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Article: Improvement in Treatment Results and Long-Term Survival of Patients with Esophageal Cancer: Impact of Chemoradiation and Change in Treatment Strategy
Title | Improvement in Treatment Results and Long-Term Survival of Patients with Esophageal Cancer: Impact of Chemoradiation and Change in Treatment Strategy |
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Authors | |
Issue Date | 2003 |
Publisher | Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com |
Citation | Annals of Surgery, 2003, v. 238 n. 3, p. 339-348 How to Cite? |
Abstract | Objective: To identify prognostic factors and reasons for improved survival over time in patients with esophageal cancer. Summary Background Data: Management strategies for esophageal cancer have evolved with time. The impact of chemoradiation in the overall treatment results has not been adequately studied. Methods: From 1990 to 2000, 399 (62.4%) of 639 patients with intrathoracic squamous cancers underwent resection. Two study periods were analyzed: period I (01/1990-06/1995), and period II (07/1995-12/2000); during period II, chemoradiation was introduced. Prognostic factors were identified by multivariate analysis and the 2 periods compared. Results: Hospital mortality rate after resection decreased from 7.8% to 1.2%, P = 0.002. Five favorable prognostic factors were identified: female gender (female vs. male, HR = 0.66), infracarinal tumor location (infra vs. supra-carinal, HR = 0.63), low pTNM stage (III/IV vs. 0/I/II/T 0N 1, HR = 1.76), pM0 stage (M1a/b vs. M0, HR = 1.56), and R 0 category (R 1/2 vs. R 0, HR = 2.49). Median survival was 15.8 and 25.6 months in periods I and II, respectively, P = 0.02. More R 0 resections were evident in period II, being possible in 63% (period I) and 79% (period II) of patients, P = 0.001. This was attributed to tumor downstaging by chemoradiation and more stringent patient selection for resection in period II. Performing less R 1/2 resections in period II coincided with using primary chemoradiation in treating advanced tumors. In patients treated without resection, survival also improved from 3 (period I) to 5.8 months (period II), P < 0.01. Conclusions: Survival has improved; chemoradiation enabled better patient selection for curative resections and also resulted in more R 0 resections by tumor downstaging. This treatment strategy led to overall better outcome for the whole patient cohort, even in those treated by nonsurgical means. |
Persistent Identifier | http://hdl.handle.net/10722/49008 |
ISSN | 2023 Impact Factor: 7.5 2023 SCImago Journal Rankings: 2.729 |
PubMed Central ID | |
ISI Accession Number ID | |
References |
DC Field | Value | Language |
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dc.contributor.author | Law, S | en_HK |
dc.contributor.author | Kwong, DLW | en_HK |
dc.contributor.author | Kwok, KF | en_HK |
dc.contributor.author | Wong, KH | en_HK |
dc.contributor.author | Chu, KM | en_HK |
dc.contributor.author | Sham, JST | en_HK |
dc.contributor.author | Wong, J | en_HK |
dc.contributor.author | Demeester, TR | en_HK |
dc.contributor.author | Pellegrini, CA | en_HK |
dc.contributor.author | Krupski, WC | en_HK |
dc.date.accessioned | 2008-06-12T06:32:05Z | - |
dc.date.available | 2008-06-12T06:32:05Z | - |
dc.date.issued | 2003 | en_HK |
dc.identifier.citation | Annals of Surgery, 2003, v. 238 n. 3, p. 339-348 | en_HK |
dc.identifier.issn | 0003-4932 | en_HK |
dc.identifier.uri | http://hdl.handle.net/10722/49008 | - |
dc.description.abstract | Objective: To identify prognostic factors and reasons for improved survival over time in patients with esophageal cancer. Summary Background Data: Management strategies for esophageal cancer have evolved with time. The impact of chemoradiation in the overall treatment results has not been adequately studied. Methods: From 1990 to 2000, 399 (62.4%) of 639 patients with intrathoracic squamous cancers underwent resection. Two study periods were analyzed: period I (01/1990-06/1995), and period II (07/1995-12/2000); during period II, chemoradiation was introduced. Prognostic factors were identified by multivariate analysis and the 2 periods compared. Results: Hospital mortality rate after resection decreased from 7.8% to 1.2%, P = 0.002. Five favorable prognostic factors were identified: female gender (female vs. male, HR = 0.66), infracarinal tumor location (infra vs. supra-carinal, HR = 0.63), low pTNM stage (III/IV vs. 0/I/II/T 0N 1, HR = 1.76), pM0 stage (M1a/b vs. M0, HR = 1.56), and R 0 category (R 1/2 vs. R 0, HR = 2.49). Median survival was 15.8 and 25.6 months in periods I and II, respectively, P = 0.02. More R 0 resections were evident in period II, being possible in 63% (period I) and 79% (period II) of patients, P = 0.001. This was attributed to tumor downstaging by chemoradiation and more stringent patient selection for resection in period II. Performing less R 1/2 resections in period II coincided with using primary chemoradiation in treating advanced tumors. In patients treated without resection, survival also improved from 3 (period I) to 5.8 months (period II), P < 0.01. Conclusions: Survival has improved; chemoradiation enabled better patient selection for curative resections and also resulted in more R 0 resections by tumor downstaging. This treatment strategy led to overall better outcome for the whole patient cohort, even in those treated by nonsurgical means. | en_HK |
dc.format.extent | 388 bytes | - |
dc.format.mimetype | text/html | - |
dc.language | eng | en_HK |
dc.publisher | Lippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com | en_HK |
dc.relation.ispartof | Annals of Surgery | en_HK |
dc.subject.mesh | Carcinoma, Squamous Cell - mortality - therapy | en_HK |
dc.subject.mesh | Esophageal Neoplasms - mortality - therapy | en_HK |
dc.subject.mesh | Antineoplastic Agents - therapeutic use | en_HK |
dc.subject.mesh | Combined Modality Therapy | en_HK |
dc.subject.mesh | Esophagectomy | en_HK |
dc.title | Improvement in Treatment Results and Long-Term Survival of Patients with Esophageal Cancer: Impact of Chemoradiation and Change in Treatment Strategy | en_HK |
dc.type | Article | en_HK |
dc.identifier.email | Law, S: slaw@hku.hk | en_HK |
dc.identifier.email | Kwong, DLW: dlwkwong@hku.hk | en_HK |
dc.identifier.email | Chu, KM: chukm@hkucc.hku.hk | en_HK |
dc.identifier.email | Wong, J: jwong@hkucc.hku.hk | en_HK |
dc.identifier.authority | Law, S=rp00437 | en_HK |
dc.identifier.authority | Kwong, DLW=rp00414 | en_HK |
dc.identifier.authority | Chu, KM=rp00435 | en_HK |
dc.identifier.authority | Wong, J=rp00322 | en_HK |
dc.description.nature | link_to_OA_fulltext | en_HK |
dc.identifier.doi | 10.1097/01.sla.0000086545.45918.ee | en_HK |
dc.identifier.pmid | 14501500 | en_HK |
dc.identifier.pmcid | PMC1422701 | en_HK |
dc.identifier.scopus | eid_2-s2.0-0141871983 | en_HK |
dc.identifier.hkuros | 91998 | - |
dc.relation.references | http://www.scopus.com/mlt/select.url?eid=2-s2.0-0141871983&selection=ref&src=s&origin=recordpage | en_HK |
dc.identifier.volume | 238 | en_HK |
dc.identifier.issue | 3 | en_HK |
dc.identifier.spage | 339 | en_HK |
dc.identifier.epage | 348 | en_HK |
dc.identifier.isi | WOS:000185835200008 | - |
dc.publisher.place | United States | en_HK |
dc.identifier.scopusauthorid | Law, S=7202241293 | en_HK |
dc.identifier.scopusauthorid | Kwong, DLW=15744231600 | en_HK |
dc.identifier.scopusauthorid | Kwok, KF=7102194177 | en_HK |
dc.identifier.scopusauthorid | Wong, KH=36485841700 | en_HK |
dc.identifier.scopusauthorid | Chu, KM=7402453538 | en_HK |
dc.identifier.scopusauthorid | Sham, JST=24472255400 | en_HK |
dc.identifier.scopusauthorid | Wong, J=8049324500 | en_HK |
dc.identifier.scopusauthorid | Demeester, TR=35421636200 | en_HK |
dc.identifier.scopusauthorid | Pellegrini, CA=7101984946 | en_HK |
dc.identifier.scopusauthorid | Krupski, WC=7005871327 | en_HK |
dc.identifier.issnl | 0003-4932 | - |