Clinicopathological Characteristics and Survival Outcomes in Patients with Advanced Esophageal Squamous Cell Carcinoma Who Were Intraoperatively Diagnosed Non-Curative.

IF 2.5 3区医学 Q3 ONCOLOGY

Oncology Pub Date : 2024-01-01 Epub Date: 2023-11-03 DOI:10.1159/000533772

Takahito Sugase, Takashi Kanemura, Tomohira Takeoka, Keijiro Sugimura, Masaaki Yamamoto, Naoki Shinno, Hisashi Hara, Takeshi Omori, Yosuke Mukai, Manabu Mikamori, Shinichiro Hasegawa, Naotsugu Haraguchi, Hirofumi Akita, Junichi Nishimura, Hiroshi Wada, Chu Matsuda, Masayoshi Yasui, Hiroshi Miyata

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引用次数: 0

Abstract

Introduction: Curative esophagectomy is not always possible in patients with locally advanced esophageal cancer. However, few studies have investigated patients who underwent non-curative surgery with intraoperative judgment. This study aimed to investigate patient characteristics and clinical outcomes for patients undergoing non-curative surgery and compare them between non-resectional and non-radical surgery.

Methods: Among 989 consecutive patients with thoracic esophageal squamous cell carcinoma who were preoperatively expected for curative esophagectomy, 66 who were eligible for non-curative surgery were included in this study.

Results: Intraoperative diagnosis of T4b accounted for 93% of the reasons for the failure of curative surgery. In those patients, esophageal cancer locally invaded into the aortobronchial constriction (70%), trachea (25%), or pulmonary vein (5%). Lymph node metastasis mainly invaded into the trachea (50%) or bronchus (28%). The overall survival of patients with non-curative surgery was 51.5%, 25.7%, and 10.4% at 6, 12, and 24 months after surgery, respectively. Although there were no differences in preoperative patient characteristics between non-resectional and non-radical surgery, distant metastasis, especially pleural dissemination, was significantly observed in T4b patients due to esophageal cancer with non-radical surgery than those with non-resectional surgery (35% vs. 15%, p = 0.002). Even in patients with non-curative surgery, R1 resection and postoperative chemoradiotherapy were identified as independent factors for survival 1 year after surgery (p = 0.047, and 0.019).

Conclusions: T4b tumor located in aortobronchial constriction or trachea/bronchus makes it difficult to diagnose whether it is resectable or unresectable. Moreover, surgical procedures and perioperative treatment were deeply associated with the clinical outcomes.

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术中诊断为无效的晚期食管鳞状细胞癌患者的临床病理特征和生存结果。

引言：局部晚期食管癌症患者的治疗性食管切除术并不总是可行的。然而，很少有研究对接受非治疗性手术的患者进行术中判断。本研究旨在调查接受非治疗性手术的患者的特点和临床结果，并比较非切除手术和非根治性手术的疗效。方法：在989例术前有望接受治疗性食管切除术的胸段食管鳞状细胞癌（ESCC）患者中，66例符合非治疗性手术条件的患者被纳入本研究。结果：术中诊断为T4b占治疗性手术失败原因的93%。在这些患者中，食管癌症局部侵入主动脉支气管狭窄（70%）、气管（25%）或肺静脉（5%）。LN转移主要侵犯气管（50%）或支气管（28%），术后6个月、12个月和24个月，非根治性手术患者的总生存率分别为51.5%、25.7%和10.4%。尽管非切除和非根治性手术的术前患者特征没有差异，但与非切除手术的患者相比，非根治性外科手术的食管癌症T4b患者的远处转移，尤其是胸膜扩散显著（35%对15%，P=0.002），R1切除和术后CRT被确定为术后1年生存的独立因素（P=0.047和0.019）。此外，外科手术和围手术期治疗与临床结果密切相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Oncology 医学-肿瘤学

CiteScore

6.00

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： Although laboratory and clinical cancer research need to be closely linked, observations at the basic level often remain removed from medical applications. This journal works to accelerate the translation of experimental results into the clinic, and back again into the laboratory for further investigation. The fundamental purpose of this effort is to advance clinically-relevant knowledge of cancer, and improve the outcome of prevention, diagnosis and treatment of malignant disease. The journal publishes significant clinical studies from cancer programs around the world, along with important translational laboratory findings, mini-reviews (invited and submitted) and in-depth discussions of evolving and controversial topics in the oncology arena. A unique feature of the journal is a new section which focuses on rapid peer-review and subsequent publication of short reports of phase 1 and phase 2 clinical cancer trials, with a goal of insuring that high-quality clinical cancer research quickly enters the public domain, regardless of the trial’s ultimate conclusions regarding efficacy or toxicity.