The modern face of esophageal candidiasis in an oncology center: Correlating clinical manifestations, endoscopic grade, and pathological data in 323 contemporary cancer patients.

Publisher: W.B. Saunders Country of Publication: England NLM ID: 7908424 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-2742 (Electronic) Linking ISSN: 01634453 NLM ISO Abbreviation: J Infect Subsets: MEDLINE

Publication: Kent, UK : W.B. Saunders
Original Publication: London, New York, Academic Press.

Candidiasis*/microbiology ; Candidiasis*/pathology ; Candidiasis*/drug therapy ; Candidiasis*/epidemiology ; Fluconazole*/therapeutic use ; Antifungal Agents*/therapeutic use; Humans ; Male ; Female ; Middle Aged ; Retrospective Studies ; Aged ; Adult ; Aged, 80 and over ; Risk Factors ; Neoplasms/complications ; Neoplasms/pathology ; Candida/isolation & purification ; Candida/classification ; Esophageal Diseases/pathology ; Esophageal Diseases/microbiology ; Esophageal Diseases/drug therapy ; Treatment Failure ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/microbiology

Objectives: Clinical presentation and outcomes of esophageal candidiasis (EC) in cancer patients are scarcely studied in the azole era, as is the correlation between clinical, endoscopic, and histopathological EC manifestations.
Methods: We retrospectively reviewed the risk factors, clinical features, and outcomes of pathology-documented EC cases at MD Anderson Cancer Center. We further assessed associations between presence of symptoms, standardized 4-stage endoscopic grade (Kodsi classification), histopathological data, and fluconazole treatment failure.
Results: Among 323 cancer patients with EC, 89% had solid tumors, most commonly esophageal cancer (29%). Thirty-three percent of EC patients were asymptomatic. The proportion of symptomatic EC patients significantly increased with endoscopic grade (P = 0.005). Among 202 patients receiving oral fluconazole, 27 (13%) had treatment failure. Underlying esophageal disease was the only independent predictor of fluconazole treatment failure (odds ratio: 3.88, P = 0.005). Endoscopic grade correlated significantly with Candida organism burden (Correlation coefficient [ρ] = 0.21, P < 0.01) and neutrophilic inflammation (ρ = 0.18, P < 0.01). Candida invasion of the squamous mucosal layer was associated with treatment failure (P = 0.049).
Conclusions: EC was predominantly encountered in patients with solid tumors. One-third of EC patients were asymptomatic, challenging traditional symptom-based diagnosis. The development of integrated clinicopathological scoring systems could further guide the therapeutic management of cancer patients with EC.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. D.P.K reports honoraria and research support from Gilead Sciences and Astellas Pharma. He received consultant fees from Astellas Pharma, Merck, and Gilead Sciences, Knight and is a member of the Data Review Committee of Cidara Therapeutics, AbbVie, Scynexis and the Mycoses Study Group. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed
(Copyright © 2024. Published by Elsevier Ltd.)

Keywords: Cancer; Candida esophagitis; Esophageal candidiasis

8VZV102JFY (Fluconazole)
0 (Antifungal Agents)

Date Created: 20240512 Date Completed: 20240615 Latest Revision: 20240615

20240616

10.1016/j.jinf.2024.106172

38735485