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Surgery Adherence and Survival Outcomes in Patients With Locally Advanced (IIA-IVA) Cancer of the Lower Esophagus: A

Jingsong Liu1, Hu Chen2, Chuannan Wu3,4

  • 1Department of Thoracic Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.

The American Surgeon
|March 27, 2024
PubMed
Summary

Surgical adherence significantly impacts survival for locally advanced lower esophageal cancer patients. Factors like older age and distant SEER classification are linked to lower adherence, worsening prognosis.

Keywords:
SEER databaselocally advancedlower esophageal cancerprognosissurgical adherence

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Cancer Epidemiology

Background:

  • Esophageal cancer is a major upper gastrointestinal malignancy.
  • Locally advanced lower esophageal cancer (IIA-IVA) presents significant treatment challenges.
  • Understanding factors influencing treatment adherence is crucial for improving patient outcomes.

Purpose of the Study:

  • To evaluate the effect of surgical adherence on survival in locally advanced lower esophageal cancer.
  • To identify demographic and clinical factors associated with poor surgical adherence.

Main Methods:

  • Analysis of 4922 patients with locally advanced lower esophageal cancer (2004-2015) from the SEER database.
  • Multifactorial logistic regression to identify factors affecting surgical adherence.
  • Kaplan-Meier curves and Cox regression to assess the impact of adherence on overall survival (OS) and cancer-specific survival (CSS).

Main Results:

  • 2025 out of 2372 surgically advised patients underwent surgery; 347 refused.
  • Lower adherence was associated with older age, unmarried status, distant SEER classification, and squamous cell carcinoma.
  • Refusing surgery independently lowered OS (OR: 1.657) and CSS (OR: 1.487).

Conclusions:

  • Good surgical adherence is a positive prognostic factor for locally advanced lower esophageal cancer.
  • Poor adherence correlates with specific patient and disease characteristics.
  • Interventions to improve surgical adherence may enhance survival for this patient group.