Improving the quality of pretreatment staging in patients with esophageal carcinoma – a fast track study

Figures & data

Figure 1. Fast track staging strategy of esophageal carcinoma.

Table I. Patient characteristics.

	Number of patients (n = 111)
Median age (range)	63 (41–84) years
Male : Female	79 : 32
Location tumor (%)
Proximal esophagus	12 (11%)
Mid esophagus	23 (21%)
Distal esophagus	49 (44%)
Junction	12 (11%)
Cardia	15 (13%)
Histology (%)
Adenocarcinoma	71 (64%)
Squamous cell carcinoma	40 (36%)

Table II. Type and number of additional tests required after CT, EUS and US. Result of tests and median time interval from the fifth day until result of test is described.

	Total No.	Diagnostic yield T4 or M1		Diagnostic yield not T4 or M1
Additional diagnostic test after 5 days in 44 patients	Total No.	No.	Median time until test (range)	No.	Median time until test (range)
EUS with FNA	12	4	17 days (10–39)	8	16 days (10–32)
Bronchoscopy	7	0		7	5 days (1–31)
Ultrasonography of liver	4	0		4	7 days (5–12)
CE ultrasonography of liver	7	4	9 days (4–18)	3	6 days (4–18)
Biopsy of liver lesion	4	3	16 days (7–31)	1	27 days
CT of adrenal gland	7	2	10 days (7–13)	5	6 days (5–18)
Biopsy of adrenal lesion	2	2	25 days (24–25)	0
Repeated cytological puncture of cervical LN	6	0		6	10 days (3–19)
PET-scan	5	1	12 days	4	13 days (6–14)
Diagnostic laparoscopy	1	1	18 days	0
MRI liver	1	0		1	6 days
Pleural fluid aspiration	2	0		2	7 days (7–7)
EBUS with FNA	1	0		1	14 days
Total	59	17	14 days (4–39)	42	8.5 days (1–32)

CE ultrasonography, contrast enhanced ultrasonography; EBUS, endobronchial ultrasonography; FNA, fine needle aspiration; LN, lymph node.

Table III. Clinical TNM-stage of esophageal and gastric cardia carcinoma.

	Esophageal or gastric cardia carcinoma (n = 111)
cT stage
1	4
2	20
3	68
4	12
x	7*
cN stage
0	25
1	83
2	3
x	0
cM stage
0	82
1a	7
1	22
x	0

*EUS not performed.

Table IV. Univariate and multivariate analysis of patient and tumor related risk factors of completion of staging after CT, EUS and US.

	Total	Univariate analysis HR (95% CI)	P	Multivariate analysis HR (95% CI)	P
Age (yr)			0.57		0.52
< 60	41	1.00		1.00
≥ 60	69	0.80 (0.36–1.76)		0.73 (0.28–1.88)
Gender			0.61		0.30
Male	78	1.00		1.00
Female	32	0.80 (0.35–1.85)		0.58 (0.21–1.62)
Histology			0.81		0.28
AC	71	1.00		1.00
SCC	39	1.11 (0.50–2.46)		2.21 (0.52–9.42)
Location tumor			0.60		0.27
Proximal esophagus	12	1.24 (0.35–4.44)		0.70 (0.11–4.42)
Mid esophagus	22	1.90 (0.66–6.46)		1.40 (0.31–6.22)
Distal esophagus	49	1.00		1.00
Junction	12	1.23 (0.35–4.44)		3.01 (0.66–13.67)
Cardia	15	2.43 (0.68–9.70)		4.27 (0.99–18.30)
T-stage			0.14		0.19
T 1/2	24	1.00		1.00
T 3/4	80	0.48 (0.18–1.29)		0.47 (0.15–1.44)
N-stage			0.02		0.04
N 0	25	1.00		1.00
N 1	85	0.30 (0.10–0.86)		0.27 (0.08–0.95)
M-stage			0.04		0.03
M 0/1a	88	1.00		1.00
M 1	22	0.38 (0.15–0.98)		0.25 (0.07–0.90)

AC, adenocarcinoma; SCC, squamous cell carcinoma.

Table V. Overuse of diagnostic investigations because of signs of distant metastasis demonstrated by other modalities.

		Overuse
Diagnostic modalities leading to M1 stage	Number of patients	CT (n = 4)	EUS (n = 15)	US (n = 16)
CT	13	–	10	13
EUS	1	1	–	1
US	2	2	2	–
UE	1	1	1	1
CT and US	2	–	2	–
CT and EUS	1	–	–	1
Total	20	4	15	16

CT, computed tomography; EUS, endoscopic ultrasound; UE, upper endoscopy; US, ultrasonography of the neck.