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Int J Clin Oncol. 2017 Dec;22(6):1042-1049. doi: 10.1007/s10147-017-1154-6. Epub 2017 Jul 17.

Esophageal stenosis and the Glasgow Prognostic Score as independent factors of poor prognosis for patients with locally advanced unresectable esophageal cancer treated with chemoradiotherapy (exploratory analysis of JCOG0303).

Author information

1
Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, 7-5-1 Kusunoki Chuo, Kobe, 650-0017, Japan. t-okuno@pg7.so-net.ne.jp.
2
Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center, Tokyo, Japan.
3
Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan.
4
Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
5
Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
6
Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
7
Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan.
8
Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
9
Department of Surgery, Iwate Medical University School of Medicine, Morioka, Japan.
10
Tokyo Medical and Dental University, Tokyo, Japan.
11
Department of Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan.
12
Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
13
Department of Radiology, Koshigaya Municipal Hospital, Koshigaya, Saitama, Japan.
14
Department of Surgery, International Goodwill Hospital, Yokohama, Japan.
15
Department of Surgery, Keio University, School of Medicine, Tokyo, Japan.

Abstract

BACKGROUND:

The aim of this study was to investigate the possible prognostic factors and predictive accuracy of the Glasgow Prognostic Score (GPS) for patients with unresectable locally advanced esophageal squamous cell carcinoma (LAESCC) treated with chemoradiotherapy.

METHODS:

One hundred forty-two patients were enrolled in JCOG0303 and assigned to the standard cisplatin and 5-fluorouracil (PF)-radiotherapy (RT) group or the low-dose PF-RT group. One hundred thirty-one patients with sufficient data were included in this analysis. A Cox regression model was used to analyze the prognostic factors of patients with unresectable LAESCC treated with PF-RT. The GPS was classified based on the baseline C-reactive protein (CRP) and serum albumin levels. Patients with CRP ≤1.0 mg/dL and albumin ≥3.5 g/dL were classified as GPS0. If only CRP was increased or only albumin was decreased, the patients were classified as GPS1, and the patients with CRP >1.0 mg/dL and albumin <3.5 g/dL were classified as GPS2.

RESULTS:

The patients' backgrounds were as follows: median age (range), 62 (37-75); male/female, 119/12; ECOG PS 0/1/2, 64/65/2; and clinical stage (UICC 5th) IIB/III/IVA/IVB, 3/75/22/31. Multivariable analyses indicated only esophageal stenosis as a common factor for poor prognosis. In addition, overall survival tended to decrease according to the GPS subgroups (median survival time (months): GPS0/GPS1/GPS2 16.1/14.9/8.7).

CONCLUSIONS:

Esophageal stenosis was identified as a candidate stratification factor for randomized trials of unresectable LAESCC patients. Furthermore, GPS represents a prognostic factor for LAESCC patients treated with chemoradiotherapy.

CLINICAL TRIAL INFORMATION:

UMIN000000861.

KEYWORDS:

Chemoradiotherapy; Esophageal stenosis; Glasgow Prognostic Score; Prognostic factor; T4 esophageal cancer

PMID:
28717855
PMCID:
PMC5676839
DOI:
10.1007/s10147-017-1154-6
[Indexed for MEDLINE]
Free PMC Article

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