Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

Park, James Hugh; Woodley, Niall; Glen, Paul

doi:10.1136/bmjspcare-2017-001490

Cited by 4 publications

(4 citation statements)

References 33 publications

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“…Esophageal stent placement is indicated in patients with an expected short-term survival (i. e. less than 3 months) for its rapid relief of symptoms, usually within 1-2 days after stent placement [6]. Several prognostic tools may aid the selection of esophageal stent candidates, but these lack external validation [20][21][22]. The presence of metastases and poor performance status have repeatedly been shown to be associated with poor survival [21][22][23][24].…”

Section: Efficacymentioning

confidence: 99%

“…Several prognostic tools may aid the selection of esophageal stent candidates, but these lack external validation [20][21][22]. The presence of metastases and poor performance status have repeatedly been shown to be associated with poor survival [21][22][23][24]. When esophageal stent placement is considered, SEMSs are recommended over self-expandable plastic stents (SEPSs) owing to a lower rate of symptom recurrence and serious adverse events [6].…”

Section: Efficacymentioning

confidence: 99%

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Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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Main recommendations Malignant disease 1 ESGE recommends placement of partially or fully covered self-expandable metal stents (SEMSs) for palliation of malignant dysphagia over laser therapy, photodynamic therapy, and esophageal bypass.Strong recommendation, high quality evidence. 2 ESGE recommends brachytherapy as a valid alternative, alone or in addition to stenting, in esophageal cancer patients with malignant dysphagia and expected longer life expectancy.Strong recommendation, high quality evidence. 3 ESGE recommends esophageal SEMS placement for sealing malignant tracheoesophageal or bronchoesophageal fistulas. Strong recommendation, low quality evidence. 4 ESGE does not recommend SEMS placement as a bridge to surgery or before preoperative chemoradiotherapy because it is associated with a high incidence of adverse events. Other options such as feeding tube placement are preferable. Strong recommendation, low quality evidence. Benign disease 5 ESGE recommends against the use of SEMSs as first-line therapy for the management of benign esophageal strictures because of the potential for adverse events, the availability of alternative therapies, and their cost. Strong recommendation, low quality evidence. 6 ESGE suggests consideration of temporary placement of self-expandable stents for refractory benign esophageal strictures. Weak recommendation, moderate quality evidence. 7 ESGE suggests that fully covered SEMSs be preferred over partially covered SEMSs for the treatment of refractory benign esophageal strictures because of their very low risk of embedment and ease of removability. Weak recommendation, low quality evidence. 8 ESGE recommends the stent-in-stent technique to remove partially covered SEMSs that are embedded in the esophageal wall. Strong recommendation, low quality evidence. 9 ESGE recommends that temporary stent placement can be considered for the treatment of leaks, fistulas, and perforations. No specific type of stent can be recommended, and the duration of stenting should be individualized. Strong recommendation, low quality of evidence. 10 ESGE recommends considering placement of a fully covered large-diameter SEMS for the treatment of esophageal variceal bleeding refractory to medical, endoscopic, and/or radiological therapy, or as initial therapy for patients with massive bleeding. Strong recommendation, moderate quality evidence.

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Section: Efficacymentioning

confidence: 99%

Section: Efficacymentioning

confidence: 99%

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

et al. 2021

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“…A research from China also determined its prognostic value in predicting OS and DFS in EJA patients with resection [51]. Park et al suggested that mGPS might be an independent marker for survival in patients with EJA (163 out of 203 participants, including gastric cancer) undergoing palliative self-expandable metallic stent insertion (HR = 1.24, 95% CI: 1.03 -1.49) [52].…”

Section: Biochemical and Coagulation Parametersmentioning

confidence: 99%

Blood-based Markers in the Prognostic Prediction of Esophagogastric Junction Cancer

Liu¹,

Hong²,

Huang³

et al. 2020

J. Cancer

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Esophagogastric junction cancer poses a great threat to human beings both in western countries and East Asia, especially in China and Japan, and its incidence has increased during recent decades. The 5-year survival rate of esophagogastric junction cancer is quite poor compared with that of other gastric cancer sites. Until now, the traditional TNM staging system has been widely used in clinical practice for prognosis. However, the TNM system is based on pathology after surgical resection or radiology using CT and MRI, not on blood markers. Evidently, some research has been reported concentrated on the prognostic value of blood-based markers with the character of non-invasive and non-radioactive in EJA. Hematologic, biochemical and coagulation parameters could be obtained from clinical data and utilized to analyze their prognostic values. Tumor-associated antigens, microRNAs and circulating tumor cells have also been reported in EJC prognosis. In this article, we review research focused on blood-based markers to evaluate their prognostic value in esophagogastric junction cancer, especially its main subtype adenocarcinoma.

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“…In recent years, the presence of a preoperative innate systemic inflammatory response (SIR) has also been recognized as a potentially important prognostic marker in EC, in both palliative and curative settings. 10 It is postulated to be related to the upregulation or inappropriate activation of the innate immune response, which suppresses the more useful anticancer adaptive response. 11 It is therefore speculated that the presence of an innate SIR, represented by measurements of the acute-phase reactants C-reactive protein (CRP) and albumin in the form of the modified Glasgow Prognostic Score (mGPS) may be useful to identify EC patients who will have higher rates of postoperative morbidity and poorer prognosis following resection of locally advanced disease.…”

mentioning

confidence: 99%

Staging the Tumor and Staging the Host: Pretreatment Combined Neutrophil Lymphocyte Ratio and Modified Glasgow Prognostic Score Is Associated with Overall Survival in Patients with Esophagogastric Cancers Undergoing Treatment with Curative Intent

et al. 2020

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Background This study examined whether an innate systemic inflammatory response (SIR) measured by combination neutrophil to lymphocyte ratio (NLR) and modified Glasgow Prognostic Score (mGPS) was associated with overall survival (OS) in patients with esophagogastric cancer (EC) undergoing neoadjuvant chemotherapy (NAC) followed by surgery. Methods Patients diagnosed with EC, managed with NAC prior to surgery at a regional referral center, between January 2010 and December 2015, were included. The mGPS and NLR were calculated within 12 weeks before NAC. Patients were grouped by combined NLR/mGPS score into three groups of increasing SIR: NLR ≤ 3 ( n = 152), NLR > 3 + mGPS = 0 ( n = 55), and NLR > 3 + mGPS > 0 ( n = 32). Univariable and multivariable Cox regression was used to analyse OS. Results Overall, 337 NAC patients were included, with 301 (89%) proceeding to surgery and 215 (64%) having R0 resection. There were 203 deaths, with a median follow-up of those alive at censor of 69 months (range 44–114). Higher combined NLR/mGPS score ( n = 239) was associated with poorer OS independent of clinical stage and performance status (hazard ratio 1.28, 95% confidence interval 1.02–1.61; p = 0.032), higher rate of progression on NAC (7% vs. 7% vs. 19%; p = 0.003), and lower proportion of eventual resection (80% vs. 84% vs. 53%; p = 0.003). Conclusions The combined NLR/mGPS score was associated with OS and initial treatment outcomes in patients undergoing NAC prior to surgery for EC, stratifying survival in addition to clinical staging and performance status. The host SIR may be a useful adjunct to multidisciplinary decision making. Electronic supplementary material The online version of this article (10.1245/s10434-020-09074-5) contains supplementary material, which is available to authorized users.

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Palliative stenting for oesophagogastric cancer: tumour and host factors and prognosis

Cited by 4 publications

References 33 publications

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Blood-based Markers in the Prognostic Prediction of Esophagogastric Junction Cancer

Staging the Tumor and Staging the Host: Pretreatment Combined Neutrophil Lymphocyte Ratio and Modified Glasgow Prognostic Score Is Associated with Overall Survival in Patients with Esophagogastric Cancers Undergoing Treatment with Curative Intent

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