Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Patients
2.2. Endoscopic Resections
2.3. Histological Analysis and Definitions
2.4. Organ Preservation Strategy
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Lesion Characteristics
3.3. Organ Preservation Strategy
3.4. Oncological Outcomes
3.5. Toxicity of Chemoradiotherapy
4. Discussion
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Overall n = 41 | Chemoradiotherapy n = 28 | Follow up n = 13 | p-Value | |
---|---|---|---|---|
Age, years (median (range)) | 65 (47–85) | 65 (53–85) | 61 (47–78) | 0.60 |
Sex ratio male/female-n (%) | 36/5 (88%/12%) | 25/3 (89%/11%) | 11/2 (85%/15%) | 0.64 |
Tumor location-n (%) | ||||
Upper esophagus | 5 (12%) | 5 (18%) | 0 | - |
Mid esophagus | 23 (56%) | 17 (61%) | 6 (46%) | 0.50 |
Lower esophagus | 13 (32%) | 6 (21%) | 7 (54%) | 0.07 |
Histological type | ||||
Squamous cell carcinoma | 36 (88%) | 26 (93%) | 10 (77%) | 0.30 |
Adenocarcinoma | 5 (12%) | 2 (7%) | 3 (23%) | 0.30 |
Pejorative criteria-n (%) | ||||
Deep invasion | 38 (93%) | 28 (100%) | 10 (77%) | 0.03 |
Poor tumor differentiation | 10 (24%) | 5 (18%) | 5 (38%) | 0.24 |
Lymphovascular invasion | 11 (27%) | 8 (28%) | 3 (23%) | 1 |
Endoscopic resection | ||||
Endoscopic mucosal resection | 7 (17%) | 7 (25%) | 0 | - |
Endoscopic submucosal dissection | 34 (83%) | 21 (75%) | 13 (100%) | 0.07 |
Patient | Histological Type | Quantitative Criteria | Qualitative Criteria | Number of Pejorative Criteria | ||
---|---|---|---|---|---|---|
Invasion | Depth of Submucosal Invasion (µm) | Poor Tumor Differentiation | Lymphovascular Invasion | |||
1 | SCC | T1a m3 | 1 | |||
2 | SCC | T1b | 1070 | + | + | 3 |
3 | SCC | T1a m3 | + | 2 | ||
4 | SCC | T1b | 1000 | 1 | ||
5 | SCC | T1a m3 | 1 | |||
6 | SCC | T1a m3 | 1 | |||
7 | SCC | T1a m3 | 1 | |||
8 | SCC | T1a m3 | 1 | |||
9 | ADC | T1b | 110 | + | 1 | |
10 | SCC | T1b | 2500 | + | + | 3 |
11 | ADC | T1a m4 | + | 1 | ||
12 | SCC | T1b | 120 | 1 | ||
13 | ADC | T1a m3 | + | 1 |
Study | Patients (n) | SCC (n) | ADC (n) | Histologic Characteristic | Protocol | Follow-up, Median | DFS | OS | Toxicities: Grade 3–4 Adverse Events |
---|---|---|---|---|---|---|---|---|---|
Shimizu et al., 2004 [21] | 16 | 16 | 0 | T1a m3 or T1b | 40 to 46 Gy 5FU-Cisplatin | 39 months | 100% | 100% at 5 years | Hematological 12.5% |
Canard et al., 2011 [22] | 6 | 6 | 0 | T1a m3 or T1b | NA | 44 months | 100% | NA | 0% |
Mochizuki et al., 2011 [23] | 14 | 14 | 0 | T1a m3: 8 T1b (superficial: 67%, deep: 33%) LVI: 2 | 40 Gy 5FU-Cisplatin | 45 months (mean) | 100% (CSS) | 85.7% | 0% |
Ikeda et al., 2015 [12] | 11 | 11 | 0 | Poor differentiation 9% T1b (superficial: 27%, deep: 72%) Positive deep margins: 36% LVI: 73% | 41.4 to 50.4 Gy | 43 months | 72.7% | 89% at 3 years (with adjuvant surgery or chemoradiotherapy) | 9% |
Kawaguchi et al., 2015 [24] | 16 | 16 | 0 | T1a m3 with LVI (3) or T1b (superficial: 29%, deep: 71%) | 40 to 60 Gy 5FU+/− Cisplatin | 3 years | 93.7% | 90% | Esophageal stricture 25% Leucopenia 25% Esophagitis 12.5% Nausea18.8% |
Uchinami et al., 2016 [25] | 45 | 45 | 0 | T1a m3: 8.5% | 28 to 68 Gy +/−5FU-Cisplatin (85%) | 44 months | 82.9% (CSS) | NA | 7% |
Hamada et al., 2017 [26] | 66 | 66 | 0 | T1a m3:27% T1b (superficial 12%, Deep 61 %) R1:8% LVI: 55% | 40 to 60 Gy | 51 months | 88% | 75% at 5 years | Hematological 20% Non-hematological 14% |
Hisano et al., 2018 [27] | 13 | 13 | 0 | T1a m3: 6 T1b: 7 LVI: 1 Positive deep margin: 1 | 40 to 61.4 Gy +/− 5FU-Cisplatin S-1 (4/13) | 3 years | 77.8% (CSS) | 67.1% | Esophageal stricture 1 Radiation pneumonitis 1 Neutropenia 2 |
Suzuki et al., 2018 [16] | 16 | 16 | 0 | T1b 75% LVI 69% Positive deep margin 12.5% | 40 to 50 Gy 5FU-Cisplatin | 24 months | 88% | 100% | Leucopenia 25% Esophagitis 6% |
Minashi et al., 2019 [7] | 87 | 87 | 0 | T1a m3 with LVI or T1b | 41.4 Gy 5FU-Cisplatin | 3 years | 88% | NA | Neutropenia 22.9% Esophagitis 4.2% |
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Dermine, S.; Lévi-Strauss, T.; Abou Ali, E.; Belle, A.; Leblanc, S.; Bibault, J.-E.; Barré, A.; Palmieri, L.-J.; Brezault, C.; Dhooge, M.; et al. Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement. Cancers 2020, 12, 3598. https://doi.org/10.3390/cancers12123598
Dermine S, Lévi-Strauss T, Abou Ali E, Belle A, Leblanc S, Bibault J-E, Barré A, Palmieri L-J, Brezault C, Dhooge M, et al. Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement. Cancers. 2020; 12(12):3598. https://doi.org/10.3390/cancers12123598
Chicago/Turabian StyleDermine, Solène, Thomas Lévi-Strauss, Einas Abou Ali, Arthur Belle, Sarah Leblanc, Jean-Emmanuel Bibault, Amélie Barré, Lola-Jade Palmieri, Catherine Brezault, Marion Dhooge, and et al. 2020. "Organ Preservation after Endoscopic Resection of Early Esophageal Cancer with a High Risk of Lymph Node Involvement" Cancers 12, no. 12: 3598. https://doi.org/10.3390/cancers12123598