Spirocerca lupi induced oesophageal neoplasia : predictors of surgical outcome

Abstract

Canine spirocercosis is caused by the nematode Spirocerca lupi. Migration results in oesophageal fibro-inflammatory nodules that may undergo neoplastic transformation. No studies have assessed pre- or post-surgical prognostic indicators in dogs that undergo intervention for S. lupi induced oesophageal neoplasia.

This observational, multi-center study aimed to assess the outcome of dogs with Spirocerca induced sarcoma undergoing endoscopic-guided ablation (n = 12) or surgery (n = 18), and identify prognostic indicators. Parameters evaluated included: age, weight, gender, presenting complaints, duration of clinical signs, complete blood count, serum biochemistry, neoplasia size, placement of percutaneous endoscopically-placed gastrostomy tube, histopathological mitotic indices, days to discharge and chemotherapy administration.

Kaplan-Meier survival curves showed no difference in survival between ablation and surgery {(median: 73.5 days (range: 0–1511) vs. 108 days (range: 0–1550), respectively (p = 0.982)}. Reduced survival was documented in patients presenting with weight loss (P = 0.027), hypochromasia (MCHC <33 g/dL, P = 0.023) or leucocytosis (>15 × 109/L, P = 0.017) with a hazard ratio of 2.51 (CI95% = 1.071–6.018, P = 0.034), 2.71 (CI95% = 1.10–6.65, P = 0.03) and 4.39 (CI95%: 1.21–15.97, P = 0.025) respectively. In the dogs surviving more than 21 days, Ht <36% and leucocytosis >15.0 × 109/L at presentation were associated with reduced survival (p = 0.016, p = 0.021 respectively) and hazard ratio of 3.29 (CI95% = 1.18–9.2, P = 0.023) and 3.81 (CI95% = 1.15–12.55, P = 0.028) respectively. Intra-intervention-group survival analysis identified increased survival time in dogs receiving chemotherapy, but only within the surgical group (P = 0.02).The hospitalisation time of dogs undergoing ablation (median: 0 days, range: 0–4) was significantly shorter than dogs undergoing surgery (9 days, 1–21) (P < 0.001).

In this study, no clear benefit was identified for surgery, thus when ablation is technically possible it should be considered advantageous, as hospitalisation time is significantly shorter. Weight loss, hypochromasia and leucocytosis were identified as long-term prognostic indicators at presentation.