Primary Gross Tumor Volume is Prognostic and Suggests Treatment in Upper Esophageal Cancer

Abstract

Background: To aid clinicians strategizing treatment for upper esophageal squamous cell carcinoma (ESCC), this retrospective study investigated associations between primary gross tumor volume (GTVp) and prognosis in patients given surgical resection, radiotherapy, or both resection and radiotherapy. Methods: The population comprised 568 patients with upper ESCC given definitive treatment, including 238, 216, and 114 who underwent surgery, radiotherapy, or combined radiotherapy and surgery. GTVp as a continuous variable was entered into the multivariate Cox model using penalized splines (P-splines) to determine the optimal cutoff value. Propensity score matching (PSM) was used to adjust imbalanced characteristics among the treatment groups. Results: P-spline regression revealed a dependence of patient outcomes on GTVp, with 30 cm3 being an optimal cut-off for differences in overall and progression-free survival (OS, PFS). GTVp ≥ 30 cm3 was a negative independent prognostic factor for OS and PFS. PSM analyses confirmed the prognostic value of GTVp. For GTVp < 30 cm3, no significant survival differences were observed among the 3 treatments. For GTVp ≥ 30 cm3, the worst 5-year OS rate was experienced by those given surgery. The 5-year PFS rate of patients given combined radiotherapy and surgery was significantly better than that of patients given radiotherapy. The surgical complications of patients given the combined treatment were comparable to those who received surgery, but radiation side effects were significantly lower. Conclusion: GTVp is prognostic for OS and PFS in upper ESCC. For patients with GTVp ≥ 30 cm3, radiotherapy plus surgery was more effective than either treatment alone.

A Study on Risk Factors Associated with Reflux Esophagitis in Patients Undergoing Esophageal Cancer Surgery

“…According to the International Agency for Research on Cancer under the World Health Organization, there were 572000 new patients with esophageal cancer worldwide in 2018 and 509000 patients died in the same year [ 1 , 2 ]. In China, the incidence of esophageal cancer is high, and the yearly new and dead patients with esophageal cancer account for more than half of the global total [ 3 ]. Because the patents with esophageal cancer have no specific symptom at the early stage, most patients, with late diagnoses and poor prognoses, can only be treated with individualized comprehensive treatment centering on surgical treatment.…”