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Article: Improvement in Treatment Results and Long-Term Survival of Patients with Esophageal Cancer: Impact of Chemoradiation and Change in Treatment Strategy

TitleImprovement in Treatment Results and Long-Term Survival of Patients with Esophageal Cancer: Impact of Chemoradiation and Change in Treatment Strategy
Authors
Issue Date2003
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.com
Citation
Annals Of Surgery, 2003, v. 238 n. 3, p. 339-348 How to Cite?
AbstractObjective: To identify prognostic factors and reasons for improved survival over time in patients with esophageal cancer. Summary Background Data: Management strategies for esophageal cancer have evolved with time. The impact of chemoradiation in the overall treatment results has not been adequately studied. Methods: From 1990 to 2000, 399 (62.4%) of 639 patients with intrathoracic squamous cancers underwent resection. Two study periods were analyzed: period I (01/1990-06/1995), and period II (07/1995-12/2000); during period II, chemoradiation was introduced. Prognostic factors were identified by multivariate analysis and the 2 periods compared. Results: Hospital mortality rate after resection decreased from 7.8% to 1.2%, P = 0.002. Five favorable prognostic factors were identified: female gender (female vs. male, HR = 0.66), infracarinal tumor location (infra vs. supra-carinal, HR = 0.63), low pTNM stage (III/IV vs. 0/I/II/T 0N 1, HR = 1.76), pM0 stage (M1a/b vs. M0, HR = 1.56), and R 0 category (R 1/2 vs. R 0, HR = 2.49). Median survival was 15.8 and 25.6 months in periods I and II, respectively, P = 0.02. More R 0 resections were evident in period II, being possible in 63% (period I) and 79% (period II) of patients, P = 0.001. This was attributed to tumor downstaging by chemoradiation and more stringent patient selection for resection in period II. Performing less R 1/2 resections in period II coincided with using primary chemoradiation in treating advanced tumors. In patients treated without resection, survival also improved from 3 (period I) to 5.8 months (period II), P < 0.01. Conclusions: Survival has improved; chemoradiation enabled better patient selection for curative resections and also resulted in more R 0 resections by tumor downstaging. This treatment strategy led to overall better outcome for the whole patient cohort, even in those treated by nonsurgical means.
Persistent Identifierhttp://hdl.handle.net/10722/49008
ISSN
2015 Impact Factor: 8.569
2015 SCImago Journal Rankings: 4.503
PubMed Central ID
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorKwong, DLWen_HK
dc.contributor.authorKwok, KFen_HK
dc.contributor.authorWong, KHen_HK
dc.contributor.authorChu, KMen_HK
dc.contributor.authorSham, JSTen_HK
dc.contributor.authorWong, Jen_HK
dc.contributor.authorDemeester, TRen_HK
dc.contributor.authorPellegrini, CAen_HK
dc.contributor.authorKrupski, WCen_HK
dc.date.accessioned2008-06-12T06:32:05Z-
dc.date.available2008-06-12T06:32:05Z-
dc.date.issued2003en_HK
dc.identifier.citationAnnals Of Surgery, 2003, v. 238 n. 3, p. 339-348en_HK
dc.identifier.issn0003-4932en_HK
dc.identifier.urihttp://hdl.handle.net/10722/49008-
dc.description.abstractObjective: To identify prognostic factors and reasons for improved survival over time in patients with esophageal cancer. Summary Background Data: Management strategies for esophageal cancer have evolved with time. The impact of chemoradiation in the overall treatment results has not been adequately studied. Methods: From 1990 to 2000, 399 (62.4%) of 639 patients with intrathoracic squamous cancers underwent resection. Two study periods were analyzed: period I (01/1990-06/1995), and period II (07/1995-12/2000); during period II, chemoradiation was introduced. Prognostic factors were identified by multivariate analysis and the 2 periods compared. Results: Hospital mortality rate after resection decreased from 7.8% to 1.2%, P = 0.002. Five favorable prognostic factors were identified: female gender (female vs. male, HR = 0.66), infracarinal tumor location (infra vs. supra-carinal, HR = 0.63), low pTNM stage (III/IV vs. 0/I/II/T 0N 1, HR = 1.76), pM0 stage (M1a/b vs. M0, HR = 1.56), and R 0 category (R 1/2 vs. R 0, HR = 2.49). Median survival was 15.8 and 25.6 months in periods I and II, respectively, P = 0.02. More R 0 resections were evident in period II, being possible in 63% (period I) and 79% (period II) of patients, P = 0.001. This was attributed to tumor downstaging by chemoradiation and more stringent patient selection for resection in period II. Performing less R 1/2 resections in period II coincided with using primary chemoradiation in treating advanced tumors. In patients treated without resection, survival also improved from 3 (period I) to 5.8 months (period II), P < 0.01. Conclusions: Survival has improved; chemoradiation enabled better patient selection for curative resections and also resulted in more R 0 resections by tumor downstaging. This treatment strategy led to overall better outcome for the whole patient cohort, even in those treated by nonsurgical means.en_HK
dc.format.extent388 bytes-
dc.format.mimetypetext/html-
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.annalsofsurgery.comen_HK
dc.relation.ispartofAnnals of Surgeryen_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshCarcinoma, Squamous Cell - mortality - therapyen_HK
dc.subject.meshEsophageal Neoplasms - mortality - therapyen_HK
dc.subject.meshAntineoplastic Agents - therapeutic useen_HK
dc.subject.meshCombined Modality Therapyen_HK
dc.subject.meshEsophagectomyen_HK
dc.titleImprovement in Treatment Results and Long-Term Survival of Patients with Esophageal Cancer: Impact of Chemoradiation and Change in Treatment Strategyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0003-4932&volume=238&issue=3&spage=339&epage=348&date=2003&atitle=Improvement+in+treatment+results+and+long-term+survival+of+patients+with+esophageal+cancer:+impact+of+chemoradiation+and+change+in+treatment+strategyen_HK
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.emailKwong, DLW: dlwkwong@hku.hken_HK
dc.identifier.emailChu, KM: chukm@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.identifier.authorityKwong, DLW=rp00414en_HK
dc.identifier.authorityChu, KM=rp00435en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1097/01.sla.0000086545.45918.eeen_HK
dc.identifier.pmid14501500en_HK
dc.identifier.pmcidPMC1422701en_HK
dc.identifier.scopuseid_2-s2.0-0141871983en_HK
dc.identifier.hkuros91998-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0141871983&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume238en_HK
dc.identifier.issue3en_HK
dc.identifier.spage339en_HK
dc.identifier.epage348en_HK
dc.identifier.isiWOS:000185835200008-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridKwong, DLW=15744231600en_HK
dc.identifier.scopusauthoridKwok, KF=7102194177en_HK
dc.identifier.scopusauthoridWong, KH=36485841700en_HK
dc.identifier.scopusauthoridChu, KM=7402453538en_HK
dc.identifier.scopusauthoridSham, JST=24472255400en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK
dc.identifier.scopusauthoridDemeester, TR=35421636200en_HK
dc.identifier.scopusauthoridPellegrini, CA=7101984946en_HK
dc.identifier.scopusauthoridKrupski, WC=7005871327en_HK

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