Malignant Neoplasms Of Esophagus Research Articles

Analyzing Mortality Patterns and Location of Death in Patients With Malignant Esophageal Neoplasms: A Two-Decade Study in the United States.

Background Esophageal neoplasm carries significant implications for end-of-life care. Despite medical advancements, disparities in the location of death persist. Understanding the factors influencing the place of death for esophageal neoplasm patients is crucial for delivering patient-centered care. Objectives The primary objective of this study is to inspect and evaluate mortality patterns in patients with malignant esophageal neoplasms over the past two decades. Materials and methods Using the CDC-WONDER database, the authors analyzed 309,919 esophageal neoplasm-related deaths. Data was categorized by age, gender, race, and location of death, enabling a detailed examination of the factors influencing the place of death. Result This analysis revealed significant disparities in death locations. Age, gender, race, and geographic region all played substantial roles in determining where esophageal neoplasm patients spent their final moments. Notably, males consistently experienced higher mortality rates across all settings. Geographic disparities indicated varying mortality rates by census region, with the Southern region reporting the highest rates. Racial disparities were also evident, with white individuals having the highest number of deaths. Conclusion This study underscores the importance of recognizing and addressing disparities in the place of death among esophageal neoplasm patients in the United States. By shedding light on the demographic influences on end-of-life decisions, it paves the way for more targeted and patient-centered approaches to end-of-life care for this patient population.

Association between frailty status and complications in patients undergoing surgical excision of malignant esophageal neoplasms.

Research within the last decade highlights the patients' frailty status as an important predictor of esophageal cancer outcomes, but the literature evaluating frailty's role in these patients remains limited. We evaluated the role of frailty in patients undergoing resection of malignant esophageal neoplasms. We used the Nationwide Readmissions Database from 2016 and 2017 to identify patients who underwent excision of a malignant esophageal neoplasm. Patient frailty was queried using the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator. Propensity score matching identified 289 frail patients and 281 non-frail patients. Mann-Whitney U testing was performed and receiver operating characteristic (ROC) curves were created, following the creation of logistic regression models for predicting discharge disposition. The area under the curve (AUC) served as a proxy for model performance. Frail patients had significantly more nonroutine discharges, longer inpatient lengths of stay, higher costs, more acute infections, posthemorrhagic anemia and deep vein thrombosis, and greater mortality (P<0.05). No significant differences were found between the 2 cohorts with respect to readmission rates, pulmonary embolism or dysphagia. Predictive models for patient discharge disposition demonstrated that frailty status in combination with age resulted in better ROC curves (AUC: 0.652) compared to models using age alone (AUC: 0.601). Frailty was found to be significantly correlated with higher rates of inpatient medical complications following esophagectomy. The inclusion of patient frailty status in predictive models for discharge disposition resulted in a better predictive capacity compared to those using age alone.

THE PROGNOSIS OF THE DIFFERENT ESOPHAGEAL NEUROENDOCRINE CARCINOMA SUBTYPES: A POPULATION-BASED STUDY.

Neuroendocrine neoplasms are extremely rare and account for 0.4% to 2% of all malignant esophageal neoplasms. The burden of the neuroendocrine histological type on the patients' prognosis and survival is poorly debated. This study aimed to compare the survival rates of primary neuroendocrine neoplasms compared with adenocarcinoma and squamous cell carcinoma of the esophagus. This is a retrospective cohort from the Surveillance, Epidemiology, and End Results Program database. Overall survival and cancer-specific survival were evaluated with Kaplan-Meier curves and logrank tests. Proportional Cox regression models were used to evaluate variables related to overall survival. After eligibility criteria, 66,528 patients were selected. The mean follow-up was 22.6 months (SD 35.6). Adenocarcinoma was predominant (62%), followed by squamous cell carcinoma (36%). Large cell carcinoma, small cell carcinoma, and mixed adenoneuroendocrine carcinoma each account for less than 1% each. On the long-term overall survival analysis, esophageal adenocarcinoma showed a better prognosis than all the other histologic types (P-value for logrank test <0.001). With adenocarcinoma as a reference, HR was 1.32 for large cell carcinoma (95%CI 1.2 to 1.45) and 1.37 for small cell carcinoma (95%CI 1.23 to 1.53). The HR was 1.22 for squamous cell carcinoma (95%CI: 1.2 to 1.24); and 1.3 for adenoneuroendocrine carcinoma (95%CI 1.01 to 1.66). For multivariate Cox regression analysis, besides age and stage, the neuroendocrine subtypes large cell carcinoma and small cell carcinoma were considered independent prognostic variables. In the esophagus, large cell carcinoma and small cell carcinoma show poorer long-term survival rates than squamous cell carcinoma and adenocarcinoma.

S0425 Predictors of Esophageal Cancer in Young Adults in the U.S.

INTRODUCTION: Esophageal cancer (EC) is one of the most fatal malignancies worldwide, with a dramatic increase in incidence in the Western world occurring over the past few decades. Prognosis remains poor with increased mortality related to this cancer that is often diagnosed during its advanced stages, the main reason being the lack of early clinical symptoms. Epidemiologically, EC has been predominantly a disease affecting adults older than 50 years. However, recent reports have disclosed an increased incidence of EC in younger adults aged less than 50. Our aim is to describe the prevalence and the predictors of EC in young adults less than 50 year old. METHODS: We conducted a retrospective study using Explorys database, an aggregate of electronic health record data from major US healthcare systems. After excluding patients younger than 20 years and those older than 50, a cohort of patients with a Systematized Nomenclature of Medicine-Clinical Terms of “Primary malignant neoplasm of esophagus” between 1999–2020 was recruited and prevalence of EC was calculated. Statistical analysis for multivariable model was performed using Statistical Package for Social Sciences (SPSS version 25, IBM Corp). We adjusted for the following factors: gender, race, smoking, alcohol abuse, Diabetes Mellitus (DM), obesity, and gastroesophageal reflux disease (GERD). For all analyses, a 2-sided P value of < 0.05 was considered statistically significant. RESULTS: Among 23,353,210 individuals in the database between ages 20 and 50, 1,300 were diagnosed with EC. Baseline characteristics of patients with EC and control group are presented in Table 1. The prevalence of EC among young adults in our study approximated 5.7 in 100.000. When stratified into subgroups based on age, the prevalence was higher with increasing age (Figure 1). Table 2 shows the prevalence among ethnicities with Caucasians being most affected subjects. Using Multivariate analysis model, GERD was a major predictor of EC in young adults {OR 8.623, CI 95% 7.671–9.693}. Other significant predictors included Male gender, Caucasian race, smoking, alcohol, obesity and DM (Table 3). CONCLUSION: Our study disclosed that modifiable risk factors such as social habits (smoking, alcohol abuse) and co-morbidities like GERD, Obesity and DM were major risk factors associated with EC in young adults. Interventions to control those modifiable factors in patients as well as cancer awareness education are warranted to mitigate this increasing trend of EC in young adultsTable 1Table 2Table 3

P16 in highly malignant esophageal carcinomas: the correlation with clinicopathological factors and human papillomavirus infection

p16 is generally considered to be a surrogate maker of human papillomavirus (HPV) infection and also a predictive marker of favorable clinical outcome of patients with squamous cell carcinoma of the oropharynx. p16 overexpression is also known to be induced by deregulation of RB1 in neuroendocrine carcinomas. In highly malignant esophageal neoplasms, however, the status of p16 has remained largely unknown. We immunolocalized p16 and Rb1 in 82 surgically resected esophageal high-grade squamous cell carcinomas (46 poorly differentiated and 36 basaloid squamous cell carcinomas) and 15 esophageal small-cell carcinomas in order to clarify the clinical and biological significance of p16. p16 immunoreactivity was detected in 7/82 (9%) high-grade squamous cell carcinomas and 15 (100%) small-cell carcinomas. p16 immunoreactivity was significantly associated with Rb1 protein loss in both groups (P < 0.001). HPV was detected in none of the p16-positive cases examined. Clinical outcome of the p16-positive high-grade squamous cell carcinomas was not different from that of the p16-negative counterparts (P = 0.687) but significantly better than those with the small-cell carcinomas (P = 0.023). p16 was therefore considered to be induced through an inactivation of the RB1 signaling pathway and not through HPV infection in highly malignant esophageal neoplasms. Nevertheless, patients’ clinical outcome of these neoplasms significantly differs; therefore, small-cell carcinomas have to be carefully differentiated from other neoplasms. In addition, p16 overexpression is not predictive of favorable clinical outcome in high-grade squamous cell carcinomas of the esophagus.

Histopathological Spectrum of Premalignant and Malignant Lesions of Esophagus in the Population of Karachi

Background: Squamous cell carcinoma (SCC) and adenocarcinoma are the most common esophageal cancers. Barrett’s esophagus is the change of esophageal stratified squamous epithelium to columnar cells which if remain undiagnosed follows the dysplasia – carcinoma sequence. The last two decades show a change in the histologic pattern of esophageal carcinoma. Adenocarcinoma is at majority rate than SCC in the West, however, in Asia, SCC is still the commonest cancer of esophagus. In this study, we aim to define a spectrum of premalignant and malignant neoplasms of esophagus in our region. Methods: This study was done at Dow Diagnostic Research and Reference Laboratory (DDRRL). All the cases of preneoplastic and neoplastic lesions of esophagus received during the period of 7 years (2009-2015) were reviewed. The data obtained were subjected to descriptive statistical analysis using SPSS version 21. Results: Out of 94 premalignant cases, 70 (74.5%) were diagnosed as Barrett’s esophagus, 23 (24.5%) as dysplasia and 1 (1.1%) as adenoma. From the total of 450 malignant cases, 395 (87.7%) were SCC, 54 (12%) were adenocarcinoma and a single case of leiomyoma was diagnosed. Grade II SCC was found to be most the common lesion. Conclusion: Barrett’s esophagus was more than dysplasia and showed male preponderance. SCC was the predominant esophageal cancer, which is similar to the other studies in our country. SCC was found more common in females than males and vice versa for adenocarcinoma. Majority of all the cases belonged to 41-60 years of age group.

Cause-specific mortality in adult epilepsy patients from Tyrol, Austria: hospital-based study.

Epilepsy is a devastating condition with a considerable increase in mortality compared to the general population. Few studies have focused on cause-specific mortality which we analyse in detail in over 4,000 well-characterized epilepsy patients. The cohort comprised of epilepsy patients ≥18, treated between 1970 and 2009 at the epilepsy clinic of Innsbruck Medical University, Austria, and living in the province of Tyrol, Austria. Epilepsy diagnosis was based on ILAE guidelines (1989); patients with brain tumor were excluded. Deceased patients and causes of death (ICD-codes) were obtained via record linkage to the national death registry. We computed age-, sex-, and period-adjusted standardized mortality rates (SMR) for 36 diagnoses subgroups in four major groups. Additional analyses were performed for an incidence cohort. Overall cohort: 4,295 patients, 60,649.1 person-years, 822 deaths, overall SMR 1.7 (95 % CI 1.6–1.9), highest elevated cause-specific SMR: congenital anomalies [7.1 (95 % CI 2.3–16.6)], suicide [4.2 (95 % CI 2.0–8.1)], alcohol dependence syndrome [3.9 (95 % CI 1.8–7.4)], malignant neoplasm of esophagus [3.1 (95 % CI 1.2–6.4)], pneumonia [2.7 (95 % CI 1.6–4.2)]. Incidence cohort: 1,299 patients, 14,215.4 person-years, 267 deaths, overall SMR 1.8 (95 % CI 1.6–2.1), highest elevated cause-specific SMR congenital anomalies [10.8 (95 % CI 1.3–39.3)], suicide [6.8 (95 % CI 1.4–19.8)], alcohol dependence syndrome (6.4 [95 % CI 1.8–16.5)], pneumonia [3.9 (95 % CI 1.8–7.4)], cerebrovascular disease at 3.5 (95 % CI 2.6–4.6). Mortality due to mental health problems, such as suicide or alcohol dependence syndrome, malignant neoplasms, and cerebrovascular diseases was highly increased in our study. In addition to aim for seizure freedom, we suggest improving general health promotion, including cessation of smoking, lowering of alcohol intake, and reduction of weight as well as early identification of psychiatric comorbidity in patients with epilepsy.

Imaging of uncommon esophageal malignancies

Malignant esophageal neoplasms other than squamous cell carcinoma and adenocarcinoma are uncommon and include endocrine tumors, lymphoid malignancies, melanoma, malignant stromal tumors, and secondary tumors (metastases). Imaging, though not diagnostic in many cases, helps in selecting the appropriate treatment strategy by determining the anatomic extent of the tumor and locoregional and distant spread. In this article, we provide a comprehensive review of the imaging features of these uncommon esophageal malignancies.

From the Radiologic Pathology Archives: Esophageal Neoplasms: Radiologic-Pathologic Correlation

Esophageal neoplasms have a wide spectrum of clinical features, pathologic findings, and imaging manifestations. Leiomyomas are the most common benign esophageal neoplasm, typically appearing as smoothly marginated intramural masses. Fibrovascular polyps arise in the cervical esophagus, gradually elongating as they are pulled inferiorly by esophageal peristalsis. Granular cell tumors are generally incidental small intramural masses with an appearance similar to that of leiomyomas. Malignant esophageal neoplasms are a common cause of cancer mortality, particularly squamous cell carcinoma (SCC) and adenocarcinoma. Both of these tumors occur in older men, most often appearing as irregular infiltrative lesions at barium examination, with evidence of tumor spread beyond the esophagus at cross-sectional imaging. Adenocarcinoma arises from Barrett esophagus and is much more likely than SCC to involve the gastroesophageal junction. Esophageal involvement by lymphoma is usually secondary to tumor spread from the stomach or mediastinum. Spindle cell carcinoma is a biphasic malignancy with carcinomatous and sarcomatous elements that forms a bulky polypoid intraluminal mass. Neuroendocrine carcinoma is an aggressive neoplasm that may be hypervascular and is usually associated with metastatic disease at presentation. Understanding the imaging appearances and pathologic bases of esophageal neoplasms is essential for their detection, differential diagnosis, staging, and treatment planning.

Racial Disparities in Gastrointestinal Cancers-Related Mortality in the US Population

Racial difference in cancer-related mortality has been described in epidemiological studies and evidence points towards higher mortalities in the minorities. To determine the magnitude of racial disparities and sex differences in GI cancer-related mortalities in the US population, we analyzed the data using the third National Health and Nutrition Examination Survey (NHANES III) and related mortality data files. NHANES III and its related public linked mortality files were used for this study. Our study cohort included subjects who were ≥18 years and were part of the longitudinal mortality follow-up database. The overall GI cancers related mortality was calculated using combined mortality from malignant neoplasm of esophagus, stomach, colon, liver and pancreas. The evaluation of independent predictors of overall GI cancer-related mortality and of each individual GI cancer was carried out using the Cox proportional hazards model. A total of 13,221 individuals were included in the analyses with the average person year follow-up of 13.9 years. During the follow-up period, 4,146 subjects died. Of these, 199 were from GI-related cancers. Non-Hispanic black (NHB) had significantly higher overall GI-cancer related mortality compared to non-Hispanic white (NHW, adjusted hazard ratio, aHR: 2.31, 95% CI 1.57-3.38, p < 0.001). Subgroup analyses by sex demonstrated higher mortality from gastric, colorectal and primary liver cancer related mortality in NHB men compared to NHW men. Esophageal and pancreatic cancer mortalities were higher in NHB women compared to NHW women. Overall GI cancer-related mortality is significantly higher among NHB compared to NHW in the U.S. population.

Sarcomatoid Carcinoma of Esophagus

Abstract Sarcomatoid carcinoma of the esophagus is an uncommon malignancy, representing approximately 2% of esophageal carcinomas. It has also been referred to as carcinosarcoma, pseudosarcoma, pseudosarcomatous squamous cell carcinoma, spindle cell carcinoma, and polypoid carcinoma, reflecting the uncertainty of its pathogenesis. Histologically, carcinomatous and sarcomatous components coexist. The clinical and radiologic findings resemble other esophageal neoplasms. Sarcomatoid carcinoma often presents as a large, intraluminal, polypoid mass on barium esophagram. Despite its size, however, sarcomatoid carcinoma has a more favorable prognosis than other malignant esophageal neoplasms, likely because of its exophytic growth into the lumen, rather than deep invasion. This article provides a brief overview of the clinicopathologic features and possible pathogenesis of this uncommon tumor.

Sarcomatoid Carcinoma of Esophagus

Sarcomatoid carcinoma of the esophagus is an uncommon malignancy, representing approximately 2% of esophageal carcinomas. It has also been referred to as carcinosarcoma, pseudosarcoma, pseudosarcomatous squamous cell carcinoma, spindle cell carcinoma, and polypoid carcinoma, reflecting the uncertainty of its pathogenesis. Histologically, carcinomatous and sarcomatous components coexist. The clinical and radiologic findings resemble other esophageal neoplasms. Sarcomatoid carcinoma often presents as a large, intraluminal, polypoid mass on barium esophagram. Despite its size, however, sarcomatoid carcinoma has a more favorable prognosis than other malignant esophageal neoplasms, likely because of its exophytic growth into the lumen, rather than deep invasion. This article provides a brief overview of the clinicopathologic features and possible pathogenesis of this uncommon tumor.

Extrapancreatic malignancies and intraductal papillary mucinous neoplasms of the pancreas

Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms (IPMNs). Additional malignancies have been identified in 10%-52% of patients with IPMNs. The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN. The gastrointestinal tract is most commonly involved in secondary malignancies, with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries. Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms, gastrointestinal stromal tumors, carcinoid tumors, hepatobiliary cancers, breast cancers, prostate cancers, and lung cancers. There is no clear etiology for the development of secondary malignancies in patients with IPMN. Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients, both have reached the same conclusion: there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population. This finding has significant clinical implications for both the initial evaluation and the subsequent long-term follow-up of patients with IPMNs. If a patient has not had recent colonoscopy, this should be performed during the evaluation of a newly diagnosed IPMN. Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease. Routine screening studies (breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.

Giant Pedunculated Sarcoma Together with Carcinoma in Situ in the Esophagus

Sarcomas are the least common of all malignant esophageal neoplasms, with an incidence of 0.5%. We describe a case of a giant esophageal pedunculated polyp identified by barium ingestion and endoscopy. Biopsy of the polyp was performed using panendoscopy and the pathology report was of an ulcer with atypical reactive stromal cells. Initially, the patient was thought to have a benign tumor and underwent endoscopic removal of the polyp but this failed because of bleeding from the stalk. After subtotal esophagectomy, the final histological diagnosis was that a sarcoma and a squamous cell carcinoma in situ coexisted in the esophagus. The patient had an uneventful postoperative course and showed no evidence of recurrence in three years of follow-up. We review the literature on esophageal sarcomas and discuss the limitation of panendoscopy in diagnosing unusual esophageal tumors.

Esofagectomia laparocópica transhiatal: resultados imediatos

The laparoscopic transhiatal esophagectomy for benign or malignant disease is a complex operation associated with a high rate of morbidity and mortality. In the last decade this procedure gained popularity and acceptance for treatment of the esophagus cancer and other benign diseases. To perform a retrospective analysis in patients with esophageal cancer that was underwent a laparoscopic transhiatal esophagectomy, demonstrated pre and post operative complications and immediate result. From November 1993 to June 2005, 72 patients underwent laparoscopic transhiatal esophagectomy. Sixty-four with malignant neoplasm of esophagus. The males are predominant, and the mean age was 56.5 years. The abdominal part of the operation was totally laparoscopic and the cervical one was made the conventional way. The stomach was pulled up to the neck by the posterior mediastinum. The laparoscopic transhiatal esophagectomy was initiated in 64 patients. Four patients were converted to open surgery. The mean operation time was 153 minutes. The incidence of cervical fistula was 14.06%. The mortality rate 5.6%. Laparoscopic transhiatal esophagectomy is a secure option in experience centers. The morbility is low, with a faster return to normal activity. Maybe in fact this procedure may be reminded and ponder in the treatment of esophageal disease.