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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2020; 12(9): 377-389
Published online Sep 27, 2020. doi: 10.4240/wjgs.v12.i9.377
Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy
Sungjin Kim, Timothy P DiPeri, Michelle Guan, Veronica R Placencio-Hickok, Haesoo Kim, Jar-Yee Liu, Andrew Hendifar, Samuel J Klempner, Ryan Nipp, Alexandra Gangi, Miguel Burch, Kevin Waters, May Cho, Joseph Chao, Katelyn Atkins, Mitchell Kamrava, Richard Tuli, Jun Gong
Sungjin Kim, Biostatistics and Bioinformatics Research Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Timothy P DiPeri, Alexandra Gangi, Miguel Burch, Division of Surgical Oncology, Department of Surgery, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
Michelle Guan, Veronica R Placencio-Hickok, Haesoo Kim, Jar-Yee Liu, Andrew Hendifar, Jun Gong, Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
Samuel J Klempner, Ryan Nipp, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114, United States
Kevin Waters, Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
May Cho, Division of Hematology and Oncology, Department of Medicine, University of California, Davis, Sacramento, CA 95817, United States
Joseph Chao, Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, United States
Katelyn Atkins, Mitchell Kamrava, Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA 90048, United States
Richard Tuli, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States
Author contributions: Kim S and Gong J designed the research; Kim S, Guan M, Placencio-Hickok VR, Kim H, Liu JY, and Gong J collected and analyzed the data; Kim S, DiPeri TP, and Gong J wrote the paper; all authors edited and approved the final paper.
Institutional review board statement: The data used in the study are derived from a de-identified National Cancer Database file. As all patient identification variables have been removed, no institutional review board (IRB) review was needed.
Informed consent statement: The data used in the study are derived from a de-identified National Cancer Database file. As all subject identification variables have been removed, no informed consent was needed.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jun Gong, MD, Assistant Professor, Department of Medicine, Division of Hematology and Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, 8700 Beverly Blvd, AC 1042B, Los Angeles, CA 90048, United States. jun.gong@cshs.org
Received: June 3, 2020
Peer-review started: June 3, 2020
First decision: June 15, 2020
Revised: July 2, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: September 27, 2020
Processing time: 114 Days and 9.2 Hours
ARTICLE HIGHLIGHTS
Research background
Palliative chemotherapy has been associated with improved overall survival (OS) in metastatic esophageal cancer, but the role of other palliative therapies in this population is poorly understood.
Research motivation
Palliative therapies in patients with metastatic esophageal cancer who do not receive chemotherapy, defined as surgery, radiation therapy (RT), and/or other pain management therapy provided to prolong the patient's life by controlling symptoms, to alleviate pain, or to make the patient comfortable may offer an improvement in OS as well.
Research objectives
The objectives of this study were to investigate the patient and disease characteristics associated with receipt of other palliative therapies in metastatic esophageal cancer patients not receiving palliative chemotherapy. We also investigated the association of receiving other palliative therapies vs not receiving other palliative therapies with OS in these patients who did not receive chemotherapy.
Research methods
The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who did not receive chemotherapy but had been confirmed to receive other palliative therapies or not were included. Cases with unknown chemotherapy, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Cox proportional hazards regression models were employed to examine factors influencing survival.
Research results
Out of 1493 patients who did not receive chemotherapy and had complete data, the majority (72.7%) did not receive other palliative therapies. There was no statistically significant difference in OS between those receiving other palliative therapies vs no palliative therapy. Several factors including treatment at an academic center, female sex, non-black, other race (compared to white race) were associated with improved OS, while South geographic region relative to West region and higher Charlson Comorbidity Index, histologic grade, and T-stage were associated with worse OS.
Research conclusions
Palliative therapies other than chemotherapy conferred a numerically higher, but not statistically significant difference in OS among patients with metastatic esophageal cancer not receiving chemotherapy. Several socioeconomic and clinicopathologic factors were predictive of OS and receipt of other palliative therapies in these patients who did not receive chemotherapy
Research perspectives
Additional research is needed to prospectively study the impact of other palliative therapies on patient outcomes that OS may not capture in metastatic esophageal cancer. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative therapies other than chemotherapy in metastatic esophageal cancer and future studies are warranted.
