The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Clinical implications of endoscopic ultrasonography non-traversability in patients with locoregional esophageal cancer receiving multimodality therapy

  • Cho, Charles J. (Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Ho June (Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Gin Hyug (Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Kee Don (Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yong-Hee (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ryu, Jin-Sook (Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Bae (Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong Hoon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Seung-Il (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Hwoon-Yong (Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2015.06.24
  • Accepted : 2015.09.14
  • Published : 2017.05.01
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Abstract

Background/Aims: Approximately 30% of esophageal cancer (EC) patients cannot complete endoscopic ultrasonography (EUS) due to malignant stricture (EUS non-traversability). This study examines clinical implications of EUS non-traversability in patients with advanced locoregional squamous EC receiving preoperative chemoradiotherapy (CRT) followed by esophagectomy. Methods: We retrieved data on 89 consecutive patients with advanced locoregional squamous EC (stage II or III). Relevant clinical and tumor-specific parameters were reviewed retrospectively. Significant factors affecting survival was determined by Cox regression analysis. Results: EUS non-traversable EC was observed in 26 of 89 patients (29.2%). Median serum albumin level (3.6 g/dL vs. 3.9 g/dL, p = 0.028), tumor length (6.0 cm vs. 4.0 cm, p = 0.002), and percentage of clinical stage III disease (65.4% vs. 38.1%, p = 0.019) were significantly different between the patients with EUS non-traversable and traversable EC, respectively. Patients with EUS non-traversable EC demonstrated a significantly lower 5-year overall survival than patients with EUS traversable EC (30.8% vs. 49.3%, p = 0.023). In multivariate analysis, weight loss ${\geq}10%$ (p = 0.033), EUS non-traversability (p = 0.003), non-response to preoperative CRT (p = 0.002), and incompletion of esophagectomy (p = 0.002) were significant negative factors of survival. Conclusions: EUS non-traversability has significant negative prognostic implications in patients with advanced locoregional squamous EC receiving preoperative CRT followed by esophagectomy.

Keywords

References

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