{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:23:18Z","timestamp":1773008598464,"version":"3.50.1"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 112\u20102314\u2010B\u2010037\u2010084\u2010MY3"],"award-info":[{"award-number":["NSTC 112\u20102314\u2010B\u2010037\u2010084\u2010MY3"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020595","name":"National Science and Technology Council","doi-asserted-by":"publisher","award":["NSTC 113\u20102221\u2010E\u2010037\u2010005\u2010MY2"],"award-info":[{"award-number":["NSTC 113\u20102221\u2010E\u2010037\u2010005\u2010MY2"]}],"id":[{"id":"10.13039\/100020595","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH110\u20100R02"],"award-info":[{"award-number":["KMUH110\u20100R02"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH113\u20103R03"],"award-info":[{"award-number":["KMUH113\u20103R03"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011645","name":"Kaohsiung Medical University Chung-Ho Memorial Hospital","doi-asserted-by":"publisher","award":["KMUH113\u20103R04"],"award-info":[{"award-number":["KMUH113\u20103R04"]}],"id":[{"id":"10.13039\/501100011645","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW113\u2010TDU\u2010B\u2010212\u2010114009"],"award-info":[{"award-number":["MOHW113\u2010TDU\u2010B\u2010212\u2010114009"]}],"id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Kaohsiung J of Med Scie"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Esophageal squamous cell carcinoma (ESCC) with adjacent structure invasion (T4b), affecting areas such as the aorta, vertebral body, or trachea, is associated with a poor prognosis, and the optimal treatment strategy remains unclear. While chemotherapy is considered standard, radiation therapy is often avoided due to the risk of severe complications, including tracheoesophageal fistula. This 10\u2010year cohort study investigated clinical outcomes and prognostic factors in patients with T4b ESCC. From October 2011 to May 2022, 471 ESCC patients were diagnosed at our institution, of whom 130 (27%) had T4b disease. First\u2010line treatments included definitive chemoradiotherapy (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200982), chemotherapy alone (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200915), radiotherapy alone (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20095), immunotherapy clinical trials (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20097), palliative surgery (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u20092) and best supportive care (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200919). Patients treated with definitive chemoradiotherapy demonstrated significantly longer overall survival compared with those receiving monotherapy. The mean survival was 24.2\u2009months in the chemoradiotherapy group, versus 4.2\u2009months with chemotherapy alone and 8.5\u2009months with radiotherapy alone (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Esophageal fistula developed in 22 patients (16.9%), with 5 cases identified at diagnosis and 17 occurring during follow\u2010up. Chemotherapy alone was associated with a significantly higher risk of fistula formation compared with chemoradiotherapy (adjusted hazard ratio\u2009=\u200911.22,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01). The presence of a fistula was correlated with worse survival outcomes (median survival of 8.9\u2009months versus 12.2\u2009months,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.03). These findings suggest that definitive chemoradiotherapy may enhance survival in T4b ESCC patients.\n                  <\/jats:p>","DOI":"10.1002\/kjm2.70116","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:12:40Z","timestamp":1758859960000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Outcomes in Patients With T4b Esophageal Squamous Cell Carcinoma: A 10\u2010Year Single Institution Experience"],"prefix":"10.1002","volume":"42","author":[{"given":"Yi\u2010Hsun","family":"Chen","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"School of Post Baccalaureate Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen\u2010Hung","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6260-0402","authenticated-orcid":false,"given":"I\u2010Chen","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Biomedical Artificial Intelligence Academy Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pen\u2010Tzu","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Kaohsiung Medical University Hospital  Kaohsiung Taiwan"},{"name":"Department of Radiation Oncology, Faculty of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Song\u2010Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital Kaohsiung Medical University  Kaohsiung Taiwan"},{"name":"Graduate Institute of Clinical Medicine, College of Medicine Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao\u2010Chin","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University 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