title: Prognostic significance of endoscopic ultrasound-defined pleural, pericardial or peritoneal fluid in oesophageal cancer.
abstract: 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.
authors.affiliation: South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK. chris_twine@hotmail.com
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Twine
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Barry
authors.forename: Guy R J
authors.initials: GR
authors.lastname: Blackshaw
authors.forename: Tom D
authors.initials: TD
authors.lastname: Crosby
authors.forename: S Ashley
authors.initials: SA
authors.lastname: Roberts
authors.forename: Wyn G
authors.initials: WG
authors.lastname: Lewis
mesh_terms: 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