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Clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer undergoing induction chemotherapy or chemoradiotherapy

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Abstract

Purpose

To identify clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer following induction chemotherapy or chemoradiotherapy.

Methods

Of 48 patients with T4 esophageal cancer who underwent induction treatment, 30 underwent R0 esophagectomy. The factors predicting R0 resection and prognostic indicators were assessed in the 48 and 30 patients, respectively, using univariate and multivariate analyses.

Results

In the univariate analyses, the primary tumor response, improvement of dysphagia, the post-induction therapy Glasgow Prognostic Score, an early tumor response and the post-induction therapy serum albumin and C-reactive protein levels were significantly correlated with R0 resection. Multivariate logistic regression analyses revealed that the response status and improvement of dysphagia were independent predictors of R0 resection. The univariate analyses identified a yp-T classification (yp-T0/1 vs. yp-T2/3/4), yp-nodal status and the number of pathologically positive nodes post-therapy (≤1 vs. ≥2) as significant prognostic factors. The multivariate analysis revealed that the number of pathologically positive nodes was the only significant independent prognostic indicator.

Conclusion

Patients showing an early tumor response to induction treatment and improvement of dysphagia may be appropriate candidates for esophagectomy, and individualized postoperative management strategies should be developed for patients with initially unresectable T4 esophageal cancer who have ≥2 positive nodes post-treatment.

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Acknowledgments

The authors appreciate the contributions of Kouhei Akazawa, Ph.D., Department of Medical Informatics, Niigata University Graduate School of Medicine and Dental Sciences, for the technical advice regarding the statistical analysis of the data.

Conflict of interest

There is no conflict of interest.

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Authors and Affiliations

  1. Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan

    Hiroyuki Karimata, Hideaki Shimoji & Tadashi Nishimaki

Authors
  1. Hiroyuki Karimata
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  2. Hideaki Shimoji
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  3. Tadashi Nishimaki
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Correspondence to Tadashi Nishimaki.

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Karimata, H., Shimoji, H. & Nishimaki, T. Clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer undergoing induction chemotherapy or chemoradiotherapy. Surg Today 45, 479–486 (2015). https://doi.org/10.1007/s00595-014-0980-7

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  • DOI: https://doi.org/10.1007/s00595-014-0980-7

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