nach oben

Erschienen in:

01.04.2010

Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer

verfasst von: Christopher P. Twine, S. Ashley Roberts, Wyn G. Lewis, B. Vicki Dave, Claire E. Rawlinson, David Chan, Mark Robinson, Tom D. Crosby

Erschienen in: Surgical Endoscopy | Ausgabe 4/2010

Einloggen, um Zugang zu erhalten

Abstract

Background

This study aimed to assess the prognostic significance of endoluminal ultrasound-defined total length of disease and endoluminal ultrasound defined tumor volume (EDTV) in esophageal cancer. The hypothesis was that endoscopic ultrasound (EUS)-defined total length of disease and EDTV are both significant prognostic indicators and better predictors of outcome than endoscopic tumor length.

Methods

In this study, 174 consecutive patients (median age, 64 years and 128 months) underwent specialist EUS, and the maximum potential EDTV was calculated (πr ² L, where r is the tumor thickness and L is the total length of disease) including proximal and distal lymph node metastases. Of the 174 patients, 104 underwent surgery (70 had neoadjuvant chemotherapy), 60 underwent definitive chemoradiotherapy, and 10 had palliative therapy.

Results

Survival was related to EUS T stage (p = 0.013), EUS N stage (p = 0.001), EUS M1a stage (p = 0.004), EUS disease length (<8 cm; p = 0.001), and EDTV (all patients <25 cm³, p = 0.001; surgical patients <40 cm³, p = 0.036). Forward conditional multivariate analysis showed three factors to be associated with survival: EUS N stage (hazard ratio [HR], 1.646; 95% confidence interval [CI], 1.041–2.602; p = 0.033), EUS M1a stage (HR, 2.702; 95% CI, 1.069–6.830; p = 0.036), and EDTV (HR, 2.702; 95% CI, 1.069–6.830; p = 0.025). Median and 2-year survival for EDTV <25 cm³ versus >25 cm³ was 43.4 months and 56%, respectively, compared with 23.5 months and 35%.

Conclusions

In this study, EDTV based on total EUS-defined length of disease emerged as a new and important prognostic indicator for patients with esophageal cancer.

Kelly S, Harris KM, Berry E, Hutton J, Roderick P, Cullingworth J, Gathercole L, Smith MA (2001) A systematic review of the staging performance of endoscopic ultrasound in gastro-oesophageal carcinoma. Gut 49:534–539CrossRefPubMed

Weaver SR, Blackshaw GR, Lewis WG, Edwards P, Roberts SA, Thomas GV, Allison MC (2004) Comparison of special interest computed tomography, endosonography, and histopathological stage of oesophageal cancer. Clin Radiol 59:499–504CrossRefPubMed

Peters JH, Hoeft SF, Heimbucher J, Bremner RM, DeMeester TR, Bremner CG, Clark GW, Kiyabu M, Parisky Y (1994) Selection of patients for curative or palliative resection of esophageal cancer based on preoperative endoscopic ultrasonography. Arch Surg 129:534–539PubMed

Griffiths EA, Brummell Z, Gorthi G, Pritchard SA, Welch IM (2006) Tumor length as a prognostic factor in esophageal malignancy: univariate and multivariate survival analyses. J Surg Oncol 93:258–267CrossRefPubMed

Mennigen R, Tuebergen D, Koehler G, Sauerland C, Senninger N, Bruewer M (2008) Endoscopic ultrasound with conventional probe and miniprobe in preoperative staging of esophageal cancer. J Gastrointest Surg 12:256–262CrossRefPubMed

Ishikawa H, Sakurai H, Yamakawa M, Saito Y, Nakayama Y, Kitamoto Y, Okamoto M, Harada K, Hasegawa M, Nakano T (2005) Clinical outcomes and prognostic factors for patients with early esophageal squamous cell carcinoma treated with definitive radiation therapy alone. J Clin Gastroenterol 39:495–500CrossRefPubMed

Morgan MA, Lewis WG, Casbard A, Roberts SA, Adams R, Clark G W, Havard TJ, Crosby TD (2008) Stage-for-stage comparison of definitive chemoradiation, surgery alone, and neoadjuvant chemotherapy for oesophageal carcinoma. Br J Surg (in Press)

Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317CrossRefPubMed

Crosby TD, Brewster AE, Borley A, Perschky L, Kehagioglou P, Court J, Maughan TS (2004) Definitive chemoradiation in patients with inoperable oesophageal carcinoma. Br J Cancer 90:70–75CrossRefPubMed

10.

Bowrey DJ, Clark GW, Roberts SA, Maughan TS, Hawthorne AB, Williams GT, Carey PD (1999) Endosonographic staging of 100 consecutive patients with esophageal carcinoma: introduction of the 8-mm esophagoprobe. Dis Esophagus 12:258–263CrossRefPubMed

11.

Stephens MR, Lewis WG, Brewster AE, Lord I, Blackshaw GR, Hodzovic I, Thomas GV, Roberts SA, Crosby TD, Gent C, Allison MC, Shute K (2006) Multidisciplinary team management is associated with improved outcomes after surgery for esophageal cancer. Dis Esophagus 19:164–171CrossRefPubMed

12.

Orringer MB (1984) Transhiatal esophagectomy without thoracotomy for carcinoma of the thoracic esophagus. Ann Surg 200:282–288CrossRefPubMed

13.

Lewis I (1964) The surgical treatment of carcinoma of the oesophagus, with special reference to a new operation for growths of the middle third. Br J Surg 51:53–68CrossRef

14.

Tanner IC (1947) The present position of carcinoma of the oesophagus. Postgrad Med J 23:109–139CrossRefPubMed

15.

Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 58:457–481CrossRef

16.

Landis JR, Kock GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174CrossRefPubMed

17.

Cox DR (1972) Regression models and life tables. J R Stat Soc B 18:7–200

18.

Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM (2002) Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status. Cancer 95:1434–1443CrossRefPubMed

19.

Rizk N, Venkatraman E, Park B, Flores R, Bains MS, Rusch V (2006) The prognostic importance of the number of involved lymph nodes in esophageal cancer: implications for revisions of the American Joint Committee on Cancer staging system. J Thorac Cardiovasc Surg 132:1374–1381CrossRefPubMed

20.

Tachibana M, Yoshimura H, Kinugasa S, Dhar DK, Shibakita M, Ohno S, Ueda S, Fujii T, Nagasue N (2001) Clinicopathologic factors correlated with number of metastatic lymph nodes in oesophageal cancer. Dig Liver Dis 33:534–538CrossRefPubMed

21.

van Vliet EP, Heijenbrok-Kal MH, Hunink MG, Kuipers EJ, Siersema PD (2008) Staging investigations for oesophageal cancer: a meta-analysis. Br J Cancer 98:547–557CrossRefPubMed

22.

Gheorghe C, Stanescu C, Gheorghe L, Bancila I, Herlea V, Becheanu G, Voinea D, Iacob R, Lupescu I, Anghel R, Croitoru A, Popescu I (2006) Preoperative noninvasive EUS evaluation in patients with esophageal cancer considered for esophagectomy. J Gastrointestin Liver Dis 15:137–141PubMed

23.

Moorjani N, Junemann-Ramirez M, Judd O, Fox B, Rahamim JS (2007) Endoscopic ultrasound in oesophageal carcinoma: comparison with multislice computed tomography and importance in the clinical decision-making process. Minerva Chir 62:217–223PubMed

24.

Zhang X, Watson DI, Lally C, Bessell JR (2005) Endoscopic ultrasound for preoperative staging of esophageal carcinoma. Surg Endosc 19:1618–1621CrossRefPubMed

25.

Zuccaro G Jr, Rice TW, Vargo JJ, Goldblum JR, Rybicki LA, Dumot JA, Adelstein DJ, Trolli PA, Blackstone EH (2005) Endoscopic ultrasound errors in esophageal cancer. Am J Gastroenterol 100:601–606PubMed

26.

Al-Sarira AA, David G, Willmott S, Slavin JP, Deakin M, Corless DJ (2007) Oesophagectomy practice and outcomes in England. Br J Surg 94:585–591CrossRefPubMed

27.

Medical Research Council Oesophageal Cancer Working Group (2002) Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet 359:1727–1733CrossRef

28.

Crehange G, Bosset M, Lorchel F, Buffet-Miny J, Dumas JL, Mercier M, Puyraveau M, Maingon P, Bosset JF (2006) Tumor volume as outcome determinant in patients treated with chemoradiation for locally advanced esophageal cancer. Am J Clin Oncol 29:583–587CrossRefPubMed

29.

Shinkai M, Niwa Y, Arisawa T, Ohmiya N, Goto H, Hayakawa T (2000) Evaluation of prognosis of squamous cell carcinoma of the oesophagus by endoscopic ultrasonography. Gut 47:120–125CrossRefPubMed

30.

Bedenne L, Michel P, Bouche O, Milan C, Mariette C, Conroy T, Pezet D, Roullet B, Seitz JF, Herr JP, Paillot B, Arveux P, Bonnetain F, Binquet C (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol 25:1160–1168CrossRefPubMed

31.

Lagarde SM, Reitsma JB, de Castro SM, Ten Kate FJ, Busch OR, van Lanschot JJ (2007) Prognostic nomogram for patients undergoing oesophagectomy for adenocarcinoma of the oesophagus or gastro-oesophageal junction. Br J Surg 94:1361–1368CrossRefPubMed

32.

Ruol A, Castoro C, Portale G, Cavallin F, Sileni VC, Cagol M, Alfieri R, Corti L, Boso C, Zaninotto G, Peracchia A, Ancona E (2009) Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution. Arch Surg 144:247–254CrossRefPubMed

33.

Hayano K, Okazumi S, Shuto K, Matsubara H, Shimada H, Nabeya Y, Kazama T, Yanagawa N, Ochiai T (2007) Perfusion CT can predict the response to chemoradiation therapy and survival in esophageal squamous cell carcinoma: initial clinical results. Oncol Rep 18:901–908PubMed

34.

Mamede M, El FG, Abreu-e-Lima P, Gandler W, Nose V, Gerbaudo VH (2007) Preoperative estimation of esophageal tumor metabolic length in FDG-PET images with surgical pathology confirmation. Ann Nucl Med 21:553–562CrossRefPubMed

35.

Mamede M, Abreu-e-Lima P, Oliva MR, Nose V, Mamon H, Gerbaudo VH (2007) FDG-PET/CT tumor segmentation-derived indices of metabolic activity to assess response to neoadjuvant therapy and progression-free survival in esophageal cancer: correlation with histopathology results. Am J Clin Oncol 30:377–388

36.

Guha C, Alfieri A, Blaufox MD, Kalnicki S (2008) Tumor biology-guided radiotherapy treatment planning: gross tumor volume versus functional tumor volume. Semin Nucl Med 38:105–113CrossRefPubMed

37.

Riddell AM, Allum WH, Thompson JN, Wotherspoon AC, Richardson C, Brown G (2007) The appearances of oesophageal carcinoma demonstrated on high-resolution, T2-weighted MRI, with histopathological correlation. Eur Radiol 17:391–399CrossRefPubMed

38.

Korst RJ, Rusch VW, Venkatraman E, Bains MS, Burt ME, Downey RJ, Ginsberg RJ (1998) Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 115:660–669CrossRefPubMed

39.

Wijnhoven BP, Tran KT, Esterman A, Watson DI, Tilanus HW (2007) An evaluation of prognostic factors and tumor staging of resected carcinoma of the esophagus. Ann Surg 245:717–725CrossRefPubMed

40.

Greenstein AJ, Litle VR, Swanson SJ, Divino CM, Packer S, Wisnivesky JP (2008) Prognostic significance of the number of lymph node metastases in esophageal cancer. J Am Coll Surg 206:239–246CrossRefPubMed

41.

Hofstetter W, Correa AM, Bekele N, Ajani JA, Phan A, Komaki RR, Liao Z, Maru D, Wu TT, Mehran RJ, Rice DC, Roth JA, Vaporciyan AA, Walsh GL, Francis A, Blackmon S, Swisher SG (2007) Proposed modification of nodal status in AJCC esophageal cancer staging system. Ann Thorac Surg 84:365–373CrossRefPubMed

42.

Dhar DK, Hattori S, Tonomoto Y, Shimoda T, Kato H, Tachibana M, Matsuura K, Mitsumoto Y, Little AG, Nagasue N (2007) Appraisal of a revised lymph node classification system for esophageal squamous cell cancer. Ann Thorac Surg 83:1265–1272CrossRefPubMed

43.

Mariette C, Piessen G, Briez N, Triboulet JP (2008) The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 247:365–371CrossRefPubMed

Titel: Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer
verfasst von: Christopher P. Twine
S. Ashley Roberts
Wyn G. Lewis
B. Vicki Dave
Claire E. Rawlinson
David Chan
Mark Robinson
Tom D. Crosby
Publikationsdatum: 01.04.2010
Verlag: Springer-Verlag
Erschienen in: Surgical Endoscopy / Ausgabe 4/2010
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-009-0681-2

Neu im Fachgebiet Chirurgie

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Traumatologische Notfälle Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Internistische Arzneimitteltherapie Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

„Übersichtlicher Wegweiser“: Lauterbachs umstrittener Klinik-Atlas ist online

17.05.2024 Klinik aktuell Nachrichten

Sie sei „ethisch geboten“, meint Gesundheitsminister Karl Lauterbach: mehr Transparenz über die Qualität von Klinikbehandlungen. Um sie abzubilden, lässt er gegen den Widerstand vieler Länder einen virtuellen Klinik-Atlas freischalten.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare

CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare

CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske

Dr. med. Benjamin Meyknecht

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare

CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Prognostic significance of endoluminal ultrasound-defined disease length and tumor volume (EDTV) for patients with the diagnosis of esophageal cancer