BackgroundThe prognostic value of inflammation indexes in esophageal cancer has not been established. Recent studies have shown that the advanced lung cancer inflammation index (ALI) is a useful predictive factor. The purpose of the current study was to determine whether the ALI is useful for predicting long-term survival in patients with esophageal squamous cell carcinoma (ESCC).Patients and methodsA total of 293 patients who had undergone esophagectomy for ESCC were included. The ALI was calculated as body mass index × serum albumin/neutrophil-to-lymphocyte ratio. Then, patients were divided into two groups: ALI ≥18 and ALI <18. The Kaplan–Meier method was used to calculate the cancer-specific survival (CSS), and the difference was assessed by the log-rank test. Univariate and multivariate analyses were performed to evaluate the prognostic factors.ResultsIn our study, there were 120 patients with ALI <18 and 173 patients with ALI ≥18. ALI was significantly higher in patients with large tumors (P=0.028), poor differentiation (P=0.010), deep invasion (P=0.009), and nodal metastasis (P=0.004). The 5-year CSS was 34.5% in our study. Patients with ALI <18 had a significantly poorer 5-year CSS compared to ALI ≥18 (21.7% versus 43.4%, P<0.001). On multivariate analysis, we showed that the ALI was a significant predictive factor of CSS (P=0.024).ConclusionThe ALI is still a useful predictive factor for long-term CSS in patients with ESCC. However, the prognostic value of the ALI is yet to be formally tested within randomized trials.
BACKGROUND:The thoracic radiotherapy (TRT) target volume for limited-stage small-cell lung cancer (SCLC) has been controversial for decades. In this report, the final results of a prospective randomized trial on the TRT target volume before and after induction chemotherapy are presented. METHODS: After 2 cycles of etoposide and cisplatin, patients arm were randomized to receive TRT to the postchemotherapy or prechemotherapy tumor volume in a study arm and a control arm. Involved-field radiotherapy was received in both arms. TRT consisted of 1.5 grays (Gy) twice daily in 30 fractions to up to a total dose of 45 Gy. Lymph node regions were contoured, and intentional and incidental radiation doses were recorded. RESULTS: The study was halted early because of slow accrual. Between 2002 and 2017, 159 and 150 patients were randomized to the study arm or the control arm, respectively; and 21.4% and 19.1% of patients, respectively, were staged using positron emission tomography/computed tomography (P = .31). With a median follow-up of 54.1 months (range, 19.9-165.0 months) in survivors, the 3-year local/regional progression-free probability was 58.2% and 65.5% in the study and control arms, respectively (P = .44), and the absolute difference was −7.3% (95% CI, −18.2%, 3.7%). In the study and control arms, the median overall survival was 21.9 months and 26.6 months, respectively, and the 5-year overall survival rate was 22.8% and 28.1%, respectively (P = .26). Grade 3 esophagitis was observed in 5.9% of patients in the study arm versus 15.5% of those in the control arm (P = .01). The isolated out-of-field failure rate was 2.6% in the study arm versus 4.1% in the control arm (P = .46), and all such failures were located in the supraclavicular fossa or contralateral hilum. The regions 7, 3P, 4L, 6, 4R, 5, and 2L received incidental radiation doses >30 Gy. CONCLUSIONS: TRT could be limited to the postchemotherapy tumor volume, and involved-field radiotherapy could be routinely applied for limited-stage SCLC. Cancer 2020;126:840-849.
Preoperative platelet count is a predictive factor for long-term survival in ESCC, especially in nodal-positive patients. We conclude that 205 (×10(9)/L) may be the optimum cutoff point for platelet count in predicting survival in ESCC patients.
BackgroundRecurrent laryngeal nerve (RLN) lymph node metastasis used to be shown a predictor for poor prognosis in esophageal squamous cell carcinoma. The purpose of this study was to evaluate the prognostic impact of RLN node metastasis and the number of metastatic lymph nodes in node-positive patients with squamous cell carcinoma of middle thoracic esophagus.MethodsA cohort of 235 patients who underwent curative surgery for squamous cell carcinoma of middle thoracic esophagus was investigated. The prognostic impact was evaluated by univariate and multivariate analyses.ResultsLymph node metastasis was found in 133 patients. Among them, 81 had metastatic RLN nodes, and 52 had at least one positive node but no RLN nodal involvement. The most significant difference in survival was detected between patients with metastatic lymph nodes below and above a cutoff value of six (P < 0.001). Multivariate analysis revealed that the number of metastatic lymph nodes was a significant factor associated with overall survival (P < 0.001), but RLN lymph node metastasis was not (P = 0.865).ConclusionsRLN Lymph node metastasis is not, but the number of metastatic nodes is a prognostic predictor in node-positive patients with squamous cell carcinoma of the middle thoracic esophagus.
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