ArticleEsophagus : official journal of the Japan Esophageal Society2026
Pretreatment feeding‑stoma placement in advanced esophageal cancer: defining optimal patient selection criteria.
Article in Esophagus : official journal of the Japan Esophageal Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe indication of feeding-stoma creation (gastrostomy/jejunostomy) in esophageal squamous cell carcinoma (ESCC) patients and its impact on survival remain unclear. We aimed to identify patient subgroups who benefit from feeding-stoma placement before concurrent chemoradiation therapy (CCRT).
methodsWe did a secondary analysis of prospective cohort. A total of 260 patients with advanced ESCC who underwent CCRT between April 2008 and March 2024 were included. Tumor-occupying proportion (tumor area/total lumen area) and other tumor characteristics were measured from standardized endoscopic images. Characteristics that predict post-CCRT cachexia was identified and validated as indications of feeding-stoma creation.
resultsPost-CCRT cachexia developed in 60.7% of patients. Independent predictors of cachexia included longer tumor length and bigger tumor-occupying proportion. ROC curve found tumor length ≥ 6 cm (area under ROC (AUC): 0.760, P < 0.001) and tumor-occupying proportion ≥ 70% are optimal to predict post-CCRT cachexia (AUC: 0.620, P = 0.001). Sixty-two patients (23.8%) underwent pretreatment feeding-stoma creation. In the overall cohort, feeding-stoma creation was not associated with a longer progression-free survival (PFS) or overall survival (OS). In patients with tumor-occupying proportion ≥ 70%, feeding-stoma creation was associated with reduced cachexia incidence, better treatment response (OR: 2.78, P = 0.028), longer median PFS (6 vs. 4 months, P = 0.012) and OS (11 vs. 9 months, P = 0.009). In contrast, feeding-stoma creation was not associated with an improved treatment response or survival in patients with tumor-occupying proportion < 70% or in patients with different tumor length.
conclusionTumor-occupying proportion is a novel metric that predicts cachexia and survival in advanced ESCC. Pretreatment feeding-stoma creation was associated with a better treatment response and longer survival only in patients with tumor-occupying proportion ≥ 70%, supporting its use as a selection criterion for this invasive procedure.
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