374. ENDOSCOPIC SUBMUCOSAL DISSECTION AND ADJUVANT THERAPY FOR HIGHER STAGE ESOPHAGEAL CANCER: READY FOR PRIME TIME?
Notice bibliographique
Résumé
Abstract Background Endoscopic submucosal dissection (ESD) is acceptable for pT1a esophageal cancers. Esophagectomy is standard-of-care for higher stages, even if negative margin is achieved with endoscopic resection. This is due to risks of occult nodal disease that would otherwise go undetected and untreated. Some patients are ineligible for esophagectomy (due to prohibitive medical comorbidities) or decline it. In these patients, multi-disciplinary tumor conferences struggle to understand the optimal treatment. We aimed to assess treatment patterns and outcomes for patients undergoing ESD for ≥pT1b cancers who were ineligible for or declined esophagectomy. Methods Retrospective cohort study was performed using prospectively-collected data. Patient population included all consecutive patients who underwent ESD at a tertiary hospital with pT1b or higher disease (declined or ineligible for esophagectomy). Complications and survival outcomes are reported. Univariable analysis was performed. For comparative analysis, patients who underwent esophagectomy were identified with no neoadjuvant therapy and who had pT1b or higher disease with proven pN0. Propensity-score matching (optimal matching, without replacement) was used to compare short and long-term outcomes of matched (2:1) patients undergoing ESD and esophagectomy. Perfect matching on pT-stage was mandated. Survival analysis was performed on the matched groups. Results Fifty-three ESD patients met inclusion criteria. Mean age was 74.8 (SD = 9.4) and 81.1% male. Majority were adenocarcinoma while 15.1% were squamous cell cancers. Chemoradiation was received by 24.5% (n = 13) of patients whereas 13.2% (n = 7) received adjuvant radiation alone. Most prevalent stages were pT1bSM2 (41.5%, n = 22) and pT1bSM3 (26.4%, n = 14). Incidence of positive margins (mostly focal deep positive margin) ranged from 0 in pT1bSM1 to 70–100% in pT2/pT3. Incidence of complications was 15.1% (n = 8); most requiring endoscopic dilatation. Twenty-five esophagectomy patients (no neoadjuvant) were compared to ESD population. Two-year and five-year progression-free/overall survival were not different in propensity-matched analyses (p > 0.10). Conclusion Organ-preserving treatment with ESD and adjuvant chemoradiation/radiation is feasible and has minimal complications, with comparable survival to esophagectomy in patients with higher stage (>pT1b) esophageal cancers. This was in patients who were ineligible for or declined esophagectomy; furthermore, there is higher likelihood of undiagnosed/occult nodal disease in the ESD group as the esophagectomy group was proven to be pN0. Thus, these analyses are highly biased towards worse outcomes for the ESD group. Larger comparative trials incorporating patient-reported outcomes and quality-of-life are required. Translational work to identify better biomarkers to select patients for adjuvant therapies is needed.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».