title: Treatment outcomes and prognostic factors for thoracic esophageal cancer with clinical evidence of adjacent organ invasion.
abstract: OBJECTIVE
  The status of each patient with advanced esophageal cancer varies widely, and the prognosis is generally poor. We aimed to determine which prognostic factors are involved in the management of locally advanced esophageal cancer with adjacent organ invasion.
  
  
  METHODS
  We retrospectively investigated the therapeutic outcomes of 74 patients with thoracic esophageal cancer and clinical evidence of adjacent organ invasion but without distant metastasis. The predictive factors for a chemoradiotherapeutic response and survival were evaluated.
  
  
  RESULTS
  Definitive chemoradiotherapy (CRT), bypass surgery and CRT, as well as CRT followed by esophagectomy were carried out in 48 (64.9%), 17 (23.0%), and 9 (12.2%) patients, respectively. The median survival time (MST) of patients overall was 11.3 months. The MST of patients after definitive CRT, bypass surgery plus CRT and CRT followed by esophagectomy was 10.4, 11.0 and 16.4 months, respectively; MST did not differ significantly between patients. MST of patients with a complete response (CR), a partial response (PR) and stable (SD)/progressive (PD) disease as clinical outcomes of CRT was 52.6, 11.3 and 6.7 months, respectively; the MST was considerably longer in patients with, than in those without CR (CR vs. SD/PD, p<0.0001; CR vs. PR, p=0.0004). In multivariate analysis, age <60 years [odds ratio (OR)=7.74; 95% confidence interval (CI)=1.85-32.41; p=0.005] and hemoglobin ≥13 g/dl (OR=11.54; 95% CI=1.29-103.21; p=0.03) were independently associated with CR as an outcome of CRT, and serum albumin level ≥3.5 g/dl (OR=2.11; 95% CI=1.09-4.10; p=0.03) was independently associated with prolonged survival.
  
  
  CONCLUSIONS
  Pre-treatment hemoglobin and albumin levels were valuable predictors of the outcome of CRT and survival, respectively. A better response to CRT as well as improved nutritional status prolonged the survival of patients with advanced esophageal cancer.
authors.affiliation: Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8551, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Hamai
authors.forename: Jun
authors.initials: J
authors.lastname: Hihara
authors.forename: Manabu
authors.initials: M
authors.lastname: Emi
authors.forename: Junya
authors.initials: J
authors.lastname: Taomoto
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Aoki
authors.forename: Ichiko
authors.initials: I
authors.lastname: Kishimoto
authors.forename: Yuta
authors.initials: Y
authors.lastname: Ibuki
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
mesh_terms: D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009928:Organ Specificity; D011379:Prognosis; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Anemia; chemoradiotherapy; esophageal cancer; nutrition; prognostic factor