The Korean journal of internal medicine

  • 제32권3호
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  • Pages.443-451
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  • 2017
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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DOI QR코드

DOI QR Code

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)
  • 투고 : 2015.06.24
  • 심사 : 2015.09.14
  • 발행 : 2017.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

참고문헌

  1. Kleinberg L, Forastiere AA. Chemoradiation in the management of esophageal cancer. J Clin Oncol 2007;25:4110-4117. https://doi.org/10.1200/JCO.2007.12.0881
  2. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074-2084. https://doi.org/10.1056/NEJMoa1112088
  3. Lightdale CJ, Kulkarni KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol 2005;23:4483-4489. https://doi.org/10.1200/JCO.2005.20.644
  4. Kelly S, Harris KM, Berry E, et al. A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 2001;49:534-539. https://doi.org/10.1136/gut.49.4.534
  5. Pfau PR, Perlman SB, Stanko P, et al. The role and clinical value of EUS in a multimodality esophageal carcinoma staging program with CT and positron emission tomography. Gastrointest Endosc 2007;65:377-384. https://doi.org/10.1016/j.gie.2006.12.015
  6. Catalano MF, Van Dam J, Sivak MV Jr. Malignant esophageal strictures: staging accuracy of endoscopic ultrasonography. Gastrointest Endosc 1995;41:535-539. https://doi.org/10.1016/S0016-5107(95)70186-9
  7. Wallace MB, Hawes RH, Sahai AV, Van Velse A, Hoffman BJ. Dilation of malignant esophageal stenosis to allow EUS guided fine-needle aspiration: safety and effect on patient management. Gastrointest Endosc 2000;51:309-313. https://doi.org/10.1016/S0016-5107(00)70360-9
  8. Van Dam J, Rice TW, Catalano MF, Kirby T, Sivak MV Jr. High-grade malignant stricture is predictive of esophageal tumor stage: risks of endosonographic evaluation. Cancer 1993;71:2910-2917. https://doi.org/10.1002/1097-0142(19930515)71:10<2910::AID-CNCR2820711005>3.0.CO;2-L
  9. Jethwa P, Lala A, Powell J, et al. A regional audit of iatrogenic perforation of tumours of the oesophagus and cardia. Aliment Pharmacol Ther 2005;21:479-484. https://doi.org/10.1111/j.1365-2036.2005.02324.x
  10. Clavier JB, Antoni D, Atlani D, et al. Baseline nutritional status is prognostic factor after definitive radiochemotherapy for esophageal cancer. Dis Esophagus 2014;27:560-567. https://doi.org/10.1111/j.1442-2050.2012.01441.x
  11. Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual. 6th ed. New York: Springer, 2002.
  12. Catalano MF, Sivak MV Jr, Rice T, Gragg LA, Van Dam J. Endosonographic features predictive of lymph node metastasis. Gastrointest Endosc 1994;40:442-446. https://doi.org/10.1016/S0016-5107(94)70206-3
  13. Vickers J, Alderson D. Oesophageal cancer staging using endoscopic ultrasonography. Br J Surg 1998;85:994-998. https://doi.org/10.1046/j.1365-2168.1998.00694.x
  14. Dittler HJ, Siewert JR. Role of endoscopic ultrasonography in esophageal carcinoma. Endoscopy 1993;25:156-161. https://doi.org/10.1055/s-2007-1010275
  15. Di Fiore F, Lecleire S, Pop D, et al. Baseline nutritional status is predictive of response to treatment and survival in patients treated by definitive chemoradiotherapy for a locally advanced esophageal cancer. Am J Gastroenterol 2007;102:2557-2563. https://doi.org/10.1111/j.1572-0241.2007.01437.x
  16. Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med 2003;349:2241-2252. https://doi.org/10.1056/NEJMra035010
  17. Kim MK, Kim SB, Ahn JH, et al. Treatment outcome and recursive partitioning analysis-based prognostic factors in patients with esophageal squamous cell carcinoma receiving preoperative chemoradiotherapy. Int J Radiat Oncol Biol Phys 2008;71:725-734. https://doi.org/10.1016/j.ijrobp.2007.10.009
  18. Bloem BR, Lagaay AM, van Beek W, Haan J, Roos RA, Wintzen AR. Prevalence of subjective dysphagia in community residents aged over 87. BMJ 1990;300:721-722. https://doi.org/10.1136/bmj.300.6726.721
  19. Triadafilopoulos G. Nonobstructive dysphagia in reflux esophagitis. Am J Gastroenterol 1989;84:614-618.
  20. Schatzki R. The lower esophageal ring: long term follow-up of symptomatic and asymptomatic rings. Am J Roentgenol Radium Ther Nucl Med 1963;90:805-810.
  21. Earlam R, Cunha-Melo JR. Benign oesophageal strictures: historical and technical aspects of dilatation. Br J Surg 1981;68:829-836. https://doi.org/10.1002/bjs.1800681202
  22. Hordijk ML, Zander H, van Blankenstein M, Tilanus HW. Influence of tumor stenosis on the accuracy of endosonography in preoperative T staging of esophageal cancer. Endoscopy 1993;25:171-175. https://doi.org/10.1055/s-2007-1010278
  23. Pfau PR, Ginsberg GG, Lew RJ, Faigel DO, Smith DB, Kochman ML. Esophageal dilation for endosonographic evaluation of malignant esophageal strictures is safe and effective. Am J Gastroenterol 2000;95:2813-2815. https://doi.org/10.1111/j.1572-0241.2000.02309.x
  24. Tytgat GN. Dilation therapy of benign esophageal stenoses. World J Surg 1989;13:142-148. https://doi.org/10.1007/BF01658390
  25. Lee JL, Park SI, Kim SB, et al. A single institutional phase III trial of preoperative chemotherapy with hyperfractionation radiotherapy plus surgery versus surgery alone for resectable esophageal squamous cell carcinoma. Ann Oncol 2004;15:947-954. https://doi.org/10.1093/annonc/mdh219
  26. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 2005;23:2310-2317. https://doi.org/10.1200/JCO.2005.00.034
  27. Kim CM, Hong WS, Lee JO, et al. A retrospective study on radiotherapy and radiochemotherapy in esophageal cancer. Korean J Intern Med 1988;3:58-63. https://doi.org/10.3904/kjim.1988.3.1.58
  28. Bozzetti F, Braga M, Gianotti L, Gavazzi C, Mariani L. Postoperative enteral versus parenteral nutrition in malnourished patients with gastrointestinal cancer: a randomised multicentre trial. Lancet 2001;358:1487-1492. https://doi.org/10.1016/S0140-6736(01)06578-3
  29. Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol 2008;26:1086-1092. https://doi.org/10.1200/JCO.2007.12.9593

피인용 문헌

  1. Endoscopic traversability in patients with locally advanced esophageal squamous cell carcinoma : Is it a significant prognostic factor? vol.96, pp.51, 2017, https://doi.org/10.1097/md.0000000000009441
  2. Does oesophageal stenosis have any impact on survival of oesophageal cancer patients? vol.27, pp.3, 2017, https://doi.org/10.1093/icvts/ivy095