ABSTRACT
AIMS: A study was undertaken to investigate the value of pretreatment PET-CT in predicting survival in patients with oesophageal cancer (OC). METHODS: Between June 2010 and December 2011, 18 consecutive OC patients median (61.00 ± 12.07 years) with median survival of 7.5 month had a pretreatment PET-CT scan. Staging of the disease was made in accordance to the American Joint Committee on Cancer staging system (7th edition) and grouped as stage I-IIA and stage IIB-IV. Maximum standardized uptake value (SUVmax), size of a primary tumour and the presence of fluorodeoxyglucose (FDG)-avid lymph nodes were evaluated for all patients. Survival was analysed using the Kaplan-Meier product limit method and Cox proportional hazards regression model. RESULTS: PET-CT stages I-IIA and IIB-IV had a 1-year survival of 50% and 25%, respectively. Patient with size of primary tumour (<4.5 cm) had significantly (p < 0.036) better survival than those with large size (>4.5 cm). Multivariate Cox regression analysis showed that SUVmax of >5.5 in the primary tumour [hazard ratio (HR) 23.017; 95% confidence interval, p = 0.038] and the presence of FDG-avid lymph node (HR 1.248; p = 0.028) were strongly predictive of poor overall survival on multivariate analysis. CONCLUSION: Pretreatment 18F-FDG PET-CT SUVmax of a primary tumour and the presence of FDG-avid lymph nodes independently predict survival in patients with oesophageal carcinoma which may potentially be used as surrogate markers for prognostic and therapeutic purposes.
Subject(s)
Esophageal Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Kaplan-Meier Estimate , Positron-Emission Tomography , Tomography, X-Ray Computed , Esophageal Neoplasms/pathology , Esophagus/diagnostic imaging , Esophagus/pathology , Female , Humans , Male , Middle Aged , Multimodal Imaging , Neoplasm Staging , Predictive Value of Tests , Proportional Hazards Models , Radiopharmaceuticals , Reproducibility of Results , Survival AnalysisABSTRACT
BACKGROUND: Stomach and esophageal cancers are both deadly and difficult to diagnose early. Stomach cancer is the second most common cancer in Asia. Both these are one of the most common causes of cancer related death in the world. AIM: To determine the mean time delay from appearance of the symptoms to the endoscope procedure [OGDS] and rationalized the reason for this delay in diagnosis. METHOD: This is a cross sectional study of stomach and esophageal cancer data from Jan 2004- July 2008. All patients' records of histologically confirmed stomach or esophageal cancers during the study period were reviewed. RESULT: Total of 112 consecutive patients with stomach and esophageal cancer were analysed. 86 cases of stomach and 26 cases of esophageal cancer were reviewed. The average age for stomach and esophageal cancers are 60.8 years and 58.4 years respectively. The mean duration from the first appearance of cancer symptoms to endoscope procedure was 32.4 weeks for stomach cancer patient and 16.7 weeks for esophageal cancer patients. The reasons for the delays are due to 1) self-medication, 2) Empirical treatment for dyspepsia using antacid and H2 antagonist, 3) Delay in endoscope procedure for high risk patients. CONCLUSION: Reducing the delay in endoscope procedure may lead to early detection of cancer and thereby may improve the prognosis of these patients.
Subject(s)
Early Detection of Cancer , Esophageal Neoplasms , Cross-Sectional Studies , Humans , Prognosis , Stomach NeoplasmsABSTRACT
This is a case report of an elderly male, who presented with duodenal obstruction caused by abdominal aortic aneurysm. An axillo-bifemoral shunting with an infra renal straight inlay graft together with a feeding jejunostomy was performed. This is rare presentation with only a few cases reported.
