| Objective: To analyse clinical data and prognostic factors in patientsafter resection with esophageal stump carcinoma and atypical hyperplasia, andto further explore treatment modality, in order to provide theoretical basis forevaluation of prognosis, and choice of reasonable adjuvant treatment modalityafter resection.Methods:A total of182esophageal carcinoma cases after resection atthoracic surgery department in the fourth hospital of Hebei medical universityfrom August2006to December2010with esophageal stump carcinoma andatypical hyperplasia, including60cases with I-II grades of atypicalhyperplasia,60cases with III grade of atypical hyperplasia or carcinoma insitu, and62cases with invasive carcinoma. According to pTNM,19casesinvolved in I stage,82cases in II stage, and81cases in III stage.62casesunderwent resection alone,40cases underwent postoperative radiotherapy,48cases underwent postoperative chemotherapy, and32cases underwentpostoperative radiochemotherapy (including concurrence and sequence).Survival and local control conditions were analysed, and explore effects ofpathological stage, stump pathological grade, and treatment modality onsurvival and local control condition, then prognostic factors were analysedwith univariate and multivariate analysis.Results:1Over-all survival and local control conditions:(1)A total of56cases hadlocal recurrence, including anastomotic recurrence and lymphatic metastasis,and recurrent rate was30.8%;(2)The1-,2-,3-and4-year local control rateswere77.1%,63.3%,60.3%and60.3%respectively, and the1-,2-,3-and4-year survival rates were78.6%,63.9%,46.3%and41.0%respectively;(3) Survival rate in I～II stages was higher than that in III stage (χ~2=7.254,P=0.007), but compared with1-,2-,3-and4-year local control rates, therewere no significant difference (χ~2=0.526, P=0.468);(4)Survival and localcontrol rates in patients with III grade of atypical hyperplasia or carcinoma insitu were similar with those with invasive carcinoma, which showed that bothsurvival and local control rates in patients with positive stump were lower thanthose with I-II grades of atypical hyperplasia (χ~2=4.794, P=0.029and χ~2=5.387,P=0.020);(5)All the1-,2-,3-and4-year survival and local control ratesamong groups with the four treatment modalities had significant difference(χ~2=20.243, P=0.000and χ~2=13.377, P=0.004), which were the highest in thegroup underwent postoperative radiotherapy.2Stratified analysis:(1)Survival rate in group underwent postoperativeradiotherapy with I~II grades of atypical hyperplasia was obviously higherthan those in other three groups (χ~2=6.794, P=0.009, χ~2=4.250, P=0.039,χ~2=9.920, P=0.002);1-,2-,3-and4-year local control rates among groupswith the four treatment modalities had no significant difference (χ~2=7.086,P=0.069), but there was a increasing trend in groups underwent postoperativeradiotherapy and postoperative radiochemotherapy, compared with the oneunderwent resection alone;(2)Survival rate in group underwentpostoperative radiotherapy, postoperative radiochemotherapy, and postoperat-ive chemotherapy with positive stump were all higher than the one underwentresection alone (χ~2=11.895, P=0.001, χ~2=6.927, P=0.008, χ~2=13.709, P=0.000).Compared with that in group underwent resection alone, local control rateswere higher in the groups underwent postoperative radiotherapy andpostoperative radiochemotherapy (χ~2=6.340, P=0.012, χ~2=5.868, P=0.015),while no significant difference with that underwent postoperativechemotherapy (χ~2=0.786, P=0.375);(3)1-,2-,3-and4-year survival rates ingroup underwent postoperative radiotherapy and postoperativeradiochemotherapy with I-II stages of stump positive patients were obviouslyhigher than those underwent resection alone (χ~2=7.641, P=0.006, χ~2=8.474,P=0.004), and no significant difference between the group underwent postoperative chemotherapy and the one underwent resection alone (χ~2=2.557,P=0.110). As for local control rates, there were no significant difference in thefour groups (χ~2=5.980, P=0.113). Survival rates with Ⅲ stages of stumppositive patients in the three adjuvant groups were higher than that underwentresection alone (χ~2=4.632, P=0.032, χ~2=7.157, P=0.007, χ~2=4.139, P=0.042),and no significant difference among the three groups (P>0.05). As for localcontrol rates, there were no significant difference in the four groups (χ~2=5.360,P=0.147).3Prognostic factors analysis: Tumor length, metastatic lymph node number,stump pathological grade and treatment modality were independent factors tosurvival in patients after resection with esophageal stump carcinoma andatypical hyperplasia. Invasive depth, stump pathological grade and treatmentmodality were independent factors to local control.Conclusions:1Tumor length, metastatic lymph node number, stump pathological grade andtreatment modality are independent factors to survival in patients afterresection with esophageal stump carcinoma and atypical hyperplasia. Invasivedepth, stump pathological grade and treatment modality are independentfactors to local control;2Postoperative radiotherapy is recommended to use in patients with I-IIgrades of atypical hyperplasia, for the reason that survival rates underwentpostoperative radiotherapy is the highest, and local control rates has aincreasing trend;3Local control and survival conditions are poor in patients with III grade ofatypical hyperplasia, carcinoma in situ and invasive carcinoma, and there is nosignificant difference among them, so they are all need active treatment;4For stump positive patients,the three adjuvant treatment modalities areuseful to enhancement of survival, but postoperative chemotherapy cannotimprove local control, so postoperative radiotherapy and postoperativeradiochemotherapy are recommended;5Local control, survival, distant metastasis, and tolerance to treatment are considered comprehensively, postoperative radiotherapy is recommended topatients with I-II grades of atypical hyperplasia, while it is reasonable tousepostoperative radiochemotherapy patients with III grade. |
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