Survival Of Esophageal Cancer Patients Research Articles

Prediction Model of Long-term Survival After Esophageal Cancer Surgery

We aimed to develop prediction models for estimating the long-term survival in patients who have undergone surgery for esophageal cancer. Few prediction models have been developed for the long-term survival in esophageal cancer patients. This nationwide Swedish population-based cohort study included 1542 patients who survived for ≥90 days after esophageal cancer surgery between 1987 and 2010, with follow-up until 2016. Risk prediction models for 1-, 3-, and 5-year all-cause mortality and 3- and 5-year disease-specific mortality were developed using logistic regression. Candidate predictors were established and readily identifiable prognostic factors. The performance of the models was assessed by the area under receiver-operating characteristic curve (AUC) with interquartile range (IQR) using bootstrap cross-validation and risk calibration. Predictors included in all models were age, sex, pathological tumor stage, tumor histology, and resection margin status. The models also included various additional predictors depending on the outcome, that is, education level, neoadjuvant therapy, reoperation (within 30 d of primary surgery) and comorbidity (Charlson comorbidity index). The AUC statistics after cross-validation were 0.71 (IQR 0.69-0.74) for 1-year, 0.77 (IQR 0.75-0.80) for 3-year, and 0.78 (IQR 0.76-0.81) for 5-year all-cause mortality. The corresponding values were 0.76 (IQR 0.74-0.79) for 3-year and 0.77 (IQR 0.71-0.83) for 5-year disease-specific mortality. All models showed good agreement between the observed and predicted risks. These models showed good performance for predicting long-term survival after esophageal cancer surgery and may thus be useful for patients in planning their lives and to guide the postoperative treatment and follow-up.

The association between statin use and survival of esophageal cancer patients

Whether statin use has any impact on survival of esophageal cancer patients remains controversial. Therefore, we conducted a meta-analysis focusing on current topic for the first time.We systematically searched the following databases for relevant studies comparing survival between statin users and non-users among esophageal cancer patients up to March 16, 2019: Pubmed, Embase, and Web of Science. We extracted data of hazard ratio (HR) with 95%confidence interval (CI) of all-cause and cancer-specific mortality for analysis. We used the STATA 12.0 software to perform this meta-analysis.We finally included a total of 4 cohort studies involving a total of 20,435 esophageal cancer patients (5319 statin users and 15116 non-users). Our meta-analysis found that statin use after diagnosis of esophageal cancer was significantly correlated to decreased all-cause (random effects: HR = 0.81, 95%CI: 0.75–0.89, P < .001; I2 = 68.1%) and cancer-specific mortality (fixed effects: HR = 0.84, 95%CI: 0.78–0.89, P < .001; I2 = 46.6%) in esophageal cancer patients. When stratified by pathological subtypes, the protective effect of statin use after diagnosis of esophageal cancer was observed in both esophageal adenocarcinoma patients and esophageal squamous cell carcinoma patients. Moreover, statin use before diagnosis of esophageal cancer was also confirmed to have favorable survival benefit for esophageal cancer patients.Statin use was significantly correlated to lower mortality risk of esophageal cancer patients regardless of the time when statins were taken and pathological subtypes of esophageal cancer. Statins may serve as promising adjunctive anticancer agents for treating esophageal cancer.

Association between potentially functional polymorphisms of chemokine family members and the survival of esophageal cancer patients in a Chinese population.

Background: The chemokine family plays an important role in the growth, invasion, and metastasis of tumors. However, most studies have only focused on a few genes or a few gene loci, and thus could not reveal the associations between functional polymorphisms of chemokine family members and tumor progression. This study aimed to determine the associations between single nucleotide polymorphisms (SNPs) of chemokine family members and the prognosis of esophageal cancer (EC).Methods: The Cox risk proportional model and log-rank test were used to analyze the associations of 16 potentially functional SNPs in 13 genes from the chemokine family with the survival of 729 Chinese patients with EC.Results: Prognostic analysis on the 16 SNPs showed that different genotypes of 5 SNPs were associated with patients’ survival and the risk of death. Multivariate Cox regression analysis showed that the risk of death was higher in CCL26rs2302009 genotype A/C carriers than in A/A carriers and it was also higher in CX3CL1rs2239352 genotype T/T carriers than in C/C carriers. Stepwise Cox regression analysis showed that CCL26rs2302009 genotype A/C was an independent prognostic factor of EC, and its association with increased risk of death was stronger in patients who were ≤60 years old, female, with tumors located in the middle part of esophagus, with undifferentiated or poorly differentiated tumors, with early-stage pathologic type disease, with the longest diameter of tumor ≤5cm than in their counterparts.Conclusion: These findings suggest that CCL26rs2302009 may be a candidate biomarker for EC and its effect on death risk are associated with the histological grade, pathologic type, and the longest diameter of tumor.

Clinical significance of systemic immune-inflammation index (SII) and C-reactive protein-to-albumin ratio (CAR) in patients with esophageal cancer: a meta-analysis.

Background: Numerous studies have reported that systemic immune-inflammation index (SII) and C-reactive protein-to-albumin ratio (CAR) correlate with tumor progression and prognosis in various types of human cancer. The aim of this study is to systematically investigate the clinical significance of SII and CAR in esophageal cancer (EC).Methods: We searched a number of databases for articles reporting the effect of pretreatment SII and CAR on the survival of EC patients. Review Manager 5.3 and STATA/SE 14.1 were applied in this meta-analysis. The multivariable-adjusted hazard ratio (HR) was used for calculating the relationship between SII and CAR and overall survival (OS), and the odds ratio (OR) was applied for the clinical pathology.Results: Five original studies for SII and seven original datasets for CAR were included for analysis. Increased SII showed a significant association with shorter OS in EC patients after surgery (HR: 1.34, 95% CI: 1.15–1.53, P<0.001) and high CAR indicated worse long-term OS in EC (HR: 1.60, 95% CI: 1.29–1.90, P<0.001). Different subgroup analyses were also confirmed the prognostic roles in EC patients. Furthermore, the adverse impacts of elevated SII and CAR on tumor progression were revealed in the infiltration depth, lymph node metastasis, and clinical stage.Conclusions: Both pretreatment SII and CAR might be promising predictors of cancer survival and tumor progression in EC. Further studies are warranted to verify the clinical usefulness in patients with EC.

Prognostic significance of combined pretreatment body mass index (BMI) and BMI loss in patients with esophageal cancer.

Background: Body mass index (BMI) has been associated with a risk of esophageal cancer. However, the influence of BMI and BMI loss on people with esophageal cancer that were treated with different therapies has not been described in China.Methods: In total, 615 consecutive patients that underwent esophagectomy and/or chemotherapy/radiotherapy were classified according to the Asian-specific BMI (kg/m2) cutoff values. The impact of BMI and BMI loss on long-term overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazard models.Results: Multivariate analysis showed that overweight and obese patients had a more favorable survival than normal weight and underweight patients (p=0.017). Patients with a low BMI and high BMI loss before therapy had worse OS than others (p=0.001). Subgroup analysis showed that patients with a high BMI were more likely to suffer hypertension (p<0.001) and receive only surgery (p<0.001), and they were less likely to be smokers (p=0.007) and anemic (p<0.001). Conversely, patients with high BMI loss were more likely to be anemic (p=0.001), to have advanced pathological stage (p=0.012), and to receive chemotherapy and radiotherapy (p=0.001). Moreover, the mortality rate was higher when patients had a high BMI loss. There is no survival benefit of higher BMI in the non-esophageal squamous cell carcinoma (ESCC) group.Conclusion: Pretreatment BMI was an independent prognostic factor for long-term survival in esophageal cancer patients treated with different treatments. The overall survival was increased in esophageal cancer patients with a high pretreatment BMI and no BMI loss. There is no survival benefit of higher BMI in the non-ESCC group.

Bayesian Semiparametric Joint Regression Analysis of Recurrent Adverse Events and Survival in Esophageal Cancer Patients.

We propose a Bayesian semiparametric joint regression model for a recurrent event process and survival time. Assuming independent latent subject frailties, we define marginal models for the recurrent event process intensity and survival distribution as functions of the subject's frailty and baseline covariates. A robust Bayesian model, called Joint-DP, is obtained by assuming a Dirichlet process for the frailty distribution. We present a simulation study that compares posterior estimates under the Joint-DP model to a Bayesian joint model with lognormal frailties, a frequentist joint model, and marginal models for either the recurrent event process or survival time. The simulations show that the Joint-DP model does a good job of correcting for treatment assignment bias, and has favorable estimation reliability and accuracy compared with the alternative models. The Joint-DP model is applied to analyze an observational dataset from esophageal cancer patients treated with chemo-radiation, including the times of recurrent effusions of fluid to the heart or lungs, survival time, prognostic covariates, and radiation therapy modality.

Statin use after diagnosis is associated with an increased survival in esophageal cancer patients: a Belgian population-based study.

Preclinical studies have shown that statins reduce proliferation in esophageal cancer. Three recent observational studies have shown encouraging results but suffered from limitations. This work aimed to assess at the Belgian population level whether statin usage was associated with a decreased mortality in esophageal cancer patients. We conducted an observational, population-based study by linking data of the Belgian Cancer Registry (BCR) with medical claims data coming from health insurance companies and mortality records collected by regional governments for patients diagnosed with esophageal cancer between 2004 and 2014. Using time-dependent Cox regression models, hazard ratios (HRs) and 95% confidence intervals (CI) for overall and cancer-specific mortality were calculated. Of 6,238 patients with stage I-III esophageal cancer, post-diagnostic use of statins was found in 1,628 (26%) patients. Statins use after diagnosis was associated with a reduction in overall mortality (adjusted HR = 0.84, 95% CI [0.77; 0.92]) and cancer-specific mortality (adjusted HR = 0.87, 95% CI [0.78; 0.97]). Similar association were also seen for pre-diagnostic statin use in overall (adjusted HR = 0.83, 95% CI [0.76-0.91]) and cancer-specific analysis (adjusted HR = 0.86, 95% CI [0.77-0.96]). In this large cohort of Belgian patients with esophageal cancer, statins use after diagnosis was associated with a decreased mortality.

Metabolic parameters of sequential 18F-FDG PET/CT predict overall survival of esophageal cancer patients treated with (chemo-) radiation

BackgroundTo evaluate the prognostic value of metabolic parameters of pre-treatment and interim 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for overall survival (OS) of esophageal cancer(EC) patients undergoing (chemo-) radiotherapy.MethodsA retrospective analysis of 134 patients with pathology confirmed squamous cell EC treated between July 2009 and October 2013 in our hospital was performed. Inclusion criteria for this study were curative intended radiotherapy and availability of pre-treatment and interim 18F-FDG PET. 18F-FDG PET/CT scans were acquired before treatment and after 40 Gray (Gy) of radiotherapy. Maximum standard uptake value (SUVmax), metabolic tumor volume(MTV), total lesion glycolysis (TLG), and the percentual changes during both PET scans were recorded. The parameters were named as SUVmax1,MTV1,TLG1,SUVmax2,MTV2,TLG2,△SUVmax,△MTV and △TLG. The receiver operating characteristic curve (ROC) was used to analyze the relationship between metabolic parameters and OS, survival analysis was carried out by Kaplan-Meier and Cox regression analysis.ResultsUnivariate survival analysis showed that SUVmax2、MTV1、△MTV、TLG1、TLG2 and △TLG were associated with OS. Based on the largest Youden index of ROC curves, patients with SUVmax2 < 7.8, MTV1 < 10.5, △MTV < 0.075, TLG1 < 59.8, TLG2 < 44.3 and △TLG < 0.27 tended to live longer. Stratified for these parameters, the estimated median survival time were 27.9 months (m) vs 9.8 m, 36.9 m vs 11.3 m, 41.6 m vs 12 m, 48.9 m vs 14.3 m, 32.6 m vs 13.2 m, and 41.6 m vs 14.5 m. Cox multi-factor regression analyses revealed SUVmax2 as an independent prognostic factor for OS complementary to TNM staging and the length of primary tumor.ConclusionsSequential 18F-FDG PET/CT metabolic parameters bear important prognostic value for OS of EC patients. 18F-FDG PET/CT scan before treatment and during chemoradiotherapy seems helpful to evaluate the effect of chemoradiotherapy, guide clinical decisions and provide patients with personalized treatment.

Prognostic Value of Lymph Node Yield on Overall Survival in Esophageal Cancer Patients: A Systematic Review and Meta-analysis.

This meta-analysis determines whether increased lymph node yield improves survival in patients with esophageal cancer undergoing esophagectomy with or without neoadjuvant therapy. Esophagectomy involves resection of the esophagus and surrounding lymph nodes, which are commonly the first stations of cancer spread. The extent of lymphadenectomy during esophagectomy remains controversial, with several studies publishing conflicting results, especially in the era of neoadjuvant therapy. An electronic literature search was undertaken using Embase, Medline, and the Cochrane library databases (2000 to 2017). Articles with esophageal cancer patients undergoing esophagectomy with lymphadenectomy and investigating the effects of low and high lymph node yield on overall survival and disease-free survival were included. Meta-analysis of data was conducted using a random effects model. If the study divided the cohort into multiple groups based on lymph node yield, survival was compared between the lowest and highest lymph node yield groups. In addition to analysis of the entire cohort, subset analysis of only those patients receiving neoadjuvant therapy was also performed. A total of 26 studies were included in this meta-analysis with a follow-up ranging from 15 to 94 months. For the analysis of overall survival, 23 studies were included. A meta-analysis showed that overall survival significantly improved in the high lymph node yield group [hazard ratio (HR) = 0.81; 95% confidence interval (95% CI) = 0.74-0.87; P < 0.01]. In the 10 studies describing disease-free survival, this was significantly improved in the high lymph node yield group (HR = 0.72; 95% CI = 0.62-0.84; P < 0.01). Subset analysis of neoadjuvant-treated patients demonstrated a survival benefit of high lymph node yield on overall survival (HR = 0.82; 95% CI = 0.73-0.92; P < 0.01). This meta-analysis demonstrates the benefit of an increased lymph node yield from esophagectomy on overall and disease-free survival. In addition, a survival benefit of a high lymph node yield was demonstrated in patients receiving neoadjuvant therapy followed by esophagectomy.

High levels of RAI3 expression is linked to shortened survival in esophageal cancer patients

Expression of the retinoic acid-induced protein 3 (RAI3) has been suggested to predict clinical outcome in a variety of malignancies. However, its role in esophageal cancers remains unclear. Immunohistochemical RAI3 staining was analyzed on tissue microarrays containing 359 esophageal adenocarcinomas (EAC) and 254 esophageal squamous cell carcinomas (ESCC). RAI3 immunostaining was typically absent or weakly detectable in the membranes in benign esophageal tissues. RAI3 staining was higher in malignant than in benign esophagus epithelium. High-levels of RAI3 staining were found in 79.2% of interpretable EACs and 55.9% of ESCCs. In EACs, strong RAI3 staining was associated with advanced pathological tumor stage (p < .0001), high UICC stage (p < .0001), high tumor grade (p = .0133), and positive lymph nodal status (p = .0002). Additionally, high RAI3 staining predicted shortened overall survival of EAC and ESCC patients (p = .0298 and p = .0227). RAI3 overexpression is associated with poor prognosis in esophageal cancers. We propose that RAI3 overexpression might play a biologically relevant role of RAI3 in esophageal cancers.

Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis.

The impact of preoperative sarcopenia on long-term survival of esophageal cancer patients after esophagectomy remains unclear. We conducted an updated meta-analysis focusing on current topic comprehensively. We systematically searched relevant studies investigating the impact of preoperative sarcopenia on survival of patients with surgically treated esophageal cancer in PubMed, Embase, and Web of Science up to July 20, 2018. Data of 3-year and 5-year overall survival (OS) rates as well as hazard ratio (HR) of OS and disease-free survival (DFS) were collected for analysis by using the STATA 12.0 package. Finally, a total of 11 cohort studies consisting of 1520 patients (795 sarcopenic patients and 725 nonsarcopenic patients) were included for analysis. Our meta-analysis showed that patients with sarcopenia had a significantly lower 3-year (51.6% vs. 65.4%, P<0.001) and 5-year OS rate (41.2% vs. 52.2%, P=0.018) than those without sarcopenia. Sarcopenia was found to be an independent predictor of poor OS (HR=1.58; 95% confidence interval (CI)=[1.35, 1.85]; P<0.001) and DFS (HR=1.46; 95% CI=[1.12, 1.90]; P=0.005) in esophageal cancer patients after esophagectomy. No obvious heterogeneities or publication bias were observed during analysis. Therefore, patients with sarcopenia had a significantly worse prognosis than those without after surgical resection of esophageal cancer. Preoperative sarcopenia is an independent unfavorable prognostic factor for esophageal cancer patients after esophagectomy. However, high-quality studies with appropriate adjustments for confounding factors are needed to confirm our conclusions.

Impact of Chemoradiation-to-Surgery Interval on Pathological Complete Response and Short- and Long-Term Overall Survival in Esophageal Cancer Patients.

The impact of the neoadjuvant chemoradiation-to-surgery (CRT-S) interval in patients with esophageal cancer is not clear. We aimed to determine the relationship between CRT-S interval and pathological complete response rate (pCR) and overall survival (OS). National Cancer Data Base patients with CRT followed by surgery were studied. CRT-S interval was studied as a continuous (weeks) and categorical variable (quintiles: 15-37, 38-45, 46-53, 54-64, and 65-90days, with n = 1016, 1063, 1081, 1083, and 938 patients, respectively). A total of 5181 patients were included; 81% had adenocarcinoma. There was a significant increase of pCR rate across quintiles (18%, 21%, 24%, 25%, and 29%, p < 0.001) and per week increase of CRT-S interval [odds ratio (OR) 1.11, p < 0.001]. The 90-day mortality increased as CRT-S increased across quintiles (5.7%, 6.2%, 6.8%, 8.5%, and 8.2%, p = 0.02) and through weeks (OR 1.05, p = 0.03). Mean OS across CRT-S quintiles was 36.4, 35.1, 33.9, 33.2, and 30.7months, respectively. Multivariate Cox regression showed significantly worse OS per week increase in CRT-S interval [hazard ratio (HR) 1.02, p = 0.02], especially among the last quintile (CRT-S = 65-90days: HR 1.2, p = 0.009). The squamous cell carcinoma (SCC) and pCR groups had similar OS across CTR-S intervals. Despite the higher pCR rate with longer CRT-S interval, surgery is optimal less than 65days after CRT to avoid worse 90-day mortality and achieve better OS. In patients with SCC and those with pCR, prolonged CRT-S interval had no impact on OS. Further studies are needed to consolidate our findings.

Esophageal Cancer and Treatment Modalities

Esophageal cancer is eighth most common cancer worldwide with high biological aggressiveness and poor prognosis. Switching of predominant type from squamous cell carcinoma to adenocarcinoma in Western population, ethnic discrepancies and increased occurrences have identified it as major public health problem. Though monotherapy includes – surgery, radiotherapy and chemotherapy, optimal therapy for esophageal cancer is still debated. Treatment requires a multi-modal approach which includes chemotherapy, radiation therapy with or without surgical follow-up for most patients and chemoradiation for those with inoperable disease; endoscopic therapies, including radiofrequency ablation, endoscopic mucosal resection and endoscopic sub mucosal dissection for Barrett’s esophagus/ early carcinoma patients and minimally invasive surgical approaches are standards for esophagectomy. Advancement in diagnostic techniques and the multi-modal treatment approach has led to an improvement in the overall survival of esophageal cancer patients. Key words: Esophageal Cancer, Treatment, Surgery, Radiation, Chemotherapy, Chemoradiation

PS02.123: LYMPH NODE METASTASIS STATUS AFTER DIFFERENT STRATEGIES OF NEO-ADJUVANT THERAPIES FOR THE ESOPHAGEAL SQUAMOUS CELLS CARCINOMAS

Abstract Background Lymph node status is an essential prognostic factor for the long term survival of esophageal cancer patients. The impact of neo-adjuvant therpay on lymph node status remains unconcern, especially for squamous cells carcinomas. The study objectives were to retrospective analyzed the impact on the numbers and stations of metastasis of lymph nodes after the neo-adjuvant therapy. Methods Patients undergoing esophagectomy for thoracic esophageal squamous cell carcinoma at Tianjin Medical University Cancer Institute and Hospital from 2013 to 2017 were included in this study. Group 1 included the patients who were treated with surgery only (N = 120). Group 2 included the patients who received the neo-adjuvant chemoradiation (n = 77). Group 3 included the patients who received the neo-adjuvant chemotherapy (n = 117). Results In group 2, the pathological complete response (pCR) rate was 45.61%, partial response (PR) rate was 22.8%, and stable disease (SD) rate was 22.39%. In group 3, the pCR rate was 12.7%, PR rate was 27.8%, and SD rate was 59.5%. The lymph node metastasis rate at upper mediastinum was 22.39% in group 1, 17.54% in group 2, 35.90% in group 3. The lymph node metastasis rate at middle mediastinum was 19.40% in group 1, 1.75% in group 17.54% in group 3. There were no significant differences at other part of station. Conclusion There is still no standardized guideline for the treatment of esophageal squamous cells carcinomas. In our study, we retrospectively compared the effects of neo-adjuvant chemoradiation and chemotherapy on the status of lymph node metastasis. It is showed that there were less lymph node metastasis after the the neo-adjuvant therapy compared with the surgery alone group. But the group 2 had better pCR rates than the group 3. And after the chemoradiation, it also showed less lymph node metastasis on the upper and middle mediastinum. From the results of our study, we may draw a conclusion that neo-adjuvant chemoradiation would be a better choice for those patients who had multiple stations of lymph node metastasis. But we still need the prospective studies to verify our hypothesis. Disclosure All authors have declared no conflicts of interest.

PS01.165: HIGH BMI HAS NO IMPACT ON THE SURVIVAL OF CHINESE PATIENTS WITH ESOPHAGEAL ADENOCARCINOMA TREATED WITH CURATIVE ESOPHAGECTOMY: A PROPENSITY SCORE-MATCHED STUDY

Abstract Background Controversy still exists as to whether high BMI has any impact on the long-term survival of esophageal cancer patients treated with curative esophagectomy. Due to the rarity of esophageal adenocarcinoma in Chinese patients, its characteristics were rarely reported and the prognostic value of high BMI in Chinese esopaheagl adenocarcinoma patients has not been investigated yet. Therefore, we conducted this propensity score-matched study to explore the prognostic value of high BMI in Chinese patients with esophageal adenocarcinoma for the first time. Methods We retrospectively collected data of patients with lower thoracic esophageal adenocarcinoma who underwent curative esophagectomy in our department from January 2009 to December 2016. Patients were grouped into high BMI group (≥ 23 kg/m2) and normal BMI group (18.5–22.9 kg/m2) according to the Asian specific BMI cutoff value. Both Cox regression survival analysis and propensity score-matched analysis were applied. Results A total of 132 patients were included for analysis. Fifty-three patients were in the high BMI group while 79 patients were in the normal BMI group. There were no significant differences regarding age, gender, comorbidity, tumor differentiation, tumor site, lymphovascular invasion, or surgical approaches between the two groups. However, patients in the high BMI group had more stage III diseases but less rate of adjuvant therapy than patients in the normal group. For survival, there was no significant survival difference between patients with high BMI and those with normal BMI (5-year overall survival rate: 40.8%VS 48.1%; P = 0.398). In the multivariate analysis, high BMI was not found to be an independent prognostic factor of Chinese patients with esophageal adenocarcinoma (HR = 1.028, 95%CI: 0.621–1.667, P = 0.945). A total of 92 patients were included after propensity-score matched analysis, and all those baseline data were comparable between the two groups. However, there was still no significant difference of survival between patients with high BMI and those with normal BMI (5-year overall survival rate: 41.4%VS 43.3%; P = 0.760). Conclusion High BMI have no impact on survival of Chinese patients with lower thoracic esophageal adenocarcinoma treated with curative esophagectomy. Therefore, esophageal adenocarcinoma patients with high BMI should not be denied for curative esophagectomy. Disclosure All authors have declared no conflicts of interest.

PS01.170: IMPACT OF MUSCLE MASS, NUTRITIONAL STATUS AND MUSCLE STRENGTH ON OUTCOMES FOLLOWING SURGERY FOR ESOPHAGEAL CANCER

Abstract Background Muscle function loss and loss of skeletal muscle have been associated with worse outcomes following surgery for malignancies of gastrointestinal origin. The influence on post-operative outcomes and survival after esophageal surgery remains unclear. Primary objectives of this study were to evaluate the incidence of sarcopenia and malnutrition and to evaluate the influence of skeletal muscle surface area and muscle strength on postoperative outcomes and overall survival in esophageal cancer patients. Methods A retrospective cohort study from a prospective database was conducted in patients with resectable esophageal cancer who underwent curative-intent treatment between January 2011 and January 2016. Skeletal muscle surface area was calculated with CT scans at L3 level and corrected for height and weight before start of treatment and in the interval between neoadjuvant treatment and surgery. Muscle strength was evaluated with various tests on muscle functions and lung function tests. Nutritional status was evaluated using BMI. Results 273 Patients were included. There were 4 patients with sarcopenia before neoadjuvant therapy and only one patient with sarcopenia after completion of neoadjuvant therapy. Median skeletal muscle surface area was 78cm2/m2 for men and 61cm2/m2 for woman. Table 1 shows skeletal muscle surface area, muscle strength and BMI in relation to no, minor or major complications. Muscle strength and nutritional status did not have a significant influence on postoperative complications and overall survival. Conclusion Sarcopenia did not occur frequently in this cohort with potentially curable esophageal cancer patients. Muscle function, skeletal muscle index and BMI did not statistically influence post-operative complications or survival. Disclosure All authors have declared no conflicts of interest.

FA01.02: THE EFFECT OF POSTOPERATIVE COMPLICATIONS AFTER MIE ON LONG-TERM SURVIVAL: A RETROSPECTIVE, MULTI-CENTER COHORT STUDY.

Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated. Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade≥3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses. A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade≥3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29-2.32, P<0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32-2.63, P<0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38-5.35, p 0.004). For all other complications, no significant influence on long-term survival was found. The occurrence and severity of anastomotic leakage and cardiac complications after MIE negatively affect long-term survival of esophageal cancer patients. All authors have declared no conflicts of interest.

Dose-escalated radiotherapy improved survival for esophageal cancer patients with a clinical complete response after standard-dose radiotherapy with concurrent chemotherapy.

PurposeFor esophageal cancer patients with a clinical complete response (cCR) after standard-dose radiotherapy with concurrent chemotherapy, data on the survival outcomes and recurrence patterns remain scarce. To evaluate the impact of dose escalation on overall survival for this subset of patients, we carried out the current investigation.Materials and methodsMedical records of 80 esophageal cancer patients with a cCR after standard-dose radiotherapy with concurrent chemotherapy at our center from 2010 to 2014 were allocated into the standard-dose group (50.4 Gy, observation group) or the radiation dose-escalation group (59.4 Gy, control group). In this cohort study, we compared the outcomes between the 2 groups.ResultsThere were no differences in patient characteristics between the 2 groups. The median recurrence-free survival and overall survival times for all patients were 38 and 54 months, respectively. Patients in the control group had significantly better 5-year recurrence-free survival rate (12% vs 0%, p=0.019) and 5-year overall survival rate (42.8% vs 21.0%, p=0.028) than the observation group. Additionally, local control rate was significantly higher in the control group (p=0.04), and ~60% of treatment failures were local failures even for patients achieving cCR after chemoradiotherapy. There were no significant differences in treatment-related toxicities between the groups.ConclusionThe results of the current study suggest that for esophageal cancer patients with a cCR after standard-dose radiotherapy with concurrent chemotherapy, those with dose-escalated radiotherapy showed significantly better local control, recurrence-free survival, and overall survival than patients receiving 50.4 Gy radiotherapy.

Prognostic value of circumferential resection margin in T3N0M0 esophageal squamous cell carcinoma.

The prognostic value of positive circumferential resection margins (CRM) in resected esophageal squamous cell carcinoma (ESCC) is unclear. The Royal College of Pathologists criteria and the College of American Pathologists criteria are the two commonly used definitions of CRM involvement. The aim of this report was to compare the prognostic performance of the two criteria and to propose a modified stratification in patients who underwent radical esophagectomy for ESCC. We retrospectively reviewed 112 patients with pathologically confirmed T3N0M0 ESCC and without neoadjuvant therapy from June 2009 and July 2011. The optimal cutoff point was obtained by the X-tile. The prognostic performance of different classifications of CRM was assessed in terms of homogeneity, discriminatory ability, and monotonicity. According to the Royal College of Pathologists criteria, a positive CRM was detected in 87 patients (77.7%); and 24 patients (21.4%) were found with positive CRM according to the College of American Pathologists criteria. Non-significant associations between overall survival and CRM were observed according to either of the two criteria. The analysis of reclassifying the CRM criteria demonstrated that the optimal cutoff CRM value for best prognostic power was 600 µm. Patients with CRM more than 600 µm showed better overall survival (P<0.05) than the cases with CRM less than 600 µm. Furthermore, the improved homogeneity, discriminatory ability, and monotonicity gradients were also found in this modified criteria, as compared with the two existing criteria. Our study highlighted that CRM was an independent prognostic factor for survival in esophageal cancer patients, and the modified CRM criteria had better prognostic power than the traditional criteria in patients with ESCC.

Pre-treatment CT radiomics to predict 3-year overall survival following chemoradiotherapy of esophageal cancer

Background: Radiomic features retrieved from standard CT-images have shown prognostic power in several tumor sites. In this study, we investigated the prognostic value of pretreatment CT radiomic features to predict overall survival of esophageal cancer patients after chemoradiotherapy.Material and methods: Two datasets of independent centers were analyzed, consisting of esophageal cancer patients treated with concurrent chemotherapy (Carboplatin/Paclitaxel) and 41.4Gy radiotherapy, followed by surgery if feasible. In total, 1049 radiomic features were calculated from the primary tumor volume. Recursive feature elimination was performed to select the 40 most relevant predictors. Using these 40 features and six clinical variables as input, two random forest (RF) models predicting 3-year overall survival were developed.Results: In total 165 patients from center 1 and 74 patients from center 2 were used. The radiomics-based RF model yielded an area under the curve (AUC) of 0.69 (95%CI 0.61–0.77), with the top-5 most important features for 3-year survival describing tumor heterogeneity after wavelet filtering. In the validation dataset, the RF model yielded an AUC of 0.61 (95%CI 0.47–0.75). Kaplan Meier plots were significantly different between risk groups in the training dataset (p = .027) and borderline significant in the validation dataset (p = .053). The clinical RF model yielded AUCs of 0.63 (95%CI 0.54–0.71) and 0.62 (95%CI 0.49–0.76) in the training and validation dataset, respectively. Risk groups did not reach a significant correlation with pathological response in the primary tumor.Conclusions: A RF model predicting 3-year overall survival based on pretreatment CT radiomic features was developed and validated in two independent datasets of esophageal cancer patients. The radiomics model had better prognostic power compared to the model using standard clinical variables.