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Related Concept Videos

Barrett Esophagus-I: Introduction01:21

Barrett Esophagus-I: Introduction

102
Barrett's esophagus is a medical condition where the esophageal mucosa is significantly damaged by stomach acid or other digestive fluids, often due to long-term exposure associated with gastroesophageal reflux disease (GERD). In GERD, a weakened or abnormally relaxed lower esophageal sphincter allows stomach acid to flow persistently into the esophagus.
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
102

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Establishment and Histological Analysis of Esophageal Organoids Modeling the Progression from Normal to Cancerous Tissues
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Defining Pathologic Upstaging in cT1b Esophageal Cancer: Should We Consider Neoadjuvant Therapy?

David R Mann1, Kathryn E Engelhardt1, Barry C Gibney1

  • 1Department of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.

The Journal of Surgical Research
|November 22, 2023
PubMed
Summary

Neoadjuvant chemoradiation therapy (NCRT) does not improve survival for early esophageal cancer (cT1b). Pathologic upstaging in cT1b lesions is linked to worse overall survival (OS), with esophagectomy offering better outcomes than endoscopic excision.

Keywords:
Adult thoracicChemoradiation therapyEsophageal cancerEsophagectomyNeoadjuvantTreatment outcomes

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastroenterology

Background:

  • Neoadjuvant chemoradiation therapy (NCRT) is not standard for cT1b esophageal cancer, despite risks of pathologic upstaging.
  • Understanding factors and outcomes related to upstaging is crucial for treatment decisions.

Purpose of the Study:

  • To determine the rate and predictors of pathologic upstaging in cT1b esophageal cancer.
  • To analyze current treatment trends for these lesions.
  • To compare overall survival (OS) for cT1b esophageal cancer treated with or without NCRT before surgery.

Main Methods:

  • Utilized the 2020 National Cancer Database for patients with cT1b N0 esophageal cancer.
  • Employed multivariable logistic regression to identify factors associated with pathologic upstaging.
  • Applied log-rank analysis and Cox proportional hazards regressions to compare survival outcomes.

Main Results:

  • 17.3% of cT1b esophageal cancer patients experienced pathologic upstaging, linked to higher tumor grade, size, and lympho-vascular invasion.
  • Neoadjuvant chemoradiation therapy (NCRT) was given to 8.0% of patients.
  • Upfront esophagectomy showed improved 5-year OS (67.2%) compared to NCRT (49.4%). Pathologic upstaging significantly decreased OS (43.7% vs. 67.7%).

Conclusions:

  • Pathologic upstaging in cT1b esophageal cancer correlates with reduced overall survival.
  • Esophagectomy provides a survival advantage over endoscopic local tumor excision for cT1b lesions.
  • Neoadjuvant chemoradiation therapy (NCRT) does not enhance OS for cT1b esophageal cancer when compared to upfront esophagectomy.