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Endoscopic ultrasound staging for early esophageal cancer: Are we denying patients neoadjuvant chemo-radiation?

World Journal of Gastroenterology 2017年第46期23卷 8193-8199页

作者： carrie luu Marisa Amaral Jason Klapman Cynthia Harris Khaldoun Almhanna Sarah Hoffe Jessica Frakes Jose M Pimiento Jacques P Fontaine Department of Thoracic Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Gastrointestinal Oncology H. Lee Moffitt Cancer Center and Research Institute Department of Radiation Oncology H. Lee Moffitt Cancer Center and Research Institute

AIM To evaluate the accuracy of endoscopic ultrasound(EUS) in early esophageal cancer(EC) performed in a highvolume tertiary cancer center. METHODS A retrospective review of patients undergoing esophagectomy was performed and patients with c T1 N0 and c T2 N0 esophageal cancer by EUS were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. EUS staging was compared to surgical pathology to determine accuracy of EUS. Descriptive statistics was used to describe the cohort. Student's t test and Fisher's exact test or χ~2 test was used to compare variables. Logistic regression analysis was used to determine if clinical variables such as tumor location and tumor histology were associated with EUS *** Between 2000 and 2015, 139 patients with clinical stage Ⅰ or Ⅱ?A esophageal cancer undergoing esophagectomy were identified. There were 25(18%) female and 114(82%) male patients. The tumor location included the middle third of the esophagus in 11(8%) and lower third and gastroesophageal junction in 128(92%) patients. Ninety-three percent of patients had adenocarcinoma. Preoperative EUS matched the final surgical pathology in 73/139 patients for a concordance rate of 53%. Twenty-nine patients(21%) were under-staged by EUS; of those, 19(14%) had unrecognized nodal disease. Positron emission tomography(PET) was used in addition to EUS for clinical staging in 62/139 patients. Occult nodal disease was only found in 4 of 62 patients(6%) in whom both EUS and PET were negative for nodal involvement. CONCLUSION EUS is less accurate in early EC and endoscopic mucosal resection might be useful in certain settings. The addition of PET to EUS improves staging accuracy.

关键词： Esophageal cancer Endoscopic ultrasound Staging Early esophageal cancer Endoscopic mucosal resection

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Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma

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World Journal of Gastrointestinal Surgery 2013年第6期5卷 178-186页

作者： Amanda K Arrington Rebecca A Nelson Ann Falor carrie luu Rebecca L Wiatrek Marwan Fakih Gagandeep Singh Joseph Kim Division of Surgical Oncology City of Hope Comprehensive Cancer CenterDuarteCA 91010United States Department of Biostatistics City of Hope Comprehensive Cancer CenterDuarteCA 91010United States Department of Surgery Harbor-UCLA Medical CenterTorranceCA 90509United States Department of Medical Oncology City of Hope Comprehensive Cancer CenterDuarteCA 91010United States

AIM:To examine surgical and medical outcomes for patients with cholangiocarcinoma using a populationbased cancer ***:Using the California Cancer Registry's Cancer Surveillance Program,patients with intrahepatic cholangiocarcinoma treated in Los Angeles County from 1988 to 2006 were identified and evaluated for clinical and pathologic factors and therapies received(surgery,radiation,and chemotherapy).The surgical cohort was further categorized into three treatment groups:patients who received adjuvant chemotherapy,adjuvant chemoradiation,or underwent surgery alone(no chemotherapy or radiation administered).Survival was assessed by Kaplan-Meier method;and Cox proportional hazard modeling was used in multivariate ***:Of 825 patients,60.2% received no *** the remaining 328 patients,18.5% chemotherapy only,7.4% chemoradiation,and 13.8% underwent *** male patients underwent surgical resection(P = 0.004).Surgical patients were younger than the patients receiving chemotherapy or chemoradiation(P < 0.001).Of the surgical cohort(n = 114),60.5% underwent surgery alone while 39.5% underwent surgery plus adjuvant therapy(chemotherapy n = 20;chemoradiation,n = 21)(P < 0.001).Median survival for all patients in the study was 6.6 *** survival was highest for patients who underwent surgery(23 mo),whereas both chemotherapy(9 mo) and chemoradiation(8 mo) alone were each less effective(P < 0.001).By multivariate analysis,extent of disease,receipt of surgery,and administration of chemotherapy(with/without surgery) were independent predictors of overall ***:This study demonstrates that surgery is a critical treatment *** treatment has yet to be standardized,but play a role in optimal therapy for cholangiocarcinoma.

关键词： Cholangiocarcinoma Chemotherapy Surgery Survival Therapies

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与 resectable 在病人化疗和幸存预定胃的腺癌

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World Journal of Gastrointestinal Surgery 2013年第12期5卷 321-328页

作者： Amanda K Arrington Rebecca Nelson Supriya S Patel carrie luu Michelle Ko Julio Garcia-Aguilar Joseph Kim Division of Surgical Oncology City of Hope Comprehensive Cancer Center Department of Biostatistics City of Hope Comprehensive Cancer Center Department of Surgery University of Southern California Department of Surgery Harbor-UCLA Medical Center Division of Colorectal Surgery Memorial Sloan-Kettering Cancer Center

AIM: To evaluate the timing of chemotherapy in gastric cancer by comparing survival outcomes in treatment groups. METHODS: Patients with surgically resected gastric adenocarcinoma from 1988 to 2006 were identified from the Los Angeles County Cancer Surveillance Program. To evaluate the population most likely to receive and/or benefit from adjunct chemotherapy, inclusion criteria consisted of Stage Ⅱ or Ⅲ gastric cancer patients > 18 years of age who underwent curative-intentsurgical resection. Patients were categorized into three groups according to the receipt of chemotherapy:(1) no chemotherapy;(2) preoperative chemotherapy; or(3) postoperative chemotherapy. Clinical and pathologic characteristics were compared across the different treatment ***: Of 1518 patients with surgically resected gastric cancer, 327(21.5%) received perioperative chemotherapy. The majority of these 327 patients were male(68%) with a mean age of 61.5 years; and they were significantly younger than non-chemotherapy patients(mean age, 70.7; P < 0.001). Most patients had tumors frequently located in the distal stomach(34.5%). Preoperative chemotherapy was administered to 11.3% of patients(n = 37) and postoperative therapy to 88.7% of patients(n = 290). An overall survival benefit according to timing of chemotherapy was not observed on univariate or multivariate analysis. Similar results were observed with stagespecific survival analyses(5-year overall survival: Stage Ⅱ, 25% vs 30%, respectively; Stage Ⅲ, 14% vs 11%, respectively). Therefore, our results do not identify a survival advantage for specific timing of chemotherapy in locally advanced gastric cancer. CONCLUSION: This study supports the implementation of a randomized trial comparing the timing of perioperative therapy in patients with locally advanced gastric cancer.

关键词： Chemotherapy Gastric cancer Adjunct therapy Postoperative therapy Preoperative therapy Timing

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