Endoscopic ultrasound for early stage esophageal adenocarcinoma
Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying ear...
محفوظ في:
| المؤلف الرئيسي: | |
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| مؤلفون آخرون: | , , , , |
| التنسيق: | article |
| منشور في: |
2011
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| الوصول للمادة أونلاين: | http://hdl.handle.net/10725/4128 http://dx.doi.org/10.1016/j.athoracsur.2011.01.063 http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php http://www.annalsthoracicsurgery.org/article/S0003-4975(11)00253-0/fulltext?refuid=S0003-4975(13)00741-8&refissn=0003-4975 |
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| _version_ | 1864513462907961344 |
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| author | Azar, Riad |
| author2 | Crabtree, Traves D. Yacoub, Wael N. Puri, Varun Zoole, Jennifer Bell Patterson, G. Alexander |
| author2_role | author author author author author |
| author_facet | Azar, Riad Crabtree, Traves D. Yacoub, Wael N. Puri, Varun Zoole, Jennifer Bell Patterson, G. Alexander |
| author_role | author |
| dc.creator.none.fl_str_mv | Azar, Riad Crabtree, Traves D. Yacoub, Wael N. Puri, Varun Zoole, Jennifer Bell Patterson, G. Alexander |
| dc.date.none.fl_str_mv | 2011 2016-06-22T10:17:50Z 2016-06-22T10:17:50Z 2016-06-22 |
| dc.identifier.none.fl_str_mv | 0003-4975 http://hdl.handle.net/10725/4128 http://dx.doi.org/10.1016/j.athoracsur.2011.01.063 Crabtree, T. D., Yacoub, W. N., Puri, V., Azar, R., Zoole, J. B., Patterson, G. A., ... & Meyers, B. F. (2011). Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. The Annals of thoracic surgery, 91(5), 1509-1516. http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php http://www.annalsthoracicsurgery.org/article/S0003-4975(11)00253-0/fulltext?refuid=S0003-4975(13)00741-8&refissn=0003-4975 |
| dc.language.none.fl_str_mv | en |
| dc.relation.none.fl_str_mv | The Annals of Thoracic Surgery |
| dc.rights.*.fl_str_mv | info:eu-repo/semantics/openAccess |
| dc.title.none.fl_str_mv | Endoscopic ultrasound for early stage esophageal adenocarcinoma implications for staging and survival |
| dc.type.none.fl_str_mv | Article info:eu-repo/semantics/publishedVersion info:eu-repo/semantics/article |
| description | Background Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) (p <0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy (p = 0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p = 0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Conclusions Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection. |
| eu_rights_str_mv | openAccess |
| format | article |
| id | LAURepo_b47f1daa5d02ae7a6500a540701b9653 |
| identifier_str_mv | 0003-4975 Crabtree, T. D., Yacoub, W. N., Puri, V., Azar, R., Zoole, J. B., Patterson, G. A., ... & Meyers, B. F. (2011). Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. The Annals of thoracic surgery, 91(5), 1509-1516. |
| language_invalid_str_mv | en |
| network_acronym_str | LAURepo |
| network_name_str | Lebanese American University repository |
| oai_identifier_str | oai:laur.lau.edu.lb:10725/4128 |
| publishDate | 2011 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| spelling | Endoscopic ultrasound for early stage esophageal adenocarcinomaimplications for staging and survivalAzar, RiadCrabtree, Traves D.Yacoub, Wael N.Puri, VarunZoole, Jennifer BellPatterson, G. AlexanderBackground Patients often receive induction therapy based on endoscopic ultrasound (EUS)–identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes. Methods We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008. Computed tomography (CT) was performed in all patients, whereas positron emission tomography (PET) was performed in 91%. Clinical stage (c), pathologic stage (p), operative mortality, and survival were recorded. Results Unanticipated pathologic nodal disease was similar in patients with cT1N0 and cT2N0 tumors (6/25 [24%] versus 7/18 [38.8%]; p = 0.6). Among the 18 cases of cT2N0 disease, 9 (50%) were pathologically staged as T1N0, 8 (44%) were upstaged to pT3N0-1, and 1 (6%) was pT2N0. One case of cT1N0 tumor (4%) was upstaged to pT3N0. Among patients with cT1-2N0 tumors, 5-year disease-free survival for the group that was appropriately staged was 89.8% versus 39.9% for the group that had a higher pathologic stage than their clinical stage (ie, >T2N0) (p <0.001). Operative mortality for patients with cT1-2N0 tumors was 0/43 (0%), which was no different from that in the higher clinical stage groups with (1/37, 2.7%) or without (2/68, 2.9%) induction therapy (p = 0.5). Multivariate analysis identified marked/intense uptake on staging PET (odds ratio, 5.76, 95%; confidence interval, 1.25 to 26.52; p = 0.021) to be a factor predictive of upstaging of cT1-2N0 tumors. Conclusions Current staging techniques are inadequate for predicting T1-2N0 disease in esophageal adenocarcinoma. Survival is excellent with operation alone in patients with tumors appropriately staged as T1-2N0, although patients with tumors upstaged to greater than T2N0 have significantly worse survival. Other preoperative factors such as PET uptake may help select patients with cT1-2N0 tumors that will be upstaged at resection.PublishedN/A2016-06-22T10:17:50Z2016-06-22T10:17:50Z20112016-06-22Articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article0003-4975http://hdl.handle.net/10725/4128http://dx.doi.org/10.1016/j.athoracsur.2011.01.063Crabtree, T. D., Yacoub, W. N., Puri, V., Azar, R., Zoole, J. B., Patterson, G. A., ... & Meyers, B. F. (2011). Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival. The Annals of thoracic surgery, 91(5), 1509-1516.http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.phphttp://www.annalsthoracicsurgery.org/article/S0003-4975(11)00253-0/fulltext?refuid=S0003-4975(13)00741-8&refissn=0003-4975enThe Annals of Thoracic Surgeryinfo:eu-repo/semantics/openAccessoai:laur.lau.edu.lb:10725/41282021-03-19T10:03:20Z |
| spellingShingle | Endoscopic ultrasound for early stage esophageal adenocarcinoma Azar, Riad |
| status_str | publishedVersion |
| title | Endoscopic ultrasound for early stage esophageal adenocarcinoma |
| title_full | Endoscopic ultrasound for early stage esophageal adenocarcinoma |
| title_fullStr | Endoscopic ultrasound for early stage esophageal adenocarcinoma |
| title_full_unstemmed | Endoscopic ultrasound for early stage esophageal adenocarcinoma |
| title_short | Endoscopic ultrasound for early stage esophageal adenocarcinoma |
| title_sort | Endoscopic ultrasound for early stage esophageal adenocarcinoma |
| url | http://hdl.handle.net/10725/4128 http://dx.doi.org/10.1016/j.athoracsur.2011.01.063 http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php http://www.annalsthoracicsurgery.org/article/S0003-4975(11)00253-0/fulltext?refuid=S0003-4975(13)00741-8&refissn=0003-4975 |