Surgical treatment strategy for esophagogastric junction cancers based on the tumor diameter

Abstract

BackgroundThe number of patients with esophagogastric junction (EGJ) cancers has tended to increase. However, no clear consensus on the optimum treatment policy has yet been reached.MethodsThis study included patients diagnosed with adenocarcinoma of Sievert type II in whom resection was performed in our hospital. We performed a clinicopathological examination, and patients were divided into two groups by the tumor size: L group, tumor size ≥4 cm; and S group, tumor size < 4 cm. The clinical factors, such as nodal dissection and recurrence pattern, were then analyzed.ResultsA total of 48 patients were diagnosed with ECJ cancers. The average tumor size was 55.1 mm, and 32 cases (66.7%) had tumors ≥4 cm. Metastasis to the mediastinum was noted in 4 cases (12.5%) in the L group but none in the S group. Recurrence in the upper or middle mediastinum lymph nodes was noted in 3 cases (9.4%) in the L group. The 5-year overall survival rates were 49.7 and 83.9% in the L and S groups, respectively.ConclusionsAs the tumor grows large, it is difficult to accurately judge EGJ on the image, and as a result it is difficult to understand the exact esophageal invasion distance of the tumor. Therefore, lymph node dissection including the upper mediastinum is considered vital, regardless of the degree of esophageal invasion.

Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

“…As is known, tumor size is a key factor affecting prognosis, and previous articles used tumor diameter of 4 cm as the dividing line to analyze prognosis [18]. In this study, it was found that tumor size affected prognosis more than T stage and pTNM stage, and patients with tumor size more than 4 cm also with poor prognosis.…”

Long-term outcomes and prognostic factor analysis of resected Siewert type II adenocarcinoma of esophagogastric junction in China: a seven-year study

“…This may be because the number of lymph nodes dissected in different surgeries varies greatly, and mere comparisons of the number of positive lymph nodes cannot accurately assess the prognosis of patients; thus, PNLNR is a better predictor of prognosis. Tumor size is a key factor affecting prognosis, and previous articles used a tumor diameter of 4 cm as the cutoff to analyze prognosis [18]. In this study, it was found that tumor size affected prognosis more than T stage and pTNM stage, and patients with a tumor size larger than 4 cm also had a worse prognosis.…”

“…Tumor size is a key factor affecting prognosis, and previous articles used a tumor diameter of 4 cm as the cutoff to analyze prognosis [ 18 ]. In this study, it was found that tumor size affected prognosis more than T stage and pTNM stage, and patients with a tumor size larger than 4 cm also had a worse prognosis.…”

Fighting Fire With Fire: Oncolytic Virotherapy for Thoracic Malignancies

“…However, advanced esophageal cancer continues to be a difficult problem, with low a 5-year survival rate (* 20%) despite improved locoregional and systemic treatments. [69][70][71] Oncolytic virotherapy has been studied as part of the multi-modal treatment for patients with esophageal cancer.…”

“…(2) NV1066 was tested in subcutaneous and intraperitoneal xenograft models; effective viral replication and oncolysis were evident in vitro (MOI, 0.1; an estimated 3500- ± 630-fold increase in viral production) and in vivo (a 73–77% decrease in tumor burden in the viral treated group vs phosphate buffered saline (PBS)) Vaccinia virus VV.mIFNβ 63 , vvDD-IL2-RG, vvDD(67) Preclinical: NSCLC 44 VV.mIFNβ was able to slow tumor growth significantly in both models. VV.mIFNβ slowed tumor growth by ~ 40% ( p < 0.05) after both systemic and intratumoral administration Measles virus MV-GFP 81 Preclinical: MPE 81 Intrapleural administration of 1.5 × 10 6 PFU total dose of MV significantly improved median survival by approximately 80% vs the control animal group Adenovirus H101;Ad-Gfp 72 ; Ad.p53 51 Preclinical: NSCLC 72 ; esophageal cancer 71 , 76 (1) Intratumorally injected H101 virus suppressed growth of XWLC-05 (lung adenocarcinoma) in mouse models. (2) H101 for esophageal cancer yielded a 27% increase in overall response rates vs fluorouracil plus cisplatin-based chemotherapy alone(3) HSV, herpes simplex virus; NSCLC, non-small cell lung cancer; PBS, phosphate buffered saline; VV, vaccinia virus; IFN, interferon; DD, double deletion; IL, interleukin; RG, rigid linker; MPE, malignant pleural effusion; PFU, plaque-forming unit; MV, measles virus; H101, Oncorine …”