Successfully reported this slideshow.
Your SlideShare is downloading. ×

Kshivets sso2013

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Upcoming SlideShare
Kshivets barcelona2016
Kshivets barcelona2016
Loading in …3
×

Check these out next

1 of 24 Ad
Advertisement

More Related Content

Slideshows for you (20)

Similar to Kshivets sso2013 (20)

Advertisement

Kshivets sso2013

  1. 1. Cardioesophageal and Esophageal Cancer: Optimization of Management Oleg Kshivets, MD, PhD
  2. 2. Abstract: Oleg Kshivets Cardioesophageal and Esophageal Cancer: Optimization of Management  OBJECTIVE: Search of best treatment plan for cardioesophageal/esophageal cancer (CEC) patients (CECP) was realized.  METHODS: We analyzed data of 411 consecutive CECP (age=55.6±8.7 years; tumor size=6.7±3.3 cm) radically operated (R0) and monitored in 1975-2012 (m=307, f=104; esophagogastrectomy- EG Garlock=271, EG Lewis=140, combined EG with resection of pancreas, liver, diaphragm, colon transversum, lung, trachea, pericardium, splenectomy=127; adenocarcinoma=216, squamous=185, mix=10; T1=62, T2=99, T3=141, T4=109; N0=170, N1=57, M1A=184, G1=116, G2=98, G3=197; early CEC=43, invasive=368; esophageal cancer=139, cardioesophageal cancer=272): only surgery-S=327, adjuvant treatment-AT=84 (chemoimmunoradiotherapy=36: 5-FU+thymalin/taktivin +radiotherapy 45-50Gy, adjuvant chemoimmunotherapy=48). Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of CECP were evaluated using a log-rank test. Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap simulation and neural networks computing were used to determine any significant dependence. RESULTS: For total of 411 CECP overall life span (LS) was 1632.2±2141.6 days, (median=783 days) and cumulative 5-year survival (5YS) reached 40.1%, 10 years – 32.9%, 20 years – 24%. 102 CECP lived more than 5 years without CEC progressing. 216 CECP died because of CEC during the first 5 years after surgery. 5YS was superior significantly after AT (61.7%) compared with S (36.2%) (P=0.000 by log-rank test). Cox modeling displayed that 5YS significantly depended on: phase transition (PT) early-invasive CEC in term of synergetics, PT N0-N1M1A, AT, cell ratio factors (P=0.000-0.038). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive CEC (rank=1), PT N0-N1M1A (rank=2), AT (3), segmented neutrophils/cancer cells-CC) (4), lymphocytes/CC (5), monocytes/CC (6). Correct prediction of 5YS was 100% by neural networks computing.  CONCLUSIONS: Optimal management strategies for CECP are: 1) screening and early detection; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymphadenectomy for completeness; 4) high-precision prediction; 5) adjuvant treatment for CECP with unfavorable prognosis.
  3. 3. Data:  Males………………………………………………….307  Females………..………………………………….......104  Age=55.6±8.7 years  Tumor Size=6.7±3.3 cm  Only Surgery.………………………………………...327  Adjuvant Chemoimmunoradio/Chemoimmunotherapy (5FU+thymalin/taktivin, 5-6 cycles+RT 45-50Gy)…..84
  4. 4. Radical Procedures:  Left Thoracoabdominal Esophagogastrectomies (Garlock)……………………..……………………..271  Right Thoracoabdominal Esophagogastrectomies  (Ivor Lewis)………………….……………………...140  Combined Esophagogastrectomies with  Resection of Diaphragm, Pericardium, Lung, Liver, Pancreas, etc…………..…………..………………...127  2-Field Lymphadenectomy….……………………..303  3-Field Lymphadenectomy….……………………..108
  5. 5. Staging:  T1……62 N0..…170 G1…………116  T2……99 N1……57 G2…………..98  T3…..141 N2…..184 G3…………197  T4…..109 M1……..0  Adenocarcinoma………..................................216  Squamos Cell Carcinoma……………………185  Mix Carcinoma..……………………………….10  Early Cancer……43  Invasive Cancer…….368
  6. 6. Survival Rate:  Alive………………………………………....170 (41%)  5-Year Survivors…………..……………….102 (24.8%)  10-Year Survivors…………………………...54 (13%)  Losses………………………………….……216 (52.6%)  General Life Span=1632.2±2141.6 days  For 5-Year Survivors=4491.3±2679.0 days  For 10-Year Survivors=6228.6±2632.2 days  For Losses=648.6±387.8 days  Cumulative 5-Year Survival………………..40.1%  Cumulative 10-Year Survival………………32.9%
  7. 7. General Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (Kaplan-Meier) (n=411)
  8. 8. Results of Univariate Analysis of Phase Transition Early—Invasive Cancer in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=411)
  9. 9. Results of Univariate Analysis of Phase Transition N0—N1-2 in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=411)
  10. 10. Results of Univariate Analysis of Adjuvant Therapy in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=411)
  11. 11. Results of Univariate Analysis of Tumor Localization in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=411)
  12. 12. Results of Univariate Analysis of Tumor Hystology in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=411)
  13. 13. Results of Univariate Analysis of Tumor Growth in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=411)
  14. 14. Results of Discriminant Fanction Analysis in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Surgery (n=318)
  15. 15. Results of Multi-Factor Clustering of Clinicopathological Data in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagectomies (n=318)
  16. 16. Results of Cox Regression Modeling in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Surgery (n=411)
  17. 17. Results of Neural Networks Computing in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=318)
  18. 18. Results of Bootstrap Simulation in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagectomies (n=318)
  19. 19. Holling-Tenner Models of Esophageal/Cardioesophageal Cancer Cell Population and Cytotoxic Cell Population Dynamics
  20. 20. Results of Kohonen Self-Organizing Neural Networks Computing in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=318)
  21. 21. Esophageal/Cardioesophageal Cancer Dynamics
  22. 22. Results of Structurul Equation Modeling in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Esophagectomies, n=318
  23. 23. Conclusions:  Optimal management strategies for esophageal and cardioesophageal cancer patients are:  1) screening and early detection;  2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures;  3) aggressive en block surgery and adequate lymph node dissection for completeness;  4) high-precision prediction;  5) adjuvant treatment for esophageal and cardioesophageal cancer patients with unfavorable prognosis.
  24. 24. Address: Oleg Kshivets, M.D., Ph.D. Consultant Thoracic, Abdominal, General Surgeon & Surgical Oncologist  e-mail: okshivets@yahoo.com  skype: okshivets  http: //www.ctsnet.org/home/okshivets

×