Factors Affecting Survival in Esophageal Squamous Cell Carcinoma: Single Center Experience

Abstract

E sophageal cancer (EC) is a highly fatal malignancy.In the USA, approximately 17,750 people are diagnosed with EC each year, with 16,080 deaths from EC for the same year [1]. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) account for more than 95% of EC cases [2]. Although ABSTRACT OBJECTIVE: Squamous cell esophageal cancer (ESCC) is a highly fatal malignancy. This study aims to investigate the factors affecting survival in patients with metastatic and non-metastatic ESCC. METHODS:Between 2008 and 2016, 107 patients with ESCC who were followed up in an oncology clinic were included in the analysis. Patients were grouped based on the stage of disease as clinical-stage II to IV. RESULTS:Of the 107 patients, 55 (55.1%) of them were male and 52 (48.6%) of them were female. The mean age was 60.8 years. Based on the clinical-stage, 28 (26.2%) patients had stage II disease, 33 (30.8%) had stage III disease, and 46 (43.0%) had stage IV disease. Twenty-nine (27.1%) patients with the non-metastatic disease underwent surgery following neoadjuvant chemoradiotherapy (CRT), while 29 (27.1%) patients received definitive CRT. Twenty-six (56.5%) patients with metastatic disease received chemotherapy (CT). While median overall survival (mOS) could not be reached in patients who underwent surgery following neoadjuvant CRT, mOS for patients receiving definitive CRT versus patients treated with surgery alone-was 22.0 months and 24.0 months, respectively (p=0.008). In the metastatic stage, mOS was 8.0 months for the patients treated with a first-line CT and 3.0 months for patients receiving best supportive care (p<0.001). In multivariate analysis, factors predicting survival in patients with the non-metastatic disease were ECOG PS 3-4 (Hazard ratio [HR], 6.13), undergoing surgery (HR, 0.22), clinical-stage III disease (HR, 3.19), and presence of recurrence (HR, 24.12). For patients with metastatic disease, ECOG PS 3-4 (HR, 3.31), grade-III histology (HR, 3.39), liver metastasis (HR, 2.53), and receiving CT (HR, 0.15) were the factors associated with survival in multivariate analysis. CONCLUSION:In our study, surgery and early clinical-stage increased survival, whereas experiencing recurrence adversely affected survival in non-metastatic ESCC. In the metastatic stage, ECOG PS 3-4, grade-3 histology and liver metastasis adversely affected survival, while receiving CT significantly improved survival.

The interventions for the main dome of Hagia Sophia throughout its history and a preservation proposal

“…The dome that was rebuilt three times Following the earthquakes in August 553 and December 557, both the main dome and the southeastern semi-dome collapsed [4] due to a 6 magnitude earthquake on May 7, 558 [5] around 21 years after the consecration of Hagia Sophia. This destruction was linked to multiple factors, including the inadequate curvature in the initial dome's design, deformation of the main supporting pillars, and distortion of the dome caused by shear forces [6,7].…”

Prognostic significance of neutrophil to lymphocyte ratio in esophageal squamous cell carcinoma

“…Current advances in perioperative treatments, staging methods, and surgical management have improved mortality and morbidity associated with EC. However, despite new advances in diagnostic and therapeutic strategies, patients still have poor prognosis [ 3 , 4 ].…”