LYMPHOPARIETAL INDEX IN ESOPHAGEAL CANCER IS STRONGER THAN TNM STAGING IN LONG-TERM SURVIVAL PROGNOSIS IN A LATIN-AMERICAN COUNTRY

FIGUEROA-GIRALT, Manuel; VALENZUELA, Catalina; TORREALBA, Andrés; CSENDES, Attila; BRAGHETTO, Italo; LANZARINI, Enrique; MUSLEH, Maher; KORN, Owen; VALLADARES, Hector; CORTÉS, Solange

doi:10.1590/0102-672020200003e1547

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ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo)

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Original Article • ABCD, arq. bras. cir. dig. 33 (03) • 2020 • https://doi.org/10.1590/0102-672020200003e1547 copy

LYMPHOPARIETAL INDEX IN ESOPHAGEAL CANCER IS STRONGER THAN TNM STAGING IN LONG-TERM SURVIVAL PROGNOSIS IN A LATIN-AMERICAN COUNTRY

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background:

The identification of prognostic factors of esophageal cancer has allowed to predict the evolution of patients.

Aim:

Assess different prognostic factors of long-term survival of esophageal cancer and evaluate a new prognostic factor of long-term survival called lymphoparietal index (N+/T).

Method:

Prospective study of the Universidad de Chile Clinical Hospital, between January 2004 and December 2013. Included all esophageal cancer surgeries with curative intent and cervical anastomosis. Exclusion criteria included: stage 4 cancers, R1 resections, palliative procedures and emergency surgeries.

Results:

Fifty-eight patients were included, 62.1% were men, the average age was 63.3 years. A total of 48.3% were squamous, 88% were advanced cancers, the average lymph node harvest was 17.1. Post-operative surgical morbidity was 75%, with a 17.2% of reoperations and 3.4% of mortality. The average overall survival was 41.3 months, the 3-year survival was 31%. Multivariate analysis of the prognostic factors showed that significant variables were anterior mediastinal ascent (p=0.01, OR: 6.7 [1.43-31.6]), anastomotic fistula (p=0.03, OR: 0.21 [0.05-0.87]), N classification (p=0.02, OR: 3.8 [1.16-12.73]), TNM stage (p=0.04, OR: 2.8 [1.01-9.26]), and lymphoparietal index (p=0.04, RR: 3.9 [1.01-15.17]. The ROC curves of lymphoparietal index, N classification and TNM stage have areas under the curve of 0.71, 0.63 and 0.64 respectively, with significant statistical difference (p=0.01).

Conclusion:

The independent prognostic factors of long-term survival in esophageal cancer are anterior mediastinal ascent, anastomotic fistula, N classification, TNM stage and lymphoparietal index. In esophageal cancer the new lymphoparietal index is stronger than TNM stage in long-term survival prognosis.

HEADINGS:
Esophageal neoplasms; Survival; Prognosis

Variável	OS< 3		OS >3		Univariable analysis
Variável	n=37	%	n=18	%	p	OR	CI 95%
Gender
Male	26	70.3%	8	44.4%	0.08
Female	11	29.7%	10	55.6%	0.08
Age	63.5		61.7		0.17
ASA
I	22	59.5%	7	38.9%	0.07
II-III	15	40.5%	11	0.0%	0.07
Comorbidities
Hypertension	19	51.4%	5	27.8%	0.14
Diabetes	7	18.9%	1	5.6%	0.25
COPD	4	10.8%	0	0.0%	0.29
Tabacco	19	51.4%	8	44.4%	0.7
BMI (kg/mt2)
<25	15	40.5%	7	38.9%	0.99
>25	22	59.5%	11	61.1%	0.99
Esophageal disease
GERD	13	35.1%	11	61.1%	0.08
BARRETT	8	21.6%	7	38.9%	0.21
HH	6	16.2%	1	5.6%	0.41
Symptoms and signs
Disphagia	30	81.1%	15	83.3%	>0.99
Weight loss	22	59.5%	6	33.3%	0.08
Pain	9	24.3%	3	16.7%	0.72
Laboratory
HTO <35%	8	21.6%	1	5.6%	0.24
Alb <3.5mg/dl	2	5.4%	2	11.1%	0.59
Localization
Middle	11	29.7%	8	44.4%	0.37
Distal	26	70.3%	10	55.6%	0.37
Pull-up
AP	20	54.1%	14	77.8%	0.04	2.02	0.002-0.48
PP	17	45.9%	4	22.2%	0.04	2.02	0.002-0.48
Esophageal fistula
Yes	29	78.4%	8	44.4%	0.016	1.76	1.11-3.25
No	8	21.6%	10	55.6%	0.016	1.76	1.11-3.25
Mediastinal abscess
Yes	7	18.9%	3	16.7%	>0.99
No	30	81.1%	15	83.3%	>0.99
Pleural effusion
Yes	2	5.4%	2	11.1%	0.59
No	35	94.6%	16	88.9%	0.59
Pneumonia
Yes	8	21.6%	1	5.6%	0.24
No	29	78.4%	17	94.4%	0.24
Arrythmia
Yes	5	13.5%	2	11.1%	>0.99
No	32	86.5%	15	83.3%	>0.99
Histology
EC	18	48.6%	8	44.4%	>0.99
ADN	19	51.4%	10	50.0%	>0.99
Tumor grade
Well	9	24.3%	6	33.3%	0.02	0.6	0.35-0.89
Moderate	18	48.6%	12	66.7%
Bad	10	27.0%	0	0.0%
TNM
Tis	0	0.0%	1	5.6%	0.06
T1a	0	0.0%	1	5.6%
T1b	2	5.4%	2	11.1%
T2	9	24.3%	5	27.8%
T3	26	70.3%	7	38.9%
N0	8	21.6%	11	61.1%	0.01	0.54	0.29-0.86
N1	11	29.7%	4	22.2%
N2	10	27.0%	4	22.2%
N3	7	18.9%	0	0.0%
Stage
0	0	0.0%	1	5.6%	0.023	0.00	0.00-0.87
IB	0	0.0%	2	11.1%
IIA	4	10.8%	7	38.9%
IIB	5	13.5%	1	5.6%
IIIA	4	10.8%	1	5.6%
IIIB	9	24.3%	6	33.3%
IVA	7	18.9%	0	0.0%
Lymphoraietal index
A (0-0.5)	13	35.1%	13	72.2%	0.02	0.6	0.37-0.88
B (>0.5)	24	64.9%	5	27.8%	0.02	0.6	0.37-0.88

Variable	Multivariable analysis
Variable	p	OR	CI 95%
Gender	0.03	3.9	1.10-14.14
Pull-up	0.01	6.7	1.43-31.60
Fistula	0.03	0.2	0.05-0.87
N	0.02	3.8	1.16-12.73
TNM stage	0.04	2.8	1.01-9.26
Lymphoparietal index	0.04	3.9	1.01-15.17

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E-mail: revistaabcd@gmail.com

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[1] Correspondence: Manuel Figueroa-Giralt E-mail: manuelfigueroa.gi@gmail.com