Esophageal Squamous Cell Carcinoma

19.
Ann Surg Oncol. 2019 Sep;26(9):2890-2898. doi: 10.1245/s10434-019-07393-w. Epub 2019 Jun 10.
Nomogram to Predict Overall Survival for Thoracic Esophageal Squamous Cell Carcinoma Patients After Radical Esophagectomy.
Deng W1, Zhang W2, Yang J3, Ni W1, Yu S4, Li C1, Chang X1, Zhou Z1, Chen D1, Feng Q1, Chen X5, Lin Y6, Zhu K5, Zheng X7, He J8, Gao S8, Xue Q8, Mao Y8, Cheng G8, Sun K8, Liu X8, Fang D8, Chen J9, Xiao Z10.

Author information
1Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.2Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention Therapy, Tianjin, China.3Department of Radiation Oncology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.4Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.5Department of Thoracic Surgery, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.6Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.7Department of Pathology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.8Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.9Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China. junqiangc@163.com.10Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. xiaozefen@sina.com.

Abstract

BACKGROUND:

Effective tools evaluating the prognosis for patients with esophageal cancer undergoing surgery is lacking. The current study aimed to develop a nomogram to predict overall survival (OS) and provide evidence for adjuvant therapy for patients with esophageal carcinoma after esophagectomy.
METHODS:

The study retrospectively reviewed patients with pathologic T1N +/T2-4aN0-3, M0 thoracic esophageal squamous cell carcinoma after radical esophagectomy, with or without adjuvant therapy, in one institution as the training cohort (n = 2281). A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS, which were validated in an independent validation cohort (n = 1437). Area under curve (AUC) values of receiver operating characteristic curves were calculated to evaluate prognostic efficacy.
RESULTS:

In the training cohort, the median OS was 50.46 months, and the 5-year OS rate was 47.08%. Adjuvant therapy, sex, tumor location, grade, lymphovascular invasion, removed lymph nodes, and T and N categories were identified as predictive factors for OS. The nomogram showed favorable prognostic efficacy in the training and validation cohorts (5-year OS AUC: 0.685 and 0.744, respectively), which was significantly higher than that of the American Joint Committee on Cancer (AJCC) staging system. The nomogram distinguished OS rates among six risk groups, whereas AJCC could not separate the OS of 2A and 1B, 3C and 3B, or 3A and 2B. Patients with a nomogram score of 72 to 227 were predicted to achieve a 5-year OS increase of 10% or more from adjuvant therapy.
CONCLUSION:

The nomogram could effectively predict OS and aided decision making in adjuvant therapy for patients with thoracic esophageal squamous cell carcinoma after esophagectomy.
PMID: 31183641 DOI: 10.1245/s10434-019-07393-w
[Indexed for MEDLINE]
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Select item 3118364020.
Ann Surg Oncol. 2019 Sep;26(9):2864-2873. doi: 10.1245/s10434-019-07478-6. Epub 2019 Jun 10.
Cardiorespiratory Comorbidity and Postoperative Complications following Esophagectomy: a European Multicenter Cohort Study.
Klevebro F1,2, Elliott JA3,4, Slaman A5, Vermeulen BD6, Kamiya S7,8, Rosman C9, Gisbertz SS5, Boshier PR10, Reynolds JV3,4, Rouvelas I7,8, Hanna GB10, van Berge Henegouwen MI5, Markar SR10.

Author information
1Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. fredrik.klevebro@ki.se.2Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden. fredrik.klevebro@ki.se.3Department of Surgery, Trinity College Dublin, Dublin, Ireland.4The National Esophageal and Gastric Center, St. James's Hospital, Dublin, Ireland.5Department of Surgery, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.6Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.7Department of Upper Abdominal Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.8Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.9Radboud University, Nijmegen, The Netherlands.10Department Surgery and Cancer, Imperial College London, London, UK.

Abstract

BACKGROUND:

The impact of cardiorespiratory comorbidity on operative outcomes after esophagectomy remains controversial. This study investigated the effect of cardiorespiratory comorbidity on postoperative complications for patients treated for esophageal or gastroesophageal junction cancer.
PATIENTS AND METHODS:

A European multicenter cohort study from five high-volume esophageal cancer centers including patients treated between 2010 and 2017 was conducted. The effect of cardiorespiratory comorbidity and respiratory function upon postoperative outcomes was assessed.
RESULTS:

In total 1590 patients from five centers were included; 274 (17.2%) had respiratory comorbidity, and 468 (29.4%) had cardiac comorbidity. Respiratory comorbidity was associated with increased risk of overall postoperative complications, anastomotic leak, pulmonary complications, pneumonia, increased Clavien-Dindo score, and critical care and hospital length of stay. After neoadjuvant chemoradiotherapy, respiratory comorbidity was associated with increased risk of anastomotic leak [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.11-3.04], pneumonia (OR 1.65, 95% CI 1.10-2.47), and any pulmonary complication (OR 1.52, 95% CI 1.04-2.22), an effect which was not observed following neoadjuvant chemotherapy or surgery alone. Cardiac comorbidity was associated with increased risk of cardiovascular and pulmonary complications, respiratory failure, and Clavien-Dindo score ≥ IIIa. Among all patients, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio > 70% was associated with reduced risk of overall postoperative complications, cardiovascular complications, atrial fibrillation, pulmonary complications, and pneumonia.
CONCLUSIONS:

The results of this study suggest that cardiorespiratory comorbidity and impaired pulmonary function are associated with increased risk of postoperative complications after esophagectomy performed in high-volume European centers. Given the observed interaction with neoadjuvant approach, these data indicate a potentially modifiable index of perioperative risk.
PMID: 31183640 PMCID: PMC6682565 DOI: 10.1245/s10434-019-07478-6
[Indexed for MEDLINE] Free PMC Article
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