Abstract
Background
The aim of the study was to determine if the two histologic tumor types in esophageal cancer exhibit different behavior at advanced tumour stages and require a differentiated therapy.
Patients and Methods
From November 1997 to December 2003, 268 patients presented with esophageal carcinoma. Esophagectomy was contraindicated in 88 (32.8%) patients (75 men, 13 women) with a median age of 64.7 (42–83) years. Fifty-six (63.6%) had squamous cell carcinoma; adenocarcinoma was identified in 31 (35.2%).
Results
The causes of incurable disease were non-resectable distant metastases in 32 (36.4%) patients, local tumor spread in 25 (28.4%), and general operative risk in 19 (21.5%). Surgical intervention was contraindicated in 7 patients because of a combination of general inoperability and local tumor spread, or the presence of distant metastases at the time of diagnosis (4 patients declined to undergo surgery and in one patient esophageal resection and reconstruction was technically not possible). The incurability rate for squamous cell carcinoma was 44.6% because of the presence of local tumor spread, compared to a rate of 12.4% for adenocarcinoma. Adenocarcinomas with proven hematogenic metastases were characterized by a higher incurability rate (64.5% vs. 21.4%) (P = 0.0014). The prevalence of technical causes of inoperability or of poor general condition was similar in both patient groups (P > 0.05). The median 1-year survival rates estimated (Kaplan-Meier) were 36.5% for patients with squamous cell carcinoma and 23.7% for patients with adenocarcinoma (P = 0.051). Therapeutic measures had a significant influence on the prognosis: patients without tumor-specific therapy survived 3.4 (0–24) months; those with radiochemotherapy 10.6 (0–25) months; those with radiotherapy 11.0 (0–65) months; and those with chemotherapy 16.5 [0–16.5] months (log-rank test: P = 0.0229). In the multivariate analysis, the therapeutic measures (P = 0.0126) and tumor localization (P = 0.0474) proved significant for prognosis, but were not the cause of incurability (P = 0.0948).
Conclusions
The histologic tumor type does not represent an independent prognostic factor in patients with incurable disease. Rather, the prognosis is dependent on the suitability of the induction of tumor-specific therapeutic measures. These are also recommended in patients with incurable disease after consideration of the extent of tumor spread, provided the performance of the selected measures is justified by the general condition of the patient and the expected prognosis.
Similar content being viewed by others
References
Bollschweiler E, Schroder W, Holscher AH, et al. Preoperative risk analysis in patients with adenocarcinoma or squamous cell carcinoma of the esophagus. Br J Surg 2000;87:1106–1110
Siewert JR, Stein HJ, Sendler A. Esophageal cancer: clinical management. In Kelsen DA, ed., Principles and Practice of Gastrointestinal Oncology, Philadelphia, Lippincott Williams & Wilkins, 2001
Siewert JR, Stein HJ, Feith M, et al. Histologic tumor type is an independent prognostic parameter in esophageal cancer: lessons from more than 1000 consecutive resections at a single center in the Western world. Ann Surg 2001;234:360–369
Holscher AH, Bollschweiler E, Schneider PM, et al. Prognosis of early esophageal cancer. Comparison between adeno- and squamous cell carcinoma. Cancer 1995;76:178–186
Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric junction. JAMA 1991;265:1287–1289
Fu JH, Rong TH, Li XD, et al. Cox regression analysis of the prognostic factors of unresectable esophageal carcinoma after stenting. Ai Zheng 2003;22:91–94
Hagen JA, Peters JH, DeMeester TR. Superiority of extended en bloc esophagogastrectomy for carcinoma of the lower esophagus and cardia. J Thorac Cardiovasc Surg 1993;106:850–858
Kneist W, Schreckenberger M, Bartenstein P, et al. Prospective evaluation of positron emission tomography in the preoperative staging of esophageal carcinoma. Arch Surg 2004;139:1043–1049
Herskovic A, Martz K, al-Sarraf M, et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med 1992;11:326:1593–1598
Pera M, Cameron AJ, Trastek VF, et al. Increasing incidence of adenocarcinoma of the esophagus and esophagogastric junction. Gastroenterology 1993;104:510–513
Wang HH, Antonioli DA, Goldman H. Comparative features of esophageal and gastric adenocarcinomas: recent changes in type and frequency. Hum Pathol 1986;17:482–487
Yang PC, Davis S. Incidence of cancer of the esophagus in the US by histologic type. Cancer 1988;61:612–617
DeMeester SR, DeMeester TR. Columnar mucosa and intestinal metaplasia of the esophagus: fifty years of controversy. Ann Surg 2000;231:303–321
Tachimori Y, Kato H, Watanabe H, et al. Difference between carcinoma of the lower esophagus and the cardia. World J Surg 1996;20:507–511
Nigro JJ, Hagen JA, DeMeester TR, et al. Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg 1999;117:16–23
Fritz P, Stoll P, Wannenmacher M, et al. Primäre Radiochemotherapie inoperabler fortgeschrittener Ösophaguskarzinome. Strahlenther Onkol 2003;179:328–336
Roussel A, Haegele P, Paillot B, et al. Results of the EORTC-GTCCG Phase III trial of irradiation versus irradiation and CDDP in inoperable esophageal cancer. For the Gastrointestinal Tract Cancer Cooperative Group. Proc Am Soc Clin Oncol 1994;13:583
Lu XJ, Miao RH, Li XQ. Combination of selective arterial infusion chemotherapy with radiotherapy in the treatment of advanced esophageal carcinoma. Chin J Clin Oncol 1995;22:262–265
Kaneta R, Takai Y, Nomoto K, et al. Effect of combination chemotherapy with daily low-dose CDDP for esophageal cancer: results of a randomized trial. Jpn J Cancer Chemother 1997;24:2099–2104
Slabber CR, Nel JS, Schoeman L, et al. A randomized study of radiotherapy alone versus radiotherapy plus 5-fluorouracil and platinum in patients with inoperable, locally advanced squamous cancer of the esophagus. Am J Clin Oncol 1998;21:462–465
Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer. Long-term follow-up of a prospective randomized trial (RTOG 85–01). JAMA 1999;281:1623–1627
Wong R, Malthaner R. Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus (Cochrane Review). Oxford: The Cochrane Library, Issue 4 (actualized software)
Urba SG, Chansky K, van Veldhuizen PJ, et al. Gemcitabine and cisplatin for patients with metastatic or recurrent esophageal carcinoma: a Southwest Oncology Group study. Investigational New Drugs 2004;22:91–97
Bleiberg H, Conroy T, Paillot B, et al. Randomized phase II study of cisplatin and 5-fluorouracil versus cisplatin alone in advanced squamous cell carcinoma. Eur J Cancer 1997;33:1216–1220
Conroy T, Etienne PL, Adenis A, et al. European Organisation for Research and Treatment of Cancer. Gastrointestinal Tract Cancer Cooperative Group. Ann Oncol 2002;13:721–729
Webb A, Cunningham D, Scarffe JH. Randomized trial comparing epirubicin, cisplatin and fluorouracil versus fluorouracil, doxorubicin and methotrexate in advanced esophagogastric cancer. Br J Cancer 1996;73:1260–1264
Szentpali K, Palotas A, Lazar G, et al. Endoscopic intubation with conventional plastic stents: a safe and cost-effective palliation for inoperable esophageal cancer. Dysphagia 2004;19:22–27
May A, Selmaier M, Hochberger J, et al. Memory metal stents for palliation of malignant obstruction of the esophagus and cardia. Gut 1995;37:309–313
Dormann AJ, Eisendrath P, Wigginghaus B, et al. Palliation of esophageal carcinoma with a new self–expanding plastic stent. Endoscopy 2003;35:207–211
Dallal HJ, Smith GD, Grieve DC, et al. A randomized trial of thermal ablative therapy versus expandable metal stents in the palliative treatment of patients with esophageal carcinoma. Gastrointest Endsoc 2001;54:549–557
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gockel, I., Kneist, W. & Junginger, T. Incurable Esophageal Cancer: Patterns of Tumor Spread and Therapeutic Consequences. World J. Surg. 30, 183–190 (2006). https://doi.org/10.1007/s00268-005-7861-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-005-7861-6