the National Cancer Database diagnosed between 2004 and 2017 with stage I-IV esophageal adenocarcinoma or squamous cell carcinoma. The association of immunotherapy with OS was assessed with Cox proportional hazards regression, adjusted for age at diagnosis, race, sex, stage, histology, Charlson score, education, income, insurance, hospital type, place of living, region, distance to facility, year of diagnosis and treatment modality. Results: Of 85,900 patients, 69,264 (81%) were men, 85,159 (88%) were White and 7,875 (9%) were Black. The median (range) age at diagnosis was 64 (18-90) years. Overall, 1990 (2.3%) received immunotherapy. Immunotherapy did not improve median OS in stage I-II (31 vs 27M, p &gt;.05) but improved median OS in stage III (from 18 to 30 M, p &lt;.0001) and IV (from 8 to 14 M p &lt;.0001). In the multivariable COX analysis, patients who received immunotherapy had significantly improved OS compared with no immunotherapy (HR 0.756; 95% CI 0.713-0.801; P =.001). Treatment with CRT without surgery plus immunotherapy was associated with significantly improved OS compared with CRT alone (HR 0.817; 95% CI 0.745-0.896; P =.001). Interestingly, addition of immunotherapy to CRT with surgery did not improve OS compared with CRT and surgery. After stratified by stage, immunotherapy was found to be associated with improved OS only in stage IV patients either in all patients (HR 0.685; 95% CI 0.641-0.731, p &lt; 0.001) or in patients who received CRT without surgery (HR 0.758; 95% CI 0.682-0.841). Conclusions: In this study, the addition of immunotherapy to standard of care, especially chemoradiation without surgery was associated with improved OS compared with standard of care (or chemoradiation) alone in patients with advanced stage esophageal cancer.

Modern concepts of systemic treatment for adjuvant and palliative treatment of locally advanced or metastasized esophageal cancer

The approval of awide variety of PD-1/PD-L1 and CTLA‑4 inhibitors has sustainably influenced the treatment landscape in many tumor entities and established immunotherapy as anew oncological treatment strategy. This article summarizes the current clinical state of treatment for locally advanced and metastatic esophageal cancer and assesses the running and future developmental program and the implementation in the clinical routine. Publications from Medline, ASCO and ESMO were systematically collected and evaluated. Many phaseI-III trials focusing on immunotherapy for gastrointestinal tumors were carried out in recent years but were however without comparable success to other tumor entities and with only moderate response rates between 10% and 25% in monotherapy. Subgroups such as microsatellite instability (MSI) cancers and tumors overexpressing PD-L1 seem to particularly benefit from treatment with immune checkpoint inhibitors. Routine testing for known molecular alterations should therefore be carried out with all advanced esophageal cancers. Initial promising approaches with a combination of chemotherapy and immunotherapy were recently published and could become new treatment standards for esophageal cancer. Due to the survival advantage with a combination of chemotherapy and immunotherapy for untreated advanced stage esophageal cancer, it seems likely that this treatment strategy will become established as anew standard of care, assuming approval is granted. Immunotherapy might also become important in the adjuvant treatment of esophageal cancer.

Clinical utility of robot-assisted transthoracic esophagectomy in advanced esophageal cancer after neoadjuvant chemoradiation therapy.

Although robot-assisted minimally-invasive esophagectomy (RAMIE) surgeries are expanding clinically, few studies have reported patients with locally-advanced esophageal cancer who underwent neoadjuvant chemoradiation therapy (nCRT). From 2013 to 2017, 219 patients with esophageal squamous cell carcinoma underwent RAMIE and 35 of them received nCRT at our institution. During the period, 289 patients underwent conventional open esophagectomy (OE) and 111 patients underwent nCRT. We compared postoperative mortality and morbidity of RAMIE and OE patients after nCRT. In patients who received nCRT, the RAMIE and OE groups had similar operative time, estimated blood loss, early-period mortality, and recurrence rate (≤1 year) and both groups showed a high rate of complete resection. With respect to postoperative morbidities, such as anastomotic leakage, chylothorax, postoperative bleeding, and wound infection, only vasopressor use was significantly higher in the OE group (P<0.001). The RAMIE group had a lower, but not statistically significant, postoperative pneumonia incidence than the OE group (5.7% vs. 13.5%, P=0.341). In patients who received nCRT for locally-advanced esophageal cancer, RAMIE is safe and feasible with comparable postoperative mortality and morbidity to conventional OE. Patients with advanced-stage esophageal cancer who received nCRT may be surgical candidates for RAMIE.

Adverse Prognostic Factors of Advanced Esophageal Cancer in Patients Undergoing Induction Therapy with Docetaxel, Cisplatin and 5-Fluorouracil

The purpose of this study was to identify adverse prognostic factors for patients with advanced esophageal cancer undergoing chemotherapy with docetaxel, cisplatin and 5-fluorouracil (DCF). The study cohort comprised of 45 patients with advanced esophageal cancer who underwent induction DCF therapy followed by esophagectomy or chemoradiotherapy. Treatment outcomes and factors affecting early recurrence and death were analyzed. Overall 3-year survival was 61.4%, and 3-year disease-free survival was 44.7%. Clinically evident lymph node metastasis and clinical stage were associated with recurrence within 1 year and death within 2 years. Low maximum standardized uptake value (SUVmax) after induction DCF therapy and small decreases in SUVmax from pre- to post-DCF therapy were also predictors of recurrence and poor prognosis. Induction DCF therapy may be ineffective for advanced-stage esophageal cancer and clinical lymph node metastasis (≥N2, ≥stage IIIB). Moreover, small decreases in SUVmax DCF therapy are associated with early disease relapse and death.

Self-expandable metallic stent application for the management of upper gastrointestinal tract disease.

The aim of the present study was to share our experiences of the use of self-expandable metallic stent for the upper gastrointestinal tract disease. We retrospectively reviewed the medical records of 18 patients who underwent self-expandable metallic stent implantation procedure for anastomosis stricture, anastomosis leak, or spontaneous fistula of the upper gastrointestinal tract at two different surgery clinics. Self-expandable metallic stent implantation procedures were performed while keeping the patient under sedation and the correct stent localization was verified using fluoroscopy. The stent localization and possible stent migration were checked using X-ray films taken a few days after the stenting procedure. Overall, 25 self-expandable metallic stents were implanted in 18 patients (malignant, 13; benign, 5) aged between 19 and 89 years. The indications for self-expandable metallic stent implantation were as follows: malignant gastric stricture (inoperable; n=6), malignant esophageal stricture (inoperable; n=4), staple line leak (laparoscopic sleeve gastrectomy; n=4), esophagojejunostomy anastomotic leak (total gastrectomy+Roux-en-Yesophagojejunostomy; n=2), and stricture (total gastrectomy+Roux-en-Yesophagojejunostomy; n=1), and esophagopleural fistula (pulmonary tuberculosis; n=1). A favorable outcome was achieved in a single session in 15 patients, whereas more than two sessions of stenting were necessary in the remaining three patients. Among the patients who underwent esophagojejunal anastomosis (n=3), self-expandable metallic stents were successfully deployed in a single session in two patients to relieve anastomosis leak (n=1) and anastomosis stricture (n=1); the remaining patients underwent four self-expandable metallic stent implantation procedures to relieve anastomosis leak and subsequent recurrent strictures. No complications developed during the stenting procedure. Three of the four patients who developed mortality had advanced stage esophageal cancer, whereas one patient had morbid obesity and developed staple line leakage. Endoscopic self-expandable metallic stent implantation under fluoroscopic guidance is a low-morbidity and effective procedure for the management of advanced stage tumors of the gastrointestinal tract and the elimination of postoperative complications.

Gefitinib single drug in treatment of advanced esophageal cancer.

The objective of this study is to evaluate the clinical efficacy and toxicity of gefitinib single drug in treatment of advanced esophageal cancer. Forty-one case of advanced esophageal cancer were included from February 2012 to June 2016 in the Department of Oncology, Huaihe Hospital of Henan University. All of the included 41 cases were pathology or cytology confirmed of esophageal cancer with advanced stage with previously chemotherapy regimen of cisplatin or fluorouracil. The patients received gefitinib 250 mg/day orally until disease progression or development of unbearable drug-related toxicity. The objective response rate, overall survival, disease-free survival, and drug-related toxicity were recorded. All of the 41 cases had evaluable lesions with complete response rate of 0.0% (0/41), partial response rate of 4.9% (2/41), stable disease rate of 34.1% (14/41), and progression disease rate of 61.0% (25/41). The objective response rate and disease control rate were 4.9% (2/41) and 39.0% (25/41), respectively. At the follow-up, end-point of October 2016, we observed 33 death of the included 41 patients with median disease progression time of 2.2 months and median survival time of 6.1 months; most of the drug-related toxicity was Grade 1-3 nonhematological toxicity with the incidence of Grade 1-2 rash of 51.2% (21/41), Grade 3-4 rash of 17.1% (7/41), Grade 1-2 diarrhea of 26.8% (11/41), Grade 3-4 diarrhea of 7.3% (3/41), Grade 1-2 nausea and vomiting of 14.6% (6/41). Gefitinib can improve the survival rate and quality of life in patients with advanced stage esophageal cancer who failed for first-line chemotherapy.

Curative efficacy of thalidomide in combination with irinotecan and concurrent radiotherapy for treatment of patients with middle and advanced-stage esophageal cancer and its effect on serum vascular endothelial growth factor

Curative efficacy of thalidomide in combination with irinotecan and concurrent radiotherapy for treatment of patients with middle and advanced-stage esophageal cancer and its effect on serum vascular endothelial growth factor

Safety of Cryotherapy in Advanced Stage Esophageal Cancer, A Very Cool Treatment Option

Introduction: Cryotherapy is a relatively new modality approved for tissue destruction in the gastrointestinal tract and has been shown to be safe in early esophageal cancer with efficacy in eradicating the cancer in some patients. There is, however, very limited data on cryotherapy in advanced esophageal cancer when used for palliation of dysphagia. Objective: To assess the safety of cryotherapy in advanced esophageal cancer as defined by T stage more than T2. Methods: Design: Single center retrospective cohort study. Setting: Tertiary care academic medical centers between 2006 and 2013. Patients: Subjects with esophageal cancer who were not surgical candidates and in whom conventional therapy failed, and those who refused or were ineligible for conventional therapy. Interventions: Cryotherapy with liquid nitrogen or carbon dioxide performed every 6 weeks for relief of dysphagia. The duration of freeze and number of cycles were determined based on the endoscopist impression of tumor and symptom response to the prior treatment session. Main Outcome Measurements: Complications.Figure 1Results: Thirty-two cryotherapy sessions were performed on patients with T3 esophageal cancer, including adenocarcinoma and squamous cell carcinoma in both the upper and lower third of the esophagus. If a decompression tube could be placed into the stomach, treatment with liquid nitrogen was performed and consisted of 3 to 4 cycles of 20 to 30 seconds of freeze and 45 seconds of thaw. If a decompression tube could not be placed because of the inability to traverse the tumor, then carbon dioxide was used with 7 to 12 cycles of 10 to 30 seconds of freeze and 45 to 60 minutes of thaw time. No immediate adverse events other that mild chest pain were reported. One patient developed a trachea-esophageal fistula in between cryotherapy cycles and required stenting. Conclusion: Spray cryotherapy appears to be safe and well-tolerated in patients with advanced stage esophageal cancer. Prospective well-designed studies to determine the efficacy of cryotherapy in this setting are needed. If proven effective, cryotherapy for dysphagia palliation in patients with advanced esophageal cancer will be a good treatment option for these patients with limited options.

Prognostic importance of serum CRP, prealbumin, and transferrin levels in patients with advanced stage esophageal cancer

Amac: Bu calismada stent takilarak tedavi edilen ileri evre ozofagus kanserli hastalarda serum C-reaktif protein (CRP), prealbumin ve transferrin duzeylerinin prognostik degeri arastirildi. Ca­lis­ma­ pla­ni:­ Temmuz 2007 ve Aralik 2008 tarihleri arasinda gerceklestirilen prospektif randomize bir calismada lokal olarak ilerlemis hastalik veya uzak organ metastazi nedeniyle stent takilarak tedavi edilen ardisik 61 hastada, stent takilmadan 1-3 gun once serum CRP, prealbumin ve transferrin duzeyleri calisildi. Tum hastalar olunceye kadar takip edildi. Bul gu lar: Stent tum hastalarda basari ile takilarak oral alim tekrar saglandi. Isleme bagli mortalite gozlenmedi. Hastalarin ortalama sagkalim suresi 164.3±120.3 gun (dagilim 15-450 gun) idi. Serum CRP seviyesi ≥10 mg/L olan hastalarda (n=38) ortalama sagkalim 103.2±82.3 gun iken serum CRP seviyesi <10 mg/L olan hastalarda (n=23) ortalama sagkalim 265.4±121.2 gun idi. Serum prealbumin seviyesi ≥15 mg/L olan hastalarda (n=28) ortalama sagkalim 237.5±132.7 gun iken serum prealbumin seviyesi <15 mg/L olan hastalarda (n=33) ortalama sagkalim 102.3±79.6 gun idi. Serum transferrin seviyesi ≥200 mg/L olan hastalarda (n=25) ortalama sagkalim 211.6±130.2 gun iken serum transferrin seviyesi <200 mg/L olan hastalarda (n=36) ortalama sagkalim 131.5±113.8 gun idi. Referans serum CRP, prealbumin ve transferrin seviyelerinin sagkalimla iliskisi istatistiksel olarak anlamli idi (sirasiyla p<0.001, p<0.001 ve p=0.003). So­nuc:­ Ileri evre ozofagus kanserli hastalarda ozofageal stent uygulamasindan once serum CRP, prealbumin ve transferrin duzeyleri kolaylikla saptanabilir ve hastalarin prognozlari hakkinda fikir elde edilebilir. Anah tar soz cuk ler: C-reaktif protein; ozofagus kanseri; prealbumin; sagkalim; transferrin. Background:­ This study investigated the prognostic value of serum C-reactive protein (CRP), prealbumin, and transferrin levels in patients with advanced stage esophageal cancers treated with stent placement. Methods: In a prospective, randomized study conducted between July 2007 and December 2008, serum CRP, prealbumin, and transferrin levels were determined 1-3 days prior to stent placement in 61 consecutive patients who underwent stent placement due to locally advanced disease or distant organ metastasis. All patients were followed until death. Results:­The stent was successfully placed in all patients and oral intake was restored. There was no procedure-related mortality. The mean survival period of the patients was 164.3±120.3 days (range 15 to 450 days). Whereas the mean survival period was 103.2±82.3 days in patients with a serum CRP level ≥10 mg/L (n=38), it was 265.4±121.2 days in patients with a serum CRP level <10 mg/L (n=23). While the mean survival period was 237.5±132.7 days in patients with a serum prealbumin level ≥15 mg/L (n=28), the mean survival period was 102.3±79.6 days in patients with a serum prealbumin level <15 mg/L (n=33). The mean survival period was 211.6±130.2 days in patients with a serum transferrin level ≥200 mg/L (n=25) while the mean survival period was 131.5±113.8 days in patients with a serum transferrin level <200 mg/L (n=36). The relationship between serum CRP, prealbumin, and transferrin levels in reference to survival was statistically significant (p<0.001, p<0.001, and p=0.003, respectively). Conclusion:­Serum CRP, prealbumin, and transferrin levels can easily be measured prior to esophageal stent placement in patients with advanced stage esophageal cancer and the results may give an idea on the prognosis of the patients.

New endoscopic and surgical treatment options for early esophageal adenocarcinoma

Although the outcome for advanced stage esophageal cancer is poor, the early detection and treatment of early stage disease is usually associated with a much better outcome. Until recently, esophagectomy has been the treatment of choice in fit patients. However, morbidity is significant, and this has encouraged the development of newer endoscopic treatments that preserve the esophagus. These techniques include ablation and mucosal resection. Promising results are described, and endoscopic methods might provide a reasonable alternative for the treatment of early esophageal cancer. However, follow-up remains short and endoscopic treatment does not deal with potential lymphatic spread. Hence, careful selection is required. Minimally invasive techniques for esophageal resection have also been shown to be feasible, although there is only limited evidence that they reduce postoperative morbidity. Better data are still required to demonstrate improved outcomes from endoscopic treatment and minimally invasive esophagectomy.

Overall survival and clinically deficient quality of life in patients with esophageal cancer or Barrett's esophagus: A Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry Consortium study.

4109 Background: Survival in patients (pts) with cancer has been linked to pt-reported clinically deficient quality of life (cdQOL). We examined patient-reported QOL and overall survival (OS) in pts with esophageal cancer (EC) or Barrett esophagus (BE) previously enrolled in the Mayo Clinic Esophageal Adenocarcinoma and Barrett's Esophagus Registry (EABE). Methods: Pts enrolled in the EABE between 09/01 and 01/09 returned a baseline questionnaire including a validated numerical analogue measure of overall QOL. Pts were categorized as having cdQOL at enrollment as defined by a score of ≤ 5 on a 0-10 scale. Kaplan-Meier methodology and Cox models explored OS in relation to cdQOL in pts with EC and BE. Results: 1,498 pts were included for analysis, 831 had BE (max follow-up of 7.5 years) and 667 had EC (max follow-up of 7.7 years). CdQOL was less likely in BE pts than EC pts (11% vs 28%). Five-year OS rate was significantly less in BE and EC for the cdQOL group (differences of 11% and 24%). Pts, where staging is available, having early stage (T1-2N0M0) EC (158 pts) or locally advanced stage EC (370 pts) had lower 5-year survival rate if they reported cdQOL (27% vs. 73%, HR=0.24, p<0.0001) and (13% vs. 25%, HR=0.58, p<0.0001). None of the pts with metastatic (TxNxM1b) disease (n=62) who had cdQOL survived to 5 years compared to 3% for those with non-cdQOL (p=0.56). Median survival was also significantly less in cdQOL early stage and locally advanced, but not metastatic, EC groups. Conclusions: A deficit in QOL is strongly associated with OS in patients with BE and nonmetastatic EC. CdQOL is a significant predictor of OS in patients with EC and should be considered as a stratification factor in the design of clinical trials. Predictor N (events) 5-year survival rate Cox proportional hazard p value HR (95% CI) BE (N = 831, 77 events) QOL ≤ 5 (cdQOL)QOL > 5 91 (18) 740 (59) 77% (66%–89%)88% (85%–91%) <0.0001 0.30 (0.18–0.51) EC (N = 667, 350 events) QOL ≤ 5 (cdQOL)QOL>5 191 (130)476 (220) 14% (9%–23%)38% (33%–45%) <0.0001 0.46 (0.37–0.58) No significant financial relationships to disclose.

Novel targeted therapies for advanced esophageal cancer

Esophageal cancer is highly aggressive and is the sixth leading cause of cancer death worldwide. Recent advances in multimodality chemoradiotherapy and surgery has improved survival in patients with loco-regional disease, but most patients with advanced stage esophageal cancer have a poor prognosis. Elucidation of the processes involved in esophageal carcinogenesis has identified a number of promising novel targets for therapy. This review focuses on the current status of targeted therapies with potential application to the treatment of advanced esophageal and gastroesophageal junction cancer. The future challenge is to confirm the efficacy of these targeted agents in appropriately selected esophageal cancer patients, and successfully integrate these agents into effective therapies for all stages and subtypes of disease.

Study of 16 cases with advanced stage esophageal cancer were local chemotherapy treated by gastroendoscopy

目的 探讨经内镜局部化疗治疗晚期食管癌的临床疗效.方法将30例晚期上段食管癌患者随机分为两组:治疗组14例,经内镜局部化疗,并联合放疗;对照组16例进行传统的外科姑息手术治疗,也联合放疗.结果治疗组与对照组近期缓解率分别为85.71%、68.75%,1年生存率分别为71.42%、50%.结论经内镜局部化疗对晚期上段食管癌有较好疗效。

3501 Endoscopic fibrin sealant injection with application of hemostatic clips: a novel method of closing a refractory gastrocutaneous fistula.

Background: Management of non-healing gastrocutanous fistula is difficult especially in debilitated patients. Methods: On an elderly man with advanced stage esophageal cancer and sever oxygen-dependent lung disease; who had persistent acid leakage from the percutaneous endoscopic gastrostomy site, small stripes of absorbable fiber(Surgicel)were introduced from the cutaneous side of the fistula and fibrin sealant(Tisseel® VH)with its two components was endoscopically injected through a specially designed syringe(Duploject® applicator) and catheter (Duplocath® 180, Immuno AG,Vienna, Austria) in addition to applying of four hemeostatic clips(Rotatable clip fixing device HX-5LR-1. Olympus,America INC,Melville,N.Y) on the gastric aspect of the fistula. Results: stopping of the leakage was successful,permanent and prevented more morbidity with no complication. Conclusion: We believe that our new technique is a novel and successful one, but large study is needed to define the proper candidates and success rate.

Clinical observation on effect of yiqi huoxue recipe in comprehensive treatment on advanced stage of esophageal cancer

To observe the effect of Yiqi Huoxue (Replenishing Qi and activating blood circulation, YQHX) decoction in patients with advanced stage esophageal cancer treated with radiotherapy (RT) and intervention chemotherapy (ICT). In comparing 31 patients who were treated with RT and ICT (Group A), and 31 patients treated with RT and ICT plus YQHX decoction (Group B). Immediate effective rate were 48.4% in Group A and 64.5% in Group B (P > 0.05). The function of bone marrow in Group B was obviously higher than that in Group A. The 1 year metastasis rate in Group A was higher than that in Group B, but the long-term survival rate of Group B was obviously higher than that in Group A (P < 0.05). YQHX decoction could reduce the inhibition of bone marrow caused by radiotherapy and intervention chemotherapy, lower the metastasis rate, prolong the long-term survival rate and improve the quality of life.