Dae Gon Ryu, Fengxue Yu, Hongqun Liu, Samuel S Lee, Sangjune Laurence Lee
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引用次数: 0
Abstract
Background: The prognosis of esophageal squamous cell carcinoma (ESCC) with obstruction is unclear. This study aimed to analyze clinical outcomes and prognosis of patients with ESCC and obstruction.
Methods: Patients with advanced ESCC were included and divided into obstructive and non-obstructive groups. Clinical outcomes and survival according to treatment were compared between these groups.
Results: Among 353 patients with advanced ESCC, obstruction was present in 105 (29.7%). ESCC with obstruction was more common in the upper thoracic location (23.8% vs. 14.5%, p = 0.036) and had a higher stage (7.6% vs. 32.7%, p < 0.001 in stage 2; 41.0% vs. 24.2%, p = 0.002 in stage 4) than those without obstruction. The median survival time of patients with obstruction was significantly shorter than that of patients without obstruction (7.6 months vs. 20.2 months, p < 0.001). Patients with obstruction had a significantly lower survival rate regardless of treatment. When surgery was performed first on patients with obstruction, the R0 resection rate was significantly lower (33.3% vs. 88.5%, p < 0.001). For patients with obstruction in resectable stages, surgery after neoadjuvant chemoradiotherapy resulted in the best survival (HR: 0.48; 95% CI: 0.15 - 1.49; p = 0.201). When only chemoradiotherapy was performed in resectable stages, clinically complete response rate was significantly lower (35.3% vs. 64.9%, p = 0.035) in the obstructive group.
Conclusion: ESCC with obstruction was at a more advanced stage and had a poor prognosis regardless of treatment. Surgery first or chemoradiotherapy alone is not recommended for these patients. Neoadjuvant chemoradiotherapy prior to surgical resection is recommended for those with ESCC and obstruction at resectable stages.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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