Cumulative 5-year Overall Survival Research Articles

349. TOTALLY MECHANICAL STAPLED SIDE-TO-SIDE VERSUS CIRCULAR END-TO-SIDE ANASTOMOSIS FOR MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY: A MULTICENTER ANALYSIS

Abstract Background Totally minimally invasive esophagectomy (TMIE) is increasingly used in treatment of patients with esophageal cancer. However, it is currently unknown if fully mechanical stapled side-to-side anastomosis for Ivor Lewis TMIE could be preferred for patients in whom both procedures are oncologically feasible. Methods The study was performed in 2 high-volume China esophageal cancer centers between Feb 2015 through Dec 2022. Prospectively collected data from consecutive patients with esophageal cancer localized in the distal esophagus or gastroesophageal junction undergoing Ivor Lewis TMIE were included. The primary outcome parameter was anastomotic leakage requiring reintervention or reoperation. Secondary outcome parameters were operation characteristics, pathology results, complications, reoperations, length of stay, mortality, and overall survival (OS). Results 147 patients were included in this study. The incidence of anastomotic leakage requiring reintervention or reoperation was 12.9% after fully mechanical stapled side-to-side versus 11.8% after circular end-to-side anastomosis (P = 0.852). Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture (5.7% vs 17.1%, p = 0.032). Pulmonary complications (20.0% vs 23.7%), recurrent laryngeal nerve palsy (7.1% vs 5.3%), chyle leakage (10.0 vs 7.9%), atrial fibrillation (12.9 vs 13.2) and median hospital length of stay (12 vs 11 days) were comparable between the two arms (all P > 0.05). R0 resection rate was similar between the groups. Overall survival was comparable between the two arms (hazard ratio [HR], 0.81, 95% CI, 0.62–1.21, P = 0.208). The cumulative 5-year OS was 44.3% in the fully mechanical stapled side-to-side anastomosis arm, as compared with 39.5% in the circular end-to-side anastomosis arm. Conclusion Compared to circular end-to-side anastomosis in patients in whom both procedures are oncologically feasible, there was no significant difference in the incidence of anastomotic leakage and other postoperative morbidity and OS with a fully mechanical stapled side-to-side anastomostic Ivor Lewis esophagectomy. Fully mechanical stapled side-to-side Ivor Lewis esophagectomy was significantly associated with a lower incidence of anastomosis stricture.

Esophagectomy With Three-Field Versus Two-Field Lymphadenectomy for Middle and Lower Thoracic Esophageal Cancer: Long-Term Outcomes of a Randomized Clinical Trial.

The optimal extent of lymphadenectomy during esophagectomy remains unclear. In this trial, we aim to clarify whether three-field (cervical-thoracic-abdominal) lymphadenectomy improved patient survival over two-field (thoracic-abdominal) lymphadenectomy for esophageal cancer. Between March 2013 and November 2016, a total of 400 patients with middle and lower thoracic esophageal cancer were included and randomly assigned to undergo esophagectomy with either three- or two-field lymphadenectomy at a 1:1 ratio. Analyses were done according to the intention-to-treat principle. The primary end point was overall survival (OS), calculated from the date of randomization to the date of death from any cause. Demographic characteristics were similar in the two arms. The median follow-up time was 55 months (95% confidence interval [CI]: 52-58). OS (hazard ratio [HR]= 1.019, 95% CI: 0.727-1.428, p= 0.912) and the disease-free survival (DFS) (HR= 0.868, 95% CI: 0.636-1.184, p= 0.371) were comparable between the two arms. The cumulative 5-year OS was 63% in the three-field arm, as compared with 63% in the two-field arm; 5-year DFS was 59% and 53%, respectively. On the basis of whether the patients had mediastinal or abdominal lymph node metastasis or not, OS was also comparable between the two arms. In this cohort, only advanced tumor stage (pathologic TNM stages III-IV) was identified as the risk factor associated with reduced OS (HR= 3.330, 95% CI: 2.140-5.183, p<0.001). For patients with middle and lower thoracic esophageal cancer, there was no improvement in OS or DFS after esophagectomy with three-field lymphadenectomy over two-field lymphadenectomy.

Comparison of prognosis between surgical resection and transarterial chemoembolization for patients with solitary huge hepatocellular carcinoma.

BackgroundFor patients with solitary huge (>10 cm in size) hepatocellular carcinoma (HCC) and without major vascular invasion, the treatment efficacy between surgical resection (SR) and transarterial chemoembolization (TACE) is not well studied. We aimed to compare the prognoses between SR and TACE for patients with solitary huge HCC.MethodsWe enrolled 143 patients with treatment-naïve, solitary HCC (>10 cm) who had received either SR or TACE treatment between 2007–2016. Factors of overall survival (OS) were analyzed by multivariate analysis. Propensity scores matching (PSM) method was adopted to adjust baseline demographic differences for further analysis.ResultsNinety patients underwent SR and 53 patients received TACE. After a median follow-up of 17.0 (interquartile range 7.7–45.6) months, 83 patients had died. The cumulative 5-year OS rate was 44.7% and 11.7% for the SR group and the TACE group, respectively (P<0.001). A multivariate analysis showed that TACE [hazard ratio (HR): 3.515, 95% confidence interval (CI): 2.202–5.610, P<0.001], and albumin-bilirubin (ALBI) grade >1 (HR: 2.181, 95% CI: 1.343–3.543, P=0.002) were the independent risk factors associated with poorer OS. After PSM, 37 pairs of matched patients were selected from each treatment arm. After matching, patients who underwent SR still evinced a significantly higher OS than did those who underwent TACE (P=0.010).ConclusionsSR provided a better OS than did TACE for patients with solitary huge (≥10 cm) HCC. As such, SR is recommended as the therapeutic priority for these patients.

Long-term outcomes and prognostic factors of young patients with mucinous and signet-ring cell colorectal cancer

IntroductionThe aim of the study was to assess the clinico-pathological features and prognosis of mucinous adenocarcinoma (MAC) and signet-ring cell carcinoma (SRC) in young colorectal cancer (CRC) patients.Material and methodsWe retrospectively evaluated the patient records of young patients with MAC and SRC (aged ≤ 40 years) treated at the Cancer Hospital of China Medical University from January 2006 to December 2013. Kaplan-Meier analysis and log-rank testing were performed to estimate overall survival (OS). Subsequently a Cox proportional hazard model was used to calculate hazard ratios for the risk of death.ResultsA total of 90 young CRC patients (MAC = 69 and SRC = 21) were included in the analysis during the study period. The overall cumulative 5-year OS rate was 56.6 ±6%. Estimated 5-year OS was 58.1 ±7.7% for MAC and 31.3 ±12.9% for SRC (p = 0.018). On univariate analysis, metastatic disease, AJCC stage, adjuvant chemotherapy (CT), cycles of adjuvant CT, surgery type, lymphovascular invasion, perineural invasion, preoperative carcinoembryonic antigen (CEA) levels, and histologic type were significant prognostic factors for OS. In multivariate analysis, preoperative CEA levels and cycles of adjuvant CT were found to be independent prognostic factors for overall survival (hazard ratio = 2.47; 95% CI: 1.06–5.78, p = 0.037; hazard ratio = 0.18; 95% CI: 0.05–0.62, p = 0.007, respectively).ConclusionsA greater proportion of young patients with MAC and SRC present with advanced disease. Young patients with SRC have poorer prognosis than MAC. Preoperative CEA levels and cycles of adjuvant CT are two independent predictors of overall survival for young CRC patients with MAC and SRC.

Predictive effects of a combined indicator in patients with hepatocellular carcinoma after thermal ablation.

This study aimed to investigate the predictive power of the combination of Systemic Immune-Inflammation Index (SII) and albumin-bilirubin (ALBI) grade in prognosis outcomes of early-stage hepatocellular carcinoma (HCC) after thermal ablation. This retrospective study was reviewed and approved by our institutional review board, and written informed consent was obtained from each patient. According to the Milan criteria, a total of 405 treatment-naïve patients with clinicopathologically confirmed HCC were enrolled who subsequently underwent thermal ablation from 2011 to 2016. The outcomes of overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were statistically analyzed. The median follow-up time of this study was 45.1 months (range, 1.3-83.2 months). After thermal ablation in patients with SII-ALBI Grades 1, 2, and 3, the cumulative 5-year OS rates were 81.7%, 63.2%, and 26.9%; the 5-year CSS rates were 82.4%, 67.5%, and 26.9%; and the 5-year RFS rates were 49.3%, 44.6%, and 25.3%, respectively (all P < 0.001). On multivariate Cox regression analyses, SII-ALBI was independently associated with the three outcomes after adjustment for various confounders (all P < 0.05). In addition, SII-ALBI played a predictive role in OS, CSS, and RFS for patients with negative alpha-fetoprotein (AFP) (P < 0.05). Compared with SII and ALBI, the AUCs for the prediction of OS and CSS using SII-ALBI were superior to single indicator (bothP < 0.05). Elevated preablation SII-ALBI is associated with shorter OS, CSS, and RFS in patients with early-stage HCC. Our indicator showed the potential to be a supplement tool for patients with negative AFP during follow-up.

Management of retropharyngeal lymph node metastasis in oral cancer

ObjectivesRetropharyngeal lymph node (RPLN) metastasis is extremely rare, and prognosis is significantly poor in oral cancer. We retrospectively examined the management of RPLN metastases in oral cancer. Materials and methodsA total of 1247 patients with oral cancer were treated at our department from January 2002 and December 2016. Among these patients, 374 (30%) had histologically positive lymph node metastases. Of these, 15 patients (1.2%) were diagnosed with RPLN metastases. We evaluated the diagnostic period, size, recurrence pattern, laterality, treatment, and therapeutic outcomes. The Kaplan–Meier method was used to determine overall survival (OS) among the RPLN metastasis group, cervical lymph node (CLN) metastases group, and treatment methods group for RPLN metastases. ResultsOne patient had RPLN involvement at the initial treatment, and RPLN involvement in other patients was found subsequently. The mean duration in confirming RPLN metastases was 228 days (range, 50–867 days). Surgical therapy was performed in 5 patients, chemoradiotherapy in 7 patients, and best supported care (BSC) in 3 patients. The cumulative 5-year OS rate for the RPLN metastasis group (n = 15) was 38.1%, compared with the rate of 71.3% for the CLN group (n = 359). Regarding the therapeutic approach for RPLN metastases, OS rates were 80.0% (n = 5) in the surgical therapy group, 28.6% (n = 7) in the chemoradiotherapy group, and 0% (n = 3) in the BSC group. ConclusionEarly detection and surgical treatment of RPLN metastases are associated with increased survival rate in oral cancer.

Prognostic impact of examined lymph node count in pT1N0M0 esophageal cancer: A population-based study.

BackgroundResearch on the impact of examined lymph node (ELN) count on node‐negative esophageal cancer (EC) especially pT1N0M0 EC is inadequate. This study was designed to analyze the prognostic impact of ELN count on pT1N0M0 EC.MethodsData of resected pT1N0M0 EC patients between 1988 and 2015 were extracted from the United States Surveillance, Epidemiology, and End Results (SEER) database. The association between ELN count and overall survival (OS) or esophageal cancer‐specific survival (ECSS) were investigated. Factors that may predict the outcome were identified using the Kaplan‐Meier method and the Cox proportional‐hazards model.ResultsA total of 906 patients who underwent resection with at least one lymph node (LN) retrieved met our criteria. The cumulative 5‐year OS was 67.6%, while the cumulative 5‐year ECSS was 75.4%. X‐Tile analysis showed that 12 was the optimal cutoff value for ELN count in terms of both OS (χ2 = 28.764, P < 0.0001) and ECSS (χ2 = 15.668, P = 0.0026). A Kaplan‐Meier survival analysis and log‐rank comparison revealed that ELN > 12 was significantly associated with better OS (HR, 0.532; 95% CI, 0.421–0.672; P < 0.001) and ECSS (HR, 0.561; 95% CI, 0.420–0.749; P < 0.001) rates than ELN ≤12. The OS and ECSS benefit of increasing ELN count were also reflected in the multivariate analysis after adjustment for age, sex, race, marital status, location, T stage, tumor size, pathology, and differentiation.ConclusionsThese findings indicated that greater number of ELN count exhibits prognostic significance in pT1N0M0 EC. We recommend more than 12 LNs should be examined in pT1N0M0 EC.

Combined preoperative platelet-to-lymphocyte ratio and serum carbohydrate antigen 19–9 level as a prognostic factor in patients with resected pancreatic cancer

BackgroundCarbohydrate antigen 19–9 (CA19-9) is the most frequently used tumor marker and serves as a prognostic indicator in patients with pancreatic cancer (PC). The platelet-to-lymphocyte ratio (PLR) is thought to be an inflammation-related serum marker. An elevated PLR represents increased inflammatory status and is associated with poor prognosis in patients with various cancers including PC. MethodsThis study involved 103 patients with a histopathological diagnosis of pancreatic ductal adenocarcinoma who underwent pancreatectomy. The patients were assessed to determine the prognostic significance of the combination of the PLR and CA19-9 level. ResultsBased on the receiver operating characteristic analysis results, the patients were divided into PLRHigh (PLR ≥ 129.1) and PLRLow (PLR < 129.1) groups and into CA19-9High (CA19-9 ≥ 74.0 U/mL) and CA19-9Low (CA19-9 < 74.0 U/mL) groups. The cumulative 5-year overall survival (OS) and disease-specific survival (DSS) rates significantly differed by both the PLR (PLRHigh group: 19.5% and 22.9%; PLRLow group: 39.1% and 45.9%) and CA19-9 (CA19-9High group: 19.1% and 25.6%; CA19-9Low group: 41.0% and 41.0%). We then divided the patients into Groups A (PLRLow/CA19-9Low), B (PLRLow/CA19-9High or PLRHigh/CA19-9Low), and C (PLRHigh/CA19-9High). The cumulative 5-year OS rates in Groups A, B, and C were 44.0%, 31.9%, and 11.9%, respectively (P = 0.002). The cumulative 5-year DSS rates in Groups A, B, and C were 47.7%, 36.4%, and 16.8%, respectively (P = 0.002). Multivariate analysis revealed that the combination of the PLR and CA19-9 was an independent prognostic factor in patients with resected PC. ConclusionsThe combination of the PLR and CA19-9 is useful for predicting the prognosis of patients with resected PC.

The Management of Vesicovaginal Fistula

The optimal extent of lymphadenectomy during esophagectomy remains unclear. In this trial, we aim to clarify whether three-field (cervical-thoracic-abdominal) lymphadenectomy improved patient survival over two-field (thoracic-abdominal) lymphadenectomy for esophageal cancer.Between March 2013 and November 2016, a total of 400 patients with middle and lower thoracic esophageal cancer were included and randomly assigned to undergo esophagectomy with either three- or two-field lymphadenectomy at a 1:1 ratio. Analyses were done according to the intention-to-treat principle. The primary end point was overall survival (OS), calculated from the date of randomization to the date of death from any cause.Demographic characteristics were similar in the two arms. The median follow-up time was 55 months (95% confidence interval [CI]: 52–58). OS (hazard ratio [HR] = 1.019, 95% CI: 0.727–1.428, p = 0.912) and the disease-free survival (DFS) (HR = 0.868, 95% CI: 0.636–1.184, p = 0.371) were comparable between the two arms. The cumulative 5-year OS was 63% in the three-field arm, as compared with 63% in the two-field arm; 5-year DFS was 59% and 53%, respectively. On the basis of whether the patients had mediastinal or abdominal lymph node metastasis or not, OS was also comparable between the two arms. In this cohort, only advanced tumor stage (pathologic TNM stages III–IV) was identified as the risk factor associated with reduced OS (HR = 3.330, 95% CI: 2.140–5.183, p < 0.001).For patients with middle and lower thoracic esophageal cancer, there was no improvement in OS or DFS after esophagectomy with three-field lymphadenectomy over two-field lymphadenectomy.