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Masao Hosokawa - One of the best experts on this subject based on the ideXlab platform.
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Prognostic factors in clinical T1N0M0 thoracic esophageal squamous cell carcinoma invading the Muscularis Mucosa or subMucosa.
Radiation oncology (London England), 2016Co-Authors: Yusuke Uchinami, M. Myojin, Hiroaki Takahashi, K. Harada, Shinichi Shimizu, Masao HosokawaAbstract:Multimodality treatment is widely performed for clinical T1N0M0 (UICC-TNM classification, 7th edition) thoracic esophageal squamous cell carcinoma (ESCC), but available articles regarding treatment results are limited. This study assessed the outcomes of clinical T1N0M0 thoracic ESCC invading the Muscularis Mucosa (MM) or subMucosa (SM) treated with radiotherapy (RT) or chemoradiotherapy (CRT). We retrospectively reviewed the medical charts of 90 patients with clinical T1N0M0 thoracic ESCC treated with RT or CRT in our hospital in 2004–2011. Of these 90 patients, we analyzed the cases of 71 patients who met our inclusion criteria. All 71 patients had MM or SM cancer. In the 47 patients treated with CRT, the chemotherapy regimen of 5-fluorouracil (5-FU) plus cisplatin (CDDP) was used for 46 patients and 5-FU and nedaplatin was used for one patient. Forty-five patients underwent endoscopic resection (ER) followed by RT or CRT as an additional treatment. Elective nodal irradiation (ENI) was used in 39 patients. For all analyses, statistical significance was defined as 0.05, and the Bonferroni correction was used for the multivariate analysis. The median age was 70 years (range 47–84). With a median follow-up of 43.6 months (range 1.5–124.2), the 5-year overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) rates were 64.0, 72.8 and 50.0 %, respectively. The multivariate analysis showed that performance status (PS) was an independent prognostic factors for DSS and DFS (DSS, p
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prognostic factors in clinical t1n0m0 thoracic esophageal squamous cell carcinoma invading the Muscularis Mucosa or subMucosa
Radiation Oncology, 2016Co-Authors: Yusuke Uchinami, M. Myojin, Hiroaki Takahashi, K. Harada, Shinichi Shimizu, Masao HosokawaAbstract:Multimodality treatment is widely performed for clinical T1N0M0 (UICC-TNM classification, 7th edition) thoracic esophageal squamous cell carcinoma (ESCC), but available articles regarding treatment results are limited. This study assessed the outcomes of clinical T1N0M0 thoracic ESCC invading the Muscularis Mucosa (MM) or subMucosa (SM) treated with radiotherapy (RT) or chemoradiotherapy (CRT). We retrospectively reviewed the medical charts of 90 patients with clinical T1N0M0 thoracic ESCC treated with RT or CRT in our hospital in 2004–2011. Of these 90 patients, we analyzed the cases of 71 patients who met our inclusion criteria. All 71 patients had MM or SM cancer. In the 47 patients treated with CRT, the chemotherapy regimen of 5-fluorouracil (5-FU) plus cisplatin (CDDP) was used for 46 patients and 5-FU and nedaplatin was used for one patient. Forty-five patients underwent endoscopic resection (ER) followed by RT or CRT as an additional treatment. Elective nodal irradiation (ENI) was used in 39 patients. For all analyses, statistical significance was defined as 0.05, and the Bonferroni correction was used for the multivariate analysis. The median age was 70 years (range 47–84). With a median follow-up of 43.6 months (range 1.5–124.2), the 5-year overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) rates were 64.0, 72.8 and 50.0 %, respectively. The multivariate analysis showed that performance status (PS) was an independent prognostic factors for DSS and DFS (DSS, p < 0.001; DFS, p < 0.001). Chemotherapy in addition to RT showed a trend for better DSS (p = 0.032) but was not significant following Bonferroni correction. ER and ENI were not significant predictive factors for DSS and DFS. PS was an independent prognostic factor for DSS and DFS. ER and ENI had no significant relationship with DSS or DFS. The present results may be helpful in treatment decisions for clinical T1N0M0 thoracic ESCC.
Yusuke Uchinami - One of the best experts on this subject based on the ideXlab platform.
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Prognostic factors in clinical T1N0M0 thoracic esophageal squamous cell carcinoma invading the Muscularis Mucosa or subMucosa.
Radiation oncology (London England), 2016Co-Authors: Yusuke Uchinami, M. Myojin, Hiroaki Takahashi, K. Harada, Shinichi Shimizu, Masao HosokawaAbstract:Multimodality treatment is widely performed for clinical T1N0M0 (UICC-TNM classification, 7th edition) thoracic esophageal squamous cell carcinoma (ESCC), but available articles regarding treatment results are limited. This study assessed the outcomes of clinical T1N0M0 thoracic ESCC invading the Muscularis Mucosa (MM) or subMucosa (SM) treated with radiotherapy (RT) or chemoradiotherapy (CRT). We retrospectively reviewed the medical charts of 90 patients with clinical T1N0M0 thoracic ESCC treated with RT or CRT in our hospital in 2004–2011. Of these 90 patients, we analyzed the cases of 71 patients who met our inclusion criteria. All 71 patients had MM or SM cancer. In the 47 patients treated with CRT, the chemotherapy regimen of 5-fluorouracil (5-FU) plus cisplatin (CDDP) was used for 46 patients and 5-FU and nedaplatin was used for one patient. Forty-five patients underwent endoscopic resection (ER) followed by RT or CRT as an additional treatment. Elective nodal irradiation (ENI) was used in 39 patients. For all analyses, statistical significance was defined as 0.05, and the Bonferroni correction was used for the multivariate analysis. The median age was 70 years (range 47–84). With a median follow-up of 43.6 months (range 1.5–124.2), the 5-year overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) rates were 64.0, 72.8 and 50.0 %, respectively. The multivariate analysis showed that performance status (PS) was an independent prognostic factors for DSS and DFS (DSS, p
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prognostic factors in clinical t1n0m0 thoracic esophageal squamous cell carcinoma invading the Muscularis Mucosa or subMucosa
Radiation Oncology, 2016Co-Authors: Yusuke Uchinami, M. Myojin, Hiroaki Takahashi, K. Harada, Shinichi Shimizu, Masao HosokawaAbstract:Multimodality treatment is widely performed for clinical T1N0M0 (UICC-TNM classification, 7th edition) thoracic esophageal squamous cell carcinoma (ESCC), but available articles regarding treatment results are limited. This study assessed the outcomes of clinical T1N0M0 thoracic ESCC invading the Muscularis Mucosa (MM) or subMucosa (SM) treated with radiotherapy (RT) or chemoradiotherapy (CRT). We retrospectively reviewed the medical charts of 90 patients with clinical T1N0M0 thoracic ESCC treated with RT or CRT in our hospital in 2004–2011. Of these 90 patients, we analyzed the cases of 71 patients who met our inclusion criteria. All 71 patients had MM or SM cancer. In the 47 patients treated with CRT, the chemotherapy regimen of 5-fluorouracil (5-FU) plus cisplatin (CDDP) was used for 46 patients and 5-FU and nedaplatin was used for one patient. Forty-five patients underwent endoscopic resection (ER) followed by RT or CRT as an additional treatment. Elective nodal irradiation (ENI) was used in 39 patients. For all analyses, statistical significance was defined as 0.05, and the Bonferroni correction was used for the multivariate analysis. The median age was 70 years (range 47–84). With a median follow-up of 43.6 months (range 1.5–124.2), the 5-year overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS) rates were 64.0, 72.8 and 50.0 %, respectively. The multivariate analysis showed that performance status (PS) was an independent prognostic factors for DSS and DFS (DSS, p < 0.001; DFS, p < 0.001). Chemotherapy in addition to RT showed a trend for better DSS (p = 0.032) but was not significant following Bonferroni correction. ER and ENI were not significant predictive factors for DSS and DFS. PS was an independent prognostic factor for DSS and DFS. ER and ENI had no significant relationship with DSS or DFS. The present results may be helpful in treatment decisions for clinical T1N0M0 thoracic ESCC.
Hyun Jik Lee - One of the best experts on this subject based on the ideXlab platform.
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A proposal for the management guideline of superficial esophageal squamous cell carcinoma: After endoscopic resection.
Journal of Clinical Oncology, 2016Co-Authors: Yong Chan Lee, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Hyun Jik LeeAbstract:145 Background: We tried to analyze and deduce a treatment guideline after endoscopic resection of superficial esophageal squamous cell carcinoma in a retrospective analysis. Methods: Medical records of 37 patients who had been treated by endoscopic resection during a 6-year period in single institution were retrospectively analyzed. Results: Mean tumor size was 11.5±5.5 mm (range 3-31). Thirty-one lesions (83.8%) were treated by endoscopic subMucosal dissection and 6 lesions by endoscopic Mucosal resection (16.2%). En bloc resection rate and complete resection rate was 91.9% and 81.8%, respectively. The tumor invasion depth was diagnosed as epithelium: 5(13.5%), lamina propria Mucosa: 12 (32.4%), Muscularis Mucosa: 10 (27.0%), subMucosa: 10 (27.0%) respectively. The lymphovascular invasion was 3 lesions (8.1%). The rates of adverse events were 13.5% including 3 cases (8.1%) of perforation. Ten patients of the invasion depth as Muscularis Mucosa and subMucosa received additional treatments including 6 pat...
Y. Kameda - One of the best experts on this subject based on the ideXlab platform.
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clinical outcome of endoscopic Mucosal resection for esophageal squamous cell cancer invading Muscularis Mucosa and subMucosal layer
Diseases of The Esophagus, 2013Co-Authors: T. Yoshii, S. Ohkawa, S. Tamai, Y. KamedaAbstract:SUMMARY When a tumor invades the Muscularis Mucosa and subMucosal layer (T1a-MM and T1b in Japan), esophageal squamous cell cancer poses 10–50% risk of lymph node metastasis. By this stage of esophageal cancer, surgery, although very invasive, is the standard radical therapy for the patients. Endoscopic Mucosal resection (EMR) is the absolutely curable treatment for cancer in the superficial Mucosal layer. Because of its minimal invasiveness, the indications of EMR may be expanded to include the treatment of T1a-MM and T1b esophageal carcinoma. To date, the clinical outcomes of EMR for T1a-MM and T1b patients have not been fully elucidated. Here, the retrospective analysis of the clinical outcomes is reported. Between January 1994 and December 2007, 247 patients underwent EMR at Kanagawa Cancer Center. Of these individuals, 44 patients with 44 lesions fulfilled the following criteria: (i) extended EMR treatment for clinical T1a-MM and T1b tumor; (ii) diagnosis of clinical N0M0; and (iii) follow up for at least 1 year, and negative vertical margin. These patients were reviewed for their clinical features and outcomes. Statistical analyses were performed by the Kaplan–Meier methods, the Chi-square test, and the Cox proportional hazard model. P-value of <0.05 was considered statistically significant. The data were analyzed in February 2009. Based on the informed consent and their general health conditions, 44 patients decided the following treatments immediately after the EMR: 2 underwent surgery, 1 underwent adjuvant chemotherapy, and 41 selected follow up without any additional therapy. Of the 41 patients, 20 selected this course by choice, 12 because of severe concurrent diseases, 2 because of poor performance status, and 7 because of other multiple primary cancers. Twelve patients died; two were cause specific (4.5%), eight from multiple primary cancers, one from severe concurrent diseases, and one from unknown causes. No critical complications were noted. Median follow-up time was 51 months (12–126). Five patients ultimately developed lymph node metastasis. One patient with adjuvant chemotherapy required surgery, and another was treated with chemotherapy whose subsequent death was cause specific. The other three patients received chemoradiotherapy and have not shown cause-specific death. Overall and cause-specific survival rates at 5 years were 67.3% and 91.8%, respectively. Among 41 patients treated by EMR alone, only one died from primary esophageal cancer (2.4%), and overall and cause-specific survival rates at 5 years were 75.6% and 97.6%, respectively. Multivariate analysis revealed that severe concurrent diseases including multiple primary cancers and the administration of 5-fluorouracil-based chemotherapy for multiple primary cancers significantly influenced survival (P= 0.025, hazard ratio [HR] 13.1 [95% confidence interval 1.5–114]) and (P= 0.037, HR 0.213 [95% confidence interval 0.05–0.914]), respectively. Eight and six patients developed metachronous esophageal squamous cell cancer and local recurrence, respectively. With the exception of one patient, they could be retreated endoscopically. EMR is a reasonable option for the patients with T1a-MM and T1b esophageal carcinoma without clinical metastasis, especially for the individuals with severe concurrent diseases. The prognostic factors for the benefit of EMR in such cases should be further examined.
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Clinical outcome of endoscopic Mucosal resection for esophageal squamous cell cancer invading Muscularis Mucosa and subMucosal layer.
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, 2012Co-Authors: T. Yoshii, S. Ohkawa, S. Tamai, Y. KamedaAbstract:SUMMARY When a tumor invades the Muscularis Mucosa and subMucosal layer (T1a-MM and T1b in Japan), esophageal squamous cell cancer poses 10–50% risk of lymph node metastasis. By this stage of esophageal cancer, surgery, although very invasive, is the standard radical therapy for the patients. Endoscopic Mucosal resection (EMR) is the absolutely curable treatment for cancer in the superficial Mucosal layer. Because of its minimal invasiveness, the indications of EMR may be expanded to include the treatment of T1a-MM and T1b esophageal carcinoma. To date, the clinical outcomes of EMR for T1a-MM and T1b patients have not been fully elucidated. Here, the retrospective analysis of the clinical outcomes is reported. Between January 1994 and December 2007, 247 patients underwent EMR at Kanagawa Cancer Center. Of these individuals, 44 patients with 44 lesions fulfilled the following criteria: (i) extended EMR treatment for clinical T1a-MM and T1b tumor; (ii) diagnosis of clinical N0M0; and (iii) follow up for at least 1 year, and negative vertical margin. These patients were reviewed for their clinical features and outcomes. Statistical analyses were performed by the Kaplan–Meier methods, the Chi-square test, and the Cox proportional hazard model. P-value of
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Clinical outcome of endoscopic Mucosal resection (EMR) in clinical stage I (cSt I ) esophageal cancer
Journal of Clinical Oncology, 2009Co-Authors: T. Yoshii, S. Tamai, Norio Aoyama, Junji Minamide, Seiichi Takagi, Osamu Motohashi, Norisuke Nakayama, Ken Nishimura, K. Takata, Y. KamedaAbstract:e15569 Background: When a tumor invades to the Muscularis Mucosa or subMucosal layer (T1a-MM or T1b, in Japan), cSt I esophageal cancer(EC) has 10–50%. risk of lymph node metastasis (LNM). Surgery,...
Manuel Sanchez-chapado - One of the best experts on this subject based on the ideXlab platform.
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Muscularis Mucosa differentiates two populations with different prognosis in Stage T1 bladder cancer
Urology, 1995Co-Authors: Javier C. Angulo, José I. López, David J. Grignon, Manuel Sanchez-chapadoAbstract:Abstract Objectives. Contrary to previous belief, the existence of a Muscularis Mucosa in the human urinary bladder has now been well described. Although the degree of development of this structure seems variable, it can frequently be used to differentiate two levels within the subepithelial connective tissue: the lamina propria and the subMucosa. The present study evaluates whether this morphologic feature is potentially useful for the identification of two populations with Stage T1 bladder cancer: those with tumor invasion confined to the lamina propria (pT1A) and those with tumors infiltrating into the subMucosa (pT1B). Methods. A series of 170 Stage T1 papillary bladder tumors was analyzed pathologically to identify the level of subepithelial connective tissue invasion. Both the reproducibility of such a differentiation and its prognostic implication were evaluated using Kaplan-Meier survival estimates and the Cox regression model. Results. In specimens from transurethral resection, categorization into T1A or T1B could be performed in 98 of 170 cases (58% of specimens). Such differentiation proved to be of prognostic value with significantly different 5-year survivals between the two subcategories (pT1A [n = 50] vs pT1B [n = 49]) (log-rank, P Conclusions. The depth of tumor infiltration can be assessed in a considerable proportion of Stage T1 bladder neoplasms. The present study validates the prognostic significance of such a distinction both by Mantel-Haenszel life table method and Cox's regression analysis.
