ABSTRACT
@#Esophageal cancer is the seventh most common cancer worldwide. On August 29, 2023, National Comprehensive Cancer Network (NCCN) released the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2023). This article aims to highlight the key updates in treatment and follow-up recommendations between the version 3 and the version 2 in 2023, providing the latest guidance for the management of esophageal cancer in our country.
ABSTRACT
@#Upper gastrointestinal tract cancers originating in the esophagus or esophagogastric junction constitute a major global health problem. On February 28, 2023, National Comprehensive Cancer Network (NCCN) released the clinical practice guidelines for esophageal and esophagogastric junction cancer (version 1.2023). This article will interpret the main updates related to the treatment and follow-up in this version compared to the version 5.2022, in order to provide the Chinese clinicians a better basis and reference for the diagnosis and treatment of the diseases.
ABSTRACT
@#The National Comprehensive Cancer Network (NCCN) has updated and released the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2022). Compared with the version 4 of the guidelines in 2021, the 3 versions in 2022 have some updates and revisions, mainly focusing on molecular marker detection, perioperative treatment, advanced immunotherapy, radiotherapy and other aspects. This article will interpret the main content of the new edition of the guidelines, in order to enhance the understanding of the guidelines and guide the clinical practice of diagnosis and treatment.
ABSTRACT
A 63-year-old man was admitted to our hospital in March 2017 with dysphagia and right homonymous hemianopsia. We diagnosed him with esophagogastric junction cancer (adenocarcinoma) with metastases to the cerebral occipital lobe, bone, and lymph nodes. After one cycle of 5FU + cisplatin (FP), the brain metastasis was resected because of the hemiplegic symptoms he developed. Histology of the resected tissue showed no viable tumor cells. After three cycles of FP, the primary lesion and metastases were resolved. Upper gastrointestinal endoscopy revealed a scar at the primary site. This was considered a complete response (CR). In April 2018, CT revealed a mass at the cardia, which was considered as lymph node metastases with gastric wall invasion. Although two additional cycles of FP were administered for recurrent tumors, the efficacy was progressive. In August 2018, proximal gastrectomy and D1 + lymph node dissection were performed. The pathological diagnosis was gastric intramural metastases and lymph node metastases (ypN1 [2/22]). Weekly paclitaxel therapy was administered for three months after surgery. Two years have passed since the last surgery without recurrence. We report a rare case of esophagogastric junction cancer with brain, bone, and gastric intramural metastases that responded to combined modality therapy.
ABSTRACT
The 91st Annual Meeting of Japanese Gastric Cancer Association was held in Shizuoka,Japan from 26th February to 1st March,2019.In this article,the author reviewed the analyzed research progress of the esophagogastric junction EGJ cancer in this meeting.Epidemiological data show that in the past 30 years,the incidence of squamous cell carcinoma of the EGJ is gradually decreasing,and the incidence of adenocarcinoma of the esophagogastric junction (AEG) is gradually increasing.Due to the special anatomical position,endoscopic surgery for early EGJ cancer is more demanding.Perioperative therapy is the standard treatment in Europe,which is confirmed by many researches.There were many researches aimed to investigate objective efficacy of neoadjuvant chemoradiotherapy.A multicenter prospective randomized study co-sponsored by the Japanese Society of Gastric Cancer and Society of Esophageal Cancer has answered the controversial clinical question of surgical approach and extent of lymph node dissection for AEG.Reasonable reconstruction of digestive tract after proximal gastrectomy is challenging.The proximal gastric tube interposition has clinical rationality,and the transhiatal approach should be chosen for jejunal interposition and double tract reconstruction.The reconstruction of lower esophageal sphincter was achieved by Kamikawa method,however,its indication should be strictly controlled.
ABSTRACT
The incidence of the esophagogastric junction (EGJ) cancer tends to increasing in recent years.Comprehensive treatment based on surgical treatment is currently a general strategy for the treatment of EGJ cancer.Because of the particularity of the anatomy and pathology of EGJ cancer,there were difficulties and controversies existing in the surgical treatment of EGJ cancer.Medical researchers have attached great importance to the treatment of EGJ cancer and made remarkable progress in it.Therefore,the authors summarize the progress of surgical treatment of EGJ cancer,and present it in four aspects of surgical approach lymph,node dissection,esophagogastric resection and digestive tract reconstruction.
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Although the incidence of gastroesophageal junction (GEJ) adenocarcinoma has been increasing worldwide, no standardized surgical strategy for its treatment has been established. This study aimed to provide an update on the surgical treatment of GEJ adenocarcinoma by reviewing previous reports and propose recommended surgical approaches. The Siewert classification is widely used for determining which surgical procedure is used, because previous studies have shown that the pattern of lymph node (LN) metastasis depends on tumor location. In terms of surgical approaches for GEJ adenocarcinoma, a consensus was reached based on two randomized controlled trials. Siewert types I and III are treated as esophageal cancer and gastric cancer, respectively. Although no consensus has been reached regarding the treatment of Siewert type II, several retrospective studies suggested that the optimal treatment strategy includes paraaortic LN dissection. Against this background, a Japanese nationwide prospective trial is being conducted to determine the proportion of LN metastasis in GEJ cancers and to identify the optimal extent of LN dissection in each type.
Subject(s)
Humans , Adenocarcinoma , Asian People , Classification , Consensus , Esophageal Neoplasms , Esophagogastric Junction , Incidence , Lymph Nodes , Neoplasm Metastasis , Prospective Studies , Retrospective Studies , Stomach NeoplasmsABSTRACT
Dysphagia is one of the common symptoms that are encountered in clinical practice. However, dysphagia is still crucial and must be thoroughly investigated because it may be a key symptom of several malignancies. There are two types of dysphagia, oropharyngeal and esophageal dysphagia. Esophageal dysphagia can be caused by esophageal neuromuscular motility disorder, various inflammatory disorders, and also extrinsic or intrinsic structural lesions such as esophageal cancer. This article focuses on malignant esophageal dysphagia, including its causes, risk factors, clinical symptoms, and management.
Subject(s)
Humans , Deglutition Disorders , Esophageal Neoplasms , Gastrointestinal Neoplasms , Risk FactorsABSTRACT
Objective@#To investigate the associations between various blood test parameters including MLR (monocyte-lymphocyte ratio) and prognosis in post-operative esophagogastric junction cancer patients.@*Methods@#We retrospectively studied the preoperative and postoperative data of 309 patients who underwent radical surgery for esophagogastric junction cancer. The relationship between MLR, neutrophil lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and overall survival (OS) was analyzed.@*Results@#The cutoff values of MLR、NLR and PLR were 0.201, 1.697 and 96.960, respectively. The median OS was 51.4 months for all the patients in the study group (n=309). MLR in patients with esophagogastric junction carcinoma was associated with gender, depth of invasion, histological grade, TNM stage, NLR and PLR (P<0.05). PLR was associated with tumor size, TNM stage, NLR and MLR (P<0.05). NLR was associated with gender, tumor size, TNM stage, PLR and MLR (both P<0.05). Univariate analysis showed that tumor size, depth of tumor invasion, metastasis of lymph nodes, pathological grading, nerve infiltration, lymphovascular invasion, TNM staging, PLR and MLR were associated with the median overall survival time (P<0.05). Multivariate analysis showed that TNM stage, nerve infiltration and MLR were independent prognostic predictors for patients with esophagogastric junction cancer (P<0.05), but not PLR or NLR. Setting the optimal cut-off value of the MLR in 0.201, the area under the curve was 0.603, significantly larger than that of PLR and NLR (P<0.05).@*Conclusions@#Preoperative MLR is a very useful predictor of patients with esophagogastric junction cancer who underwent radical rescetion. Preoperative MLR> 0.201 is an independent risk factor for postoperative survival in patients with esophagogastric cancer, and PLR> 96.960 may predict a poor prognosis risk.