Impact of Sites of Metastatic Dissemination on Survival in Advanced Gastroesophageal Adenocarcinoma

Wang, Xin; Espin-Garcia, Osvaldo; Jiang, Di Maria; Allen, Michael J.; Lucy, X.; Bach, Yvonne; Chen, Eric X.; Darling, Gail; Yeung, Jonathan; Wong, Rebecca; Veit-Haibach, Patrick; Kalimuthu, Sangeetha; Jang, Raymond; Elimova, Elena

doi:10.1159/000525616

Cited by 3 publications

(1 citation statement)

References 47 publications

(58 reference statements)

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“…Other studies suggested that the presence of lung or bone metastases is an independent risk factor for decreased survival. 28 Additionally, while in the UVA, there was a significant association between worse OS and SB, the MVA showed that only patients with a high SB cohort had a significantly increased risk of death.…”

Section: Discussionmentioning

confidence: 90%

Integrating Patient-Reported Outcomes Into Prognostication in Gastroesophageal Cancer: Results of a Population-Based Retrospective Cohort Analysis

Baccili Cury Megid,

Sharma,

Baskurt

et al. 2024

The Oncologist

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Background Patient-reported outcomes measures (PROM) are self-reflections of an individual’s physical functioning and emotional well-being. The Edmonton Symptom Assessment Scale (ESAS) is a simple and validated PRO tool of 10 common symptoms and a patient-reported functional status (PRFS) measure. The prognostic value of this tool is unknown in patients with gastroesophageal cancer (GEC). In this study, we examined the association between the ESAS score and overall survival (OS) in patients with GEC, the prognostication difference between ESAS and Eastern Cooperative Oncology Group (ECOG), and assessed the correlation between PRFS and the physician-reported ECOG performance status (PS). Methods The study was a retrospective cohort study of 211 patients with GEC with localized (stages I-III) and metastatic disease who completed at least one baseline ESAS prior to treatment. Patients were grouped into 3 cohorts based on ESAS score. OS was assessed using the Kaplan-Meier method, and the concordance index (c-index) was calculated for ESAS and physician-reported ECOG. The agreement between PRFS and physician-ECOG was also assessed. Results In total, 211 patients were included. The median age was 60.8 years; 90% of patients were ECOG PS 0-1; 38% of patients were stages I-III, while 62% were de novo metastatic patients. Median OS in low, moderate, high symptom burden (SB) patients’ cohorts was 19.17 m, 16.39 mm, and 12.68 m, respectively (P < .04). The ability to predict death was similar between physician-ECOG and ESAS (c-index 0.56 and 0.5753, respectively) and PRFS and physician-ECOG (c-index of 0.5615 and 0.5545, respectively). The PS agreement between patients and physicians was 50% with a weighted Kappa of 0.27 (95% CI: 0.17-0.38). Conclusion Patient’s SB seems to carry a prognostic significance. ESAS and physician-reported ECOG exhibit comparable prognostic values. Physicians and patients can frequently have divergent opinions on PS. ESAS takes a patient-centered approach and should be encouraged in practice among patients with GEC as an additional tool for prognostication.

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Section: Discussionmentioning

confidence: 90%

Integrating Patient-Reported Outcomes Into Prognostication in Gastroesophageal Cancer: Results of a Population-Based Retrospective Cohort Analysis

Baccili Cury Megid,

Sharma,

Baskurt

et al. 2024

The Oncologist

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Neoadjuvant Strategies for Esophageal Cancer

Barron¹,

Wang²,

Elimova³

2023

Thoracic Surgery Clinics

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Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy

Wang,

Allen,

Espin-Garcia

et al. 2024

The Oncologist

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Background The incidence of esophageal and gastric carcinoma (GEC) in elderly patients is increasing, yet patients ≥75 years have historically been underrepresented in clinical trials. We sought to investigate palliative chemotherapy administration patterns and survival outcomes in older adults. Materials and Methods A retrospective analysis identified patients aged 65-74 (young-old) and ≥75 years (older-old) diagnosed with advanced GEC. Patient and tumor characteristics were recorded, with descriptive analysis, time-to-event data analysis using Kaplan-Meier curves and multivariate Cox proportional hazards regression analysis performed. Results One hundred and ninety-eight “young-old” and 109 ‘older-old’ patients were identified. Patient characteristics were similar between groups except for Charlson Co-morbidity Index (CCI), with lower co-morbidities in the “young-old” compared to “older-old” cohort (P < .001; CCI = 0 in 103 (52%) “young-old” vs 31 (28%) “older-old”). The primary diagnosis in both groups was adenocarcinoma. 119 (60%) “young-old” and 25 (23%) “older-old” patients received chemotherapy (P < .001). Performance status was the primary explanation for chemotherapy non-receipt in both cohorts; age was the explanation in 21 (25%) “older-old” patients and none in the “young-old” patients. PFS for first-line systemic therapy in “young-old” patients was 6.4 (95% CI 5.9-7.6) versus 7.5 months (95% CI 5.1-11.3) in “older-old” patients (P = .69) whilst respective OS was 12.3 (95% CI 10.1-15.5) and 10.4 months (95% CI 9.0-14.6) (P = .0816). Toxicity prompted chemotherapy cessation in 17 (15%) “young-old” and 3 (13%) “older-old” patients (P = .97). Multivariate analysis identified CCI and ECOG performance status as predictive for PFS and OS, respectively. No causative relationship was identified with other variables. Conclusion Our study of real-world older-adults show that significant number of “older-old” patients with GEC do not receive chemotherapy. Among “older-old” adults who do receive systemic therapy, outcomes are comparable; this underscores the importance of geriatric assessment-guided care and suggests that age alone should not be a barrier to receipt of chemotherapy in patients with advanced GEC.

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Impact of Sites of Metastatic Dissemination on Survival in Advanced Gastroesophageal Adenocarcinoma

Cited by 3 publications

References 47 publications

Integrating Patient-Reported Outcomes Into Prognostication in Gastroesophageal Cancer: Results of a Population-Based Retrospective Cohort Analysis

Integrating Patient-Reported Outcomes Into Prognostication in Gastroesophageal Cancer: Results of a Population-Based Retrospective Cohort Analysis

Neoadjuvant Strategies for Esophageal Cancer

Outcomes in older adults with metastatic esophageal and gastric carcinoma treated with palliative chemotherapy

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