title: Clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer undergoing induction chemotherapy or chemoradiotherapy.
abstract: OBJECTIVE
  To identify clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer following induction chemotherapy or chemoradiotherapy.
  
  
  METHODS
  Of 48 patients with T4 esophageal cancer who underwent induction treatment, 30 underwent R0 esophagectomy. The factors predicting R0 resection and prognostic indicators were assessed in the 48 and 30 patients, respectively, using univariate and multivariate analyses.
  
  
  RESULTS
  In the univariate analyses, the primary tumor response, improvement of dysphagia, the post-induction therapy Glasgow Prognostic Score, an early tumor response and the post-induction therapy serum albumin and C-reactive protein levels were significantly correlated with R0 resection. Multivariate logistic regression analyses revealed that the response status and improvement of dysphagia were independent predictors of R0 resection. The univariate analyses identified a yp-T classification (yp-T0/1 vs. yp-T2/3/4), yp-nodal status and the number of pathologically positive nodes post-therapy (≤ 1 vs. ≥ 2) as significant prognostic factors. The multivariate analysis revealed that the number of pathologically positive nodes was the only significant independent prognostic indicator.
  
  
  CONCLUSIONS
  Patients showing an early tumor response to induction treatment and improvement of dysphagia may be appropriate candidates for esophagectomy, and individualized postoperative management strategies should be developed for patients with initially unresectable T4 esophageal cancer who have ≥ 2 positive nodes post-treatment.
authors: Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
authors: Hiroyuki
authors: H
authors: Karimata
authors: Hideaki
authors: H
authors: Shimoji
authors: Tadashi
authors: T
authors: Nishimaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D059248:Chemoradiotherapy / Q000401:mortality*; D003680:Deglutition Disorders / Q000628:therapy; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D012709:Serum Albumin / Q000032:analysis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D014408:Biomarkers, Tumor; D012709:Serum Albumin; D002097:C-Reactive Protein