What Constitutes Optimal Management of T1N0 Esophageal Adenocarcinoma?

Ramay, Fariha H.; Vareedayah, Ashley A.; Visrodia, Kavel; Iyer, Prasad G.; Wang, Kenneth K.; Eluri, Swathi; Shaheen, Nicholas J.; Reddy, Rishindra M.; Martin, Linda W.; Greenwald, Bruce D.; Edwards, Melanie

doi:10.1245/s10434-018-07118-5

Cited by 9 publications

(9 citation statements)

References 54 publications

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“…[ 24 , 25 ] Therefore, as Fariha H. et al concluded, the risk of LNM must be assessed in combination with other clinical factors such as tumor size, histology, pathology grade and lymph vascular invasion. [ 14 ] To the best of our knowledge, the present study was the first to comprehensively explore the differences in LNM and survival between SCC and AC patients, and it included many patients (a total of 4764 patients) with EC at the T1 stage. Using the PSM method, we demonstrated that patients with SCC have a similar risk of LNM as patients with AC, and we found that patients with SCC had poorer CSS and OS, which was similar with the results of some retrospective studies, by performing Gray competing risk regression model and PSM.…”

Section: Discussionmentioning

confidence: 99%

“…Using the PSM method, we demonstrated that patients with SCC have a similar risk of LNM as patients with AC, and we found that patients with SCC had poorer CSS and OS, which was similar with the results of some retrospective studies, by performing Gray competing risk regression model and PSM. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 12 , 13 ] Understanding and predicting the presence of LNM allows a determination of whether endoscopic treatment and esophagectomy is the optimal method of management. [ 8 , 14 ] Early studies showed that the rate of LNM for SCC (17%) was higher than that for AC (16.6%) [ 15 ] ; in contrast, the results of a propensity score-matched study showed that patients with AC had a higher risk of LNM than those with SCC. [ 16 ] A recent retrospective study showed that the rate and patterns of LNM between SCC and AC did not statistically differ.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of LNM and survival in T1 stage esophageal cancer patients based on histological classification: A large population-based study

Liu

Meng

2022

Medicine

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Limited evidence and contradictory results have been reported regarding the impact of squamous cell carcinoma (SCC) and adenocarcinoma (AC) classification on lymph node metastasis (LNM) and prognosis in esophageal cancer (EC). We aimed to compare 2 histology types in terms of LNM and prognosis using a comprehensive statistical analysis of a large population. The Surveillance, Epidemiology, and End Results (SEER) database was used to extract patient information. Univariate and multivariate logistic or Cox regression, a multivariate competing risk model and propensity score matching (PSM) were used to explore the association between LNM or survival and the 2 histology types. Information for 4764 patients, including 1712 SCC and 3052 AC patients, was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate logistic regression analysis revealed a correlation between LNM and histology (odds ratio [OR] = 0.654, P = .037). We found that patients with AC had a better prognosis than SCC patients through both the multivariate Cox regression (hazard ratio [HR] = 0.866) and the multivariate competing risk model (subdistribution hazard ratio [SHR] = 0.704). However, no positive relation was found between LNM and histology type ( P = .844) based on propensity score matching (PSM), and the prognosis remained poorer for the patients with SCC ( P < .001). T1-stage EC with a histology of SCC may have a comparable risk of LNM as the AC type, while SCC has a poorer prognosis than the AC type.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of LNM and survival in T1 stage esophageal cancer patients based on histological classification: A large population-based study

Liu

Meng

2022

Medicine

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“…The promise of treating esophageal cancer with endoscopy certainly has the promise of alchemy and has been supported by several retrospective institutional series demonstrating comparable overall survival between EMR and esophagectomy as long as a negative margin is achieved. 2,3 Unfortunately, as the expression goes, all that glitters is not gold, and we must question whether EMR and ESD is the 24K magic bullet we seek for early-stage esophageal adenocarcinoma.…”

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confidence: 99%

Commentary: All that glitters isn't gold: Defining low-risk lesions in early-stage esophageal adenocarcinoma

Sesti¹,

Paul²

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Neoadjuvant treatment is now regarded as the gold standard for those patients with locally advanced disease, and commonly involves the administration of chemotherapy or chemoradiotherapy. [4][5][6] Furthermore, surgical techniques are evolving with the introduction of endoscopic therapy for early-stage cancers 7 and minimally invasive and robotic techniques. [8][9][10] There is also an increasing appreciation of improving the whole patient pathway involving prehabilitation and enhanced recovery in the immediate postoperative setting.…”

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confidence: 99%

Evolution of Esophagectomy for Cancer Over 30 Years: Changes in Presentation, Management and Outcomes

et al. 2020

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Background Esophageal cancer has seen a considerable change in management and outcomes over the last 30 years. Historically, the overall prognosis has been regarded as poor; however, the use of multimodal treatment and the integration of enhanced recovery pathways have improved short- and long-term outcomes. Objective The aim of this study was to evaluate the changing trends in presentation, management, and outcomes for patients undergoing surgical treatment for esophageal cancer over 30 years from a single-center, high-volume unit in the UK. Patients and Methods Data from consecutive patients undergoing esophagectomy for cancer (adenocarcinoma or squamous cell carcinoma) between 1989 and 2018 from a single-center, high-volume unit were reviewed. Presentation method, management strategies, and outcomes were evaluated. Patients were grouped into successive 5-year cohorts for comparison and evaluation of changing trends. Results Between 1989 and 2018, 1486 patients underwent esophagectomy for cancer. Median age was 65 years (interquartile range [IQR] 59–71) and 1105 (75%) patients were male. Adenocarcinoma constituted 1105 (75%) patients, and overall median survival was 29 months (IQR 15–68). Patient presentation changed, with epigastric discomfort now the most common presentation (70%). An improvement in mortality from 5 to 2% (p < 0.001) was seen over the time period, and overall survival improved from 22 to 56 months (p < 0.001); however, morbidity increased from 54 to 68% (p = 0.004). Conclusions Long-term outcomes have significantly improved over the 30-year study period. In addition, mortality and length of stay have improved despite an increase in complications. The reasons for this are multifactorial and include the use of perioperative chemo(radio)therapy, the introduction of an enhanced recovery pathway, and improved patient selection.

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What Constitutes Optimal Management of T1N0 Esophageal Adenocarcinoma?

Cited by 9 publications

References 54 publications

Comparison of LNM and survival in T1 stage esophageal cancer patients based on histological classification: A large population-based study

Comparison of LNM and survival in T1 stage esophageal cancer patients based on histological classification: A large population-based study

Commentary: All that glitters isn't gold: Defining low-risk lesions in early-stage esophageal adenocarcinoma

Evolution of Esophagectomy for Cancer Over 30 Years: Changes in Presentation, Management and Outcomes

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