Clinical implications of endoscopic ultrasonography non-traversability in patients with locoregional esophageal cancer receiving multimodality therapy

• Published in: The Korean journal of internal medicine Vol. 32; no. 3; pp. 443 - 451
• Main Authors: Cho, Charles J., Song, Ho June, Lee, Gin Hyug, Choi, Kee Don, Kim, Yong-Hee, Ryu, Jin-Sook, Kim, Sung-Bae, Kim, Jong Hoon, Park, Seung-Il, Jung, Hwoon-Yong
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association of Internal Medicine 01.05.2017; 대한내과학회
• Subjects: Aged; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - therapy; Combined Modality Therapy; Endosonography; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - mortality; Esophageal Neoplasms - therapy; Female; Humans; Male; Middle Aged; Original; Republic of Korea - epidemiology; Retrospective Studies; 내과학; Carcinoma, squamous cell; Esophageal neoplasms; Malignant stricture; Prognosis; Endosonography
• ISSN: 1226-3303; 2005-6648; 2005-6648
• DOI: 10.3904/kjim.2015.185

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. 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. 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, = 0.028), tumor length (6.0 cm vs. 4.0 cm, = 0.002), and percentage of clinical stage III disease (65.4% vs. 38.1%, = 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%, = 0.023). In multivariate analysis, weight loss ≥ 10% ( = 0.033), EUS non-traversability ( = 0.003), non-response to preoperative CRT ( = 0.002), and incompletion of esophagectomy ( = 0.002) were significant negative factors of survival. EUS non-traversability has significant negative prognostic implications in patients with advanced locoregional squamous EC receiving preoperative CRT followed by esophagectomy.