ISSN: 2148-4902 | E-ISSN: 2536-4553
Northern Clinics of Istanbul Factors affecting survival in esophageal squamous cell carcinoma: Single-center experience [North Clin Istanb]
North Clin Istanb. 2020; 7(3): 267-274 | DOI: 10.14744/nci.2019.31384

Factors affecting survival in esophageal squamous cell carcinoma: Single-center experience

Abdullah Sakin1, Yonca Yilmaz Urun2, Suleyman Sahin3, Muhammed Mustafa Atici4, Serdar Arici4, Caglayan Geredeli4, Nurgul Yasar4, Cumhur Demir4, Sener Cihan4
1Department of Medical Oncology, Yuzuncu Yil University Faculty of Medicine, Van, Turkey
2Department of Gastroenterology, Bulent Ecevit University Faculty of Medicine, Zonguldak,Turkey
3Department of Medical Oncology, Van Training and Research Hospital, Van, Turkey
4Department of Medical Oncology, Okmeydani Training and Research Hospital, Istanbul, Turkey

OBJECTIVE: Squamous cell esophageal cancer (ESCC) is a highly fatal malignancy. This study aims to investigate the factors affecting survival in patients with metastatic and non-metastatic ESCC.
METHODS: Between 2008 and 2016, 107 patients with ESCC who were followed up in an oncology clinic were included in the analysis. Patients were grouped based on the stage of disease as clinical-stage II to IV.
RESULTS: Of the 107 patients, 55 (55.1%) of them were male and 52 (48.6%) of them were female. The mean age was 60.8 years. Based on the clinical-stage, 28 (26.2%) patients had stage II disease, 33 (30.8%) had stage III disease, and 46 (43.0%) had stage IV disease. Twenty-nine (27.1%) patients with the non-metastatic disease underwent surgery following neoadjuvant chemoradiotherapy (CRT), while 29 (27.1%) patients received definitive CRT. Twenty-six (56.5%) patients with metastatic disease received chemotherapy (CT). While median overall survival (mOS) could not be reached in patients who underwent surgery following neoadjuvant CRT, mOS for patients receiving definitive CRT versus patients treated with surgery alone–was 22.0 months and 24.0 months, respectively (p=0.008). In the metastatic stage, mOS was 8.0 months for the patients treated with a first-line CT and 3.0 months for patients receiving best supportive care (p<0.001). In multivariate analysis, factors predicting survival in patients with the non-metastatic disease were ECOG PS 3-4 (Hazard ratio [HR], 6.13), undergoing surgery (HR, 0.22), clinical-stage III disease (HR, 3.19), and presence of recurrence (HR, 24.12). For patients with metastatic disease, ECOG PS 3-4 (HR, 3.31), grade-III histology (HR, 3.39), liver metastasis (HR, 2.53), and receiving CT (HR, 0.15) were the factors associated with survival in multivariate analysis.
CONCLUSION: In our study, surgery and early clinical-stage increased survival, whereas experiencing recurrence adversely affected survival in non-metastatic ESCC. In the metastatic stage, ECOG PS 3-4, grade-3 histology and liver metastasis adversely affected survival, while receiving CT significantly improved survival.

Keywords: Chemoradiotherapy, chemotherapy; esophageal cancer; squamous cell carcinoma; survival.

Özofagus Skuamöz Hücreli Karsinomda Sağkalımı Etkileyen Faktörler: Tek Merkez Deneyimi

Abdullah Sakin1, Yonca Yilmaz Urun2, Suleyman Sahin3, Muhammed Mustafa Atici4, Serdar Arici4, Caglayan Geredeli4, Nurgul Yasar4, Cumhur Demir4, Sener Cihan4
1Yüzüncü Yıl Üniversitesi Tıp Fakültesi, Tıbbi Onkoloji Anabilim Dalı, Van, Türkiye
2Bülent Ecevit Üniversitesi Tıp Fakültesi, Gastroenteroloji Anabilim Dalı, Zonguldak, Türkiye
3Van Eğitim ve Araştırma Hastanesi, Tıbbi Onkoloji Kliniği, Van, Türkiye
4Okmeydani Eğitim ve Araştırma Hastanesi, Tıbbi Onkoloji Kliniği, İstanbul, Türkiye

Amaç: Skuamöz hücreli Özefagus kanseri (SHÖK) son derece ölümcül malignitedir. Bu çalışmada metastatik olan ve olmayan SHÖK hastalarında sağkalımı etkileyen faktörlerin retrospektif olarak incelenmesi amaçlandı.
Method: Çalışmaya 2008-2016 yılları arasında SHÖK nedeni ile takipli hastalar olarak alındı. Hastalar klinik evre II-III ve evre IV olarak guruplandırıldı.
Bulgular: Çalışmaya 55 (55.1%) erkek ve 52 (48.6%) kadın olmak üzere 107 hasta alındı. Hastaların ortalama yaşı 60.8 idi. 28 (26.2%) hasta klinik evre II, 33 (30.8%) hasta klinik evre III, 46 (%43.0) hasta evre IV tü. Non-metastatik 29 (27.1%) hasta Neoadjuvan kemoradyoterapi (KRT) sonrası opere olmuştu, 29 (27.1%) hastaya definitif KRT verilmişti. Metastatik evre olan hastaların 26 (56.5%) sine Kemoterapi (KT) verilmişti. Neoadjuvan KRT sonrası opere olanlarda ortanca sağkalıma (mGSK), ulaşılamazken, Definitif KRT verilenlerde mGSK, 22.0 ay, sadece cerrahi ile tedavi edilenlerde 24.0 aydı (p=0.008)). Metastatik evrede ise ilk seride KT verilenlerde mGSK, 8.0 ay iken en iyi destek tedavi verilenlerde 3.0 ay dı (p<0.001). Çok değişkenli analizde non-metastik evrede ECOG PS 3-4 (Tehlike oranı [TO], 6.13) operasyon varlığı(TO,0.22), Klinik evre III (TO, 3.19) ve rekürrens varlığı (TO, 24.12), Metastatik evrede ise, ECOG PS 3-4 (TO, 3.31), grad3 (TO, 3.39), karaciğer metastazı(TO, 2.53) ve KT verilmesi (TO, 0.15) sağkalımı etkileyen en anlamlı faktörler olarak saptandı.
Sonuç: Çalışmamızda non-metastatik SHÖK’de cerrahi yapılması, klinik erken evre olması sağkalımı arttırırken rekürrens gelişmesi sağkalımı olumsuz etkiliyordu. Metastatik evrede ise ECOG PS 3-4, grad 3 tümör ve karaciğer metastazı varlığı sağkalımı olumsuz etkilerken, KT verilmesi sağkalımı anlamlı şekilde arttırıyordu. (NCI-2019-0243.R1)

Anahtar Kelimeler: Özefagus kanseri, Kemoterapi; Kemoradyoterapi; Skuamöz hücreli karsinom; Sağkalım.

Abdullah Sakin, Yonca Yilmaz Urun, Suleyman Sahin, Muhammed Mustafa Atici, Serdar Arici, Caglayan Geredeli, Nurgul Yasar, Cumhur Demir, Sener Cihan. Factors affecting survival in esophageal squamous cell carcinoma: Single-center experience. North Clin Istanb. 2020; 7(3): 267-274

Corresponding Author: Abdullah Sakin, Türkiye

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