Lymphoparietal Index in Esophageal Cancer Is Stronger Than TNM Staging in Long-Term Survival Prognosis in a Latin-American Country

Abstract

Background: The identification of prognostic factors of esophageal cancer has allowed to predict the evolution of patients. Aim: Assess different prognostic factors of long-term survival of esophageal cancer and evaluate a new prognostic factor of long-term survival called lymphoparietal index (N+/T). Method: Prospective study of the Universidad de Chile Clinical Hospital, between January 2004 and December 2013. Included all esophageal cancer surgeries with curative intent and cervical anastomosis. Exclusion criteria included: stage 4 cancers, R1 resections, palliative procedures and emergency surgeries. Results: Fifty-eight patients were included, 62.1% were men, the average age was 63.3 years. A total of 48.3% were squamous, 88% were advanced cancers, the average lymph node harvest was 17.1. Post-operative surgical morbidity was 75%, with a 17.2% of reoperations and 3.4% of mortality. The average overall survival was 41.3 months, the 3-year survival was 31%. Multivariate analysis of the prognostic factors showed that significant variables were anterior mediastinal ascent (p=0.01, OR: 6.7 [1.43-31.6]), anastomotic fistula (p=0.03, OR: 0.21 [0.05-0.87]), N classification (p=0.02, OR: 3.8 [1.16-12.73]), TNM stage (p=0.04, OR: 2.8 [1.01-9.26]), and lymphoparietal index (p=0.04, RR: 3.9 [1.01-15.17]. The ROC curves of lymphoparietal index, N classification and TNM stage have areas under the curve of 0.71, 0.63 and 0.64 respectively, with significant statistical difference (p=0.01). Conclusion: The independent prognostic factors of long-term survival in esophageal cancer are anterior mediastinal ascent, anastomotic fistula, N classification, TNM stage and lymphoparietal index. In esophageal cancer the new lymphoparietal index is stronger than TNM stage in long-term survival prognosis.

Neoadjuvant Chemoradiotherapy Followed by Transhital Esophagectomy in Locally Advanced Esophageal Squamous Cell Carcinoma: Impact of Pathological Complete Response

“…In the past, radiotherapy was used as the only form of treatment for squamous cell carcinoma, demonstrating in some studies, results similar to those of surgery. Recently, chemotherapy and associated radiotherapy have shown better survival results, while radiotherapy as the definitive modality has been reserved for patients who cannot receive chemotherapy 1,2,3,9,10,13,14,22,23 .…”

“…The several advantages, such as those mentioned above, are notorious, especially when compared to other types of treatments carried out together or isolated. There is a higher rate of R0 resections, in addition to the possibility of a complete response to neoadjuvant therapy, that is, a complete absence of tumor cells in the surgical specimen 4,5,11,12,13,15,20,21,27 .…”

“…Figueroa-Giralt et al13 , in 2020, proposed the use of the lymphoparietal index in the survival of esophageal cancer, after analyzing the treatment of 58 patients, treated with neoadjuvant or adjuvant therapy according to tumor stage and esophagectomy by minimally invasive techniques and cervical esophagealgastric anastomosis. They conclude that the main independent prognostic factors for survival of more than three years, in a Latin American country, are: gender, anterior mediastinal traction, anastomotic fistula, classification N, TNM stage and lymphoparietal index.…”