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dc.contributor.authorMarkar, SR
dc.contributor.authorMackenzie, H
dc.contributor.authorJemal, S
dc.contributor.authorFaiz, O
dc.contributor.authorCunningham, D
dc.contributor.authorHanna, GB
dc.date.accessioned2018-02-19T09:50:31Z
dc.date.issued2018-04
dc.identifier.citationAnnals of surgery, 2018, 267 (4), pp. 711 - 715
dc.identifier.issn0003-4932
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/1240
dc.identifier.eissn1528-1140
dc.identifier.doi10.1097/sla.0000000000002224
dc.description.abstractObjective To identify patient factors that are associated with emergency presentation of esophageal and gastric cancer, and further to evaluate long-term prognosis in this cohort.Background The incidence of emergency presentation is variable, with the prognosis of patients stabilized and discharged to return for elective surgery unknown.Methods The primary admission of patients with esophageal or gastric cancer within the Hospital Episode Statistics database (1997-2012) was used to classify as emergency or elective diagnosis. Multivariate regression analyses were used to identify patient factors associated with emergency diagnosis and prognosis.Results A total of 35,807 (29.4%) and 45,866 (39.6%) patients with esophageal and gastric cancer presented as an emergency over the study period. Age ≥70, female sex, non-white ethnicity, Charlson comorbidity index score ≥3 and more deprived Townsend index were independent predictors of emergency cancer diagnosis. Emergency diagnosis was an independent predictor of increased 5-year mortality for all patients with esophageal cancer [hazard ratio (HR) = 1.63, 95% confidence interval (CI) 1.61-1.65] and gastric cancer (HR = 1.20, 95% CI 1.16-1.23). Specifically patients receiving surgery on an elective follow-up admission with an initial emergency diagnosis had a poorer prognosis (esophageal cancer: HR = 1.35, 95% CI 1.27-1.44, gastric cancer: HR = 1.13. 95% CI 1.04-1.22), with a significant increase in liver recurrence (esophageal cancer: 7.1% vs 4.9%; P < 0.001, gastric cancer: 7.0% vs 4.8%; P < 0.001) compared to patients referred electively.Conclusions Emergency presentation of esophageal and gastric cancer is associated with a poor prognosis, due to the increased incidence of metastatic disease at diagnosis and a higher recurrence rate after surgery.
dc.formatPrint
dc.format.extent711 - 715
dc.languageeng
dc.language.isoeng
dc.subjectHumans
dc.subjectEsophageal Neoplasms
dc.subjectStomach Neoplasms
dc.subjectNeoplasm Metastasis
dc.subjectEmergencies
dc.subjectRecurrence
dc.subjectPrognosis
dc.subjectHospitalization
dc.subjectProportional Hazards Models
dc.subjectAged
dc.subjectFemale
dc.subjectMale
dc.titleEmergency Presentation of Esophagogastric Cancer: Predictors and Long-term Prognosis.
dc.typeJournal Article
rioxxterms.versionofrecord10.1097/sla.0000000000002224
rioxxterms.licenseref.startdate2018-04
rioxxterms.typeJournal Article/Review
dc.relation.isPartOfAnnals of surgery
pubs.issue4
pubs.notesNot known
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.)
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.)
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublished
pubs.volume267
pubs.embargo.termsNot known
icr.researchteamMedicine (RMH Smith Cunningham)en_US
dc.contributor.icrauthorCunningham, Daviden
dc.contributor.icrauthorMarsden,en


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