Optimal Therapy in Locally Advanced Esophageal Cancer: a National Cancer Database Analysis

Whited, William M.; Trivedi, Jaimin R.; Bond, Emily; Berkel, Victor H. van; Fox, Matthew P.

doi:10.1007/s11605-017-3548-1

Cited by 6 publications

(3 citation statements)

References 19 publications

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“…R0 resections occurred more often with MIE in the unmatched group and have been shown to result in improved survival. 19 However, the difference in R0 resection rate was not statistically significant in the matched group so it is unlikely that this alone accounts for the 10 and 8% overall survival advantages seen with MIE at 3 and 5 years, respectively. MIE was also associated with a greater number of lymph nodes sampled and while this may not solely account for the survival advantage, studies have shown that increased lymph node clearance is associated with improved survival.…”

Section: Discussionmentioning

confidence: 88%

Minimally Invasive Esophagectomy Is Associated with Superior Survival Compared to Open Surgery

Ising

Smith

Trivedi

et al. 2022

The American Surgeon™

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Introduction Minimally invasive esophagectomy (MIE) has not been associated with a long-term survival advantage compared to open esophagectomy (OE). We investigated survival differences between MIE, including laparoscopic and robotic, and OE. Methods Patients undergoing esophagectomy from 2010 to 2014 with T1-4N0-3M0, adenocarcinoma or squamous cell histology, in middle or lower esophagus were queried from the National Cancer Database and stratified into groups based on their surgical procedure: robotic, laparoscopic, or OE. Propensity matching (1:1) was done between robotic and laparoscopic to produce an MIE group. The MIE group was matched to OE yielding a 1:1:2 matching of robotic:laparoscopic:OE. Postoperative outcomes and survival (Kaplan-Meier) were compared between groups. Results Prior to matching, 7,163 patients met inclusion criteria and a greater portion underwent OE (67.7%) than MIE (laparoscopic 24.9% and robotic 7.4%). Matching yielded similar groups (robotic = 527, laparoscopic = 527, and OE =1054). Compared to OE, MIE patients had a significantly greater number of nodes sampled and trended toward increased R0 resections (96.1% vs 94.3%, P = .053). OE was associated with a longer median postoperative stay (10 vs 9 days, P = .001). Mortality at 30 and 90 days was similar . However, postoperative survival for MIE was significantly greater than OE ( P < .001). No survival difference existed between robotic and laparoscopic ( P = .723). Conclusions MIE is associated with increased number of nodes examined and a shorter postoperative length of stay. After propensity matching, patients undergoing MIE had better long but not short-term survival than OE. This benefit seems to be independent of the use of robotic technology.

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Section: Discussionmentioning

confidence: 88%

Minimally Invasive Esophagectomy Is Associated with Superior Survival Compared to Open Surgery

Ising

Smith

Trivedi

et al. 2022

The American Surgeon™

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“…These findings suggest that the addition of immunotherapy to chemotherapy in the neoadjuvant setting improves the likelihood of achieving complete pathological response and significant tumour regression. The achievement of R0 resection serves as a pivotal criterion for evaluating the efficacy of surgical interventions in oesophageal cancer, as it is associated with improved patient prognosis and serves as a benchmark for successful treatment outcomes 44 . The two groups had no significant differences in the R0 resection rates.…”

Section: Discussionmentioning

confidence: 99%

Comparison of efficacy and safety between neoadjuvant chemotherapy and neoadjuvant immune checkpoint inhibitors combined with chemotherapy for locally advanced esophageal squamous cell carcinoma: a systematic review and meta-analysis

Xu,

Cai,

Hong

et al. 2023

International Journal of Surgery

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Background: The application of neoadjuvant immune checkpoint inhibitors combined with chemotherapy(NICT) in treating locally advanced esophageal squamous cell carcinoma (ESCC) is a subject of considerable research interest. In light of this, we undertook a comprehensive meta-analysis aiming to compare the efficacy and safety of this novel approach with conventional neoadjuvant chemotherapy (NCT) in the management of ESCC. Methods: A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science to gather relevant literature on the efficacy and safety of NICT compared to conventional NCT in locally advanced ESCC published before June 2023. Effect indicators, including odds ratios (ORs) with associated 95% confidence intervals (CIs), were employed to evaluate the safety and efficacy outcomes. The risk of bias was assessed using the Cochrane bias risk assessment tool, and subgroup analysis and sensitivity analysis were conducted to investigate the findings further. Results: A total of 9 studies qualified for the meta-analysis, all of which investigated the efficacy and safety of NICT compared to conventional NCT. The pooled rates of pathologic complete response (pCR) and major pathologic response (MPR) in the NICT group were significantly higher compared to the NCT group, with values of 26.9% versus 8.3% (P＜0.00001) and 48.1% versus 24.6% (P＜0.00001), respectively. The ORs for achieving pCR and MPR were 4.24 (95% CI, 2.84–6.32, I2=14%) and 3.30 (95% CI, 2.31–4.71, I2=0%), respectively, indicating a significant advantage for the NICT group. Regarding safety outcomes, the pooled incidences of treatment-related adverse events (TRAEs) and serious adverse events (SAEs) in the NICT group were 64.4% and 11.5%, respectively, compared to 73.8% and 9.3% in the NCT group. However, there were no significant differences observed between the two groups in terms of TRAEs (OR=0.67, 95% CI, 0.29–1.54, P=0.35, I2 =58%) or SAEs (OR=1.28, 95% CI, 0.69–2.36, P=0.43, I2=0%). Furthermore, no significant differences were found between the NICT and NCT groups regarding R0 resection rates, anastomotic leakage, pulmonary infection, and postoperative hoarseness. Conclusions: Neoadjuvant immune checkpoint inhibitors combined with chemotherapy demonstrate efficacy and safety in treating resectable esophageal squamous cell carcinoma. Nevertheless, additional randomized trials are required to confirm the optimal treatment regimen.

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“…The current National Comprehensive Cancer Network (NCCN) guidelines recommend surveillance over adjuvant treatment in patients after preoperative chemoradiation and surgery [ 14 ], as preoperative chemoradiotherapy has become a standard of care in the United States during the last decade [ 15 ] and has brought a pathological complete response rate of 20–30% [ 16 ]. A National Cancer Database Analysis reported an increase in the percentage of patients undergoing neoadjuvant treatment followed by surgery, from 29% in 2004 to 40% in 2014 [ 17 ]. However, the application of neoadjuvant treatment in Chinese esophageal carcinoma patients is not that widespread.…”

Section: Introductionmentioning

confidence: 99%

Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study

Fan

Wang

et al. 2022

Radiat Oncol

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Background To study lymphatic recurrence distribution after radical surgery in the real world and guide clinical tumor volume delineation for regional lymph nodes during postoperative radiotherapy for lower thoracic squamous cell esophageal carcinomas. Methods We enrolled patients who underwent radical esophagectomy, without radiation before or after surgery, at 3 cancer hospitals. Patients were classified into groups according to tumor locations. We included patients with tumors in the lower thoracic segment and analyzed the postoperative lymph node recurrence mode. A cutoff value of 10% was used to differentiate high-risk lymph node drainage areas from others. Results We enrolled 1905 patients in the whole study series, including 652 thoracic esophageal carcinomas that met our inclusion criteria; there were 241 cases of lower thoracic esophageal carcinomas. 1st, 2nd, 4th, 7th, 8th groups of lymph nodes, according to the 8th edition of the AJCC classification, displayed as high-risk recurrence areas, representing 17.8%, 23.9%, 11.7%, 10.9% and 12.2% of lymph node recurrence. Stage III-IV tumors located in the lower segment of the thoracic esophagus showed a tendency to recur in the left gastric nodes (7.9%) and celiac nodes (10.6%). Conclusions According to our results, we recommended including the 4th, 7th and 8th groups of lymph nodes in the radiation field, and for patients with stage III-IV disease, the 17th and 20th groups of nodes should be irradiated during postoperative treatment. Whether including 1st/2nd groups in preventive irradiation needed more proofs.

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Optimal Therapy in Locally Advanced Esophageal Cancer: a National Cancer Database Analysis

Cited by 6 publications

References 19 publications

Minimally Invasive Esophagectomy Is Associated with Superior Survival Compared to Open Surgery

Minimally Invasive Esophagectomy Is Associated with Superior Survival Compared to Open Surgery

Comparison of efficacy and safety between neoadjuvant chemotherapy and neoadjuvant immune checkpoint inhibitors combined with chemotherapy for locally advanced esophageal squamous cell carcinoma: a systematic review and meta-analysis

Postoperative lymphatic recurrence distribution and delineation of the radiation field in lower thoracic squamous cell esophageal carcinomas: a real-world study

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