Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer.
BACKGROUND
Endoscopic ultrasound (EUS) is known to detect smaller effusion volumes than computerised tomography (CT), yet the outcomes for patients diagnosed with oesophageal carcinoma and EUS-defined pleural, pericardial or ascitic fluid effusions (EDFE) are unknown. The aim of this study was to determine the outcome of multidisciplinary stage directed treatment for such patients.


METHODS
Forty-nine (9.2%) out of a consecutive 527 patients diagnosed with oesophageal cancer from a single regional upper gastrointestinal (GI) cancer network were found to have evidence of EDFE undetected by CT. Thirty-nine (79.6%) patients had pleural effusions, eight (16.3%) pericardial effusions, and two (4.1%) ascites.


RESULTS
Twelve (24.4%) underwent surgery, 3 (6.1%) received neoadjuvant chemotherapy without subsequent surgery, 12 (24.5%) received definitive chemoradiotherapy (dCRT), and 22 (44.9%) received palliative treatment. Survival in patients with EDFE was significantly shorter (median and 2-year survival 15.6 months and 24%, respectively) when compared with patients without EDFE (26.7 months and 40%, respectively, p = 0.001), and was unrelated to EDFE type (p = 0.192). Two-year survival after oesophagectomy with or without neoadjuvant therapy was 45% in patients with EDFE compared with 42% in patients without EDFE (p = 0.668).


CONCLUSIONS
EDFE was an important adverse prognostic indicator, but patients deemed to have operable tumours should still be treated with radical intent.
Twine
Christopher P
CP
South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK. chris_twine@hotmail.com
Barry
Jonathan D
JD
Blackshaw
Guy R J
GR
Crosby
Tom D
TD
Roberts
S Ashley
SA
Lewis
Wyn G
WG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001202:Ascitic Fluid / Q000000981:diagnostic imaging*; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010490:Pericardial Effusion / Q000000981:diagnostic imaging*; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014057:Tomography, X-Ray Computed