Clinical implications of endoscopic ultrasonography non-traversability in patients with locoregional esophageal cancer receiving multimodality therapy

Abstract

Background/AimsApproximately 30% of esophageal cancer (EC) patients cannot complete endoscopic ultrasonography (EUS) due to malignant stricture (EUS non-traversability). This study examines clinical implications of EUS non-traversability in patients with advanced locoregional squamous EC receiving preoperative chemoradiotherapy (CRT) followed by esophagectomy.MethodsWe retrieved data on 89 consecutive patients with advanced locoregional squamous EC (stage II or III). Relevant clinical and tumor-specific parameters were reviewed retrospectively. Significant factors affecting survival was determined by Cox regression analysis.ResultsEUS non-traversable EC was observed in 26 of 89 patients (29.2%). Median serum albumin level (3.6 g/dL vs. 3.9 g/dL, p = 0.028), tumor length (6.0 cm vs. 4.0 cm, p = 0.002), and percentage of clinical stage III disease (65.4% vs. 38.1%, p = 0.019) were significantly different between the patients with EUS non-traversable and traversable EC, respectively. Patients with EUS non-traversable EC demonstrated a significantly lower 5-year overall survival than patients with EUS traversable EC (30.8% vs. 49.3%, p = 0.023). In multivariate analysis, weight loss ≥ 10% (p = 0.033), EUS non-traversability (p = 0.003), non-response to preoperative CRT (p = 0.002), and incompletion of esophagectomy (p = 0.002) were significant negative factors of survival.ConclusionsEUS non-traversability has significant negative prognostic implications in patients with advanced locoregional squamous EC receiving preoperative CRT followed by esophagectomy.

Cancerous esophageal stenosis before treatment was significantly correlated to poor prognosis of patients with esophageal cancer: a meta-analysis

“…EUS has been widely applied in daily practice for evaluating the extent of local tumor infiltration and local lymph node status of esophageal cancer with excellent accuracy before treatment (17). However, it is reported that due to esophageal stenosis, EUS could not be performed successfully in about 30% of esophageal cancer patients before treatment (5,6). So far, only a small number of studies have been carried out evaluating the impact of endoscopic finding of cancerous esophageal stenosis before treatment on the survival of esophageal cancer patients but drawn controversial conclusions because of the limited sample size (5-9).…”

“…Therefore, taken together, we believe that endoscopic finding of cancerous esophageal stenosis before treatment was significantly correlated to poor prognosis of esophageal cancer patients. The reasons why cancerous esophageal stenosis had unfavorable impact on prognosis of esophageal cancer patients may be explained by the facts that esophageal stenosis was associated with higher tumor stage, larger tumor burden and poorer tumor differentiation as well as poor nutrition status (6,7,16). Therefore, for patients with cancerous esophageal stenosis, neoadjuvant therapy may be more emphasized before surgical treatment.…”

“…Cancerous esophageal stenosis before treatment was significantly correlated to poor prognosis of patients with esophageal cancer: a meta-analysis is also commonly defined as cancerous esophageal stenosis (5,6). Since the pT stage in TNM classification measures only the depth of infiltration (lamina propria, submucosa, etc.…”

“…), but not growth to esophagus, it is interesting to know whether tumor growth into the esophagus (and eventual stenosis) is of added value in prognostic assessment. Previously, some studies reported that esophageal stenosis was significantly correlated to poor prognosis of esophageal cancer patients (6)(7)(8) while other studies found that esophageal stenosis has no impact on the overall survival of those patients (5,9). Given the very limited sample size, it is reasonable that previous studies have drawn controversial conclusions.…”

Endoscopic traversability in patients with locally advanced esophageal squamous cell carcinoma

“…One of the major negative prognostic factors reported in patients receiving preoperative CRT and esophagectomy due to locally advanced esophageal squamous cell carcinoma is endoscopic ultrasonography (EUS) non-traversability. [ 8 ] However, only limited studies have investigated the impact that conventional endoscopic traversability has on the prognosis in patients with locally advanced squamous cell carcinoma that have been treated with definitive CRT. Because esophagogastroduodenoscopy with biopsy plays an essential role in histologically confirming esophageal cancer, we questioned whether the prognosis of patients with esophageal squamous cell carcinoma can be easily predicted according to endoscopic traversability.…”