Pathological Characteristics And Prognostic Factors Of Esophageal Carcinoma In Kazak Nationality In Hami,Xinjiang

BackgroundEsophageal carcinoma is a common malignant tumors globally,and there are many reports on esophageal carcinoma in Kazak nationality in Xinjiang.Living on nomadism,low education level,poor family living standards,simple daily diet,and insufficient intake of nutrients increase the risk of esophageal carcinoma there.Understanding the pathological characteristics of esophageal carcinoma in Kazak nationality plays an important role in judging the occurrence and development of the disease.Besides,it is of great significance for improving the molecular pathology theory,early diagnosis,efficacy prediction and prognosis of esophageal carcinoma.ObjectiveThe study was aimed to analyze the pathological characteristics and prognostic factors of esophageal carcinoma in Kazak nationality in Hami,Xinjiang through follow-up by various methods such as outpatient clinic,in-hospital reexamination and telephone.MethodsFrom December 2012 to December 2017,72 Kazakh patients with esophageal carcinoma admitted to the Second People’s Hospital of Hami were enrolled in the study.The patients’clinical data were statistically analyzed,pathological characteristics of esophageal carcinoma were analyzed,and preoperative laboratory indicators,imaging data and treatment were recorded.The prognostic data were obtained through follow-up via various methods such as outpatient clinic,in-hospital reexamination and telephone.In 3 years after operation,the patients were followed up every 3 months till December 2020 to understand the survival status.The life table method was used to calculate postoperative 1-year,2-year and 3-year survival rates,Kaplan-Meier method was used to calculate the cumulative survival rate,and the survival curve was drawn.According to the follow-up results,the patients were divided into death group and survival group（except the cases lost to follow-up）.The clinical data of the two groups were compared,the prognostic factors of esophageal carcinoma in Kazak nationality in Xinjiang were screened by single factor analysis,and the independent factors affecting the prognosis were screened by multivariate logistic regression analysis.Results1.Preoperative dataOf the 72 patients enrolled,19 had elevated fibrinogen（FIB）,15 had elevated platelet count（PLT）,23 had elevated D-dimer（D-D）,35 had unusually high blood lipid levels,and26 had low prognostic nutritional index（PNI）before operation.MRI showed asymmetric thickening centered on the tube wall on axial T1WI,irregular luminal stenosis,and disruption of circular high signal mucosal line on T2WI.DWI images showed heterochronous high signal of the mass,low signal on apparent diffusion coefficient（ADC）,and the range of ADC value was 1.12～1.86×10^-3mm²/s.2.Treatment of esophageal carcinoma in Kazak nationality in XinjiangThere were 37 patients treated by Lvor-lewis esophagectomy and 35 patients treated by Mckeown esophagectomy.Modern two-field or two-field semi-lymph node dissection was adopted to remove lymph nodes in the chest cavity,abdominal cavity and both sides of the neck.43 patients received surgical treatment alone,and 29 patients received adjuvant radiotherapy and chemotherapy after surgery.The intensity-modulated radiotherapy regimen was 1.8 Gy/time,once/d,5 times/week,28 times in total.The chemotherapy regimen（1）was paclitaxel combined with cisplatin/nedaplatin,28 d as a cycle,2 cycles completed during radiotherapy,2 cycles of consolidation chemotherapy after concurrent radiotherapy.The chemotherapy regimen（2）was cisplatin combined with fluorouracil,28 d as a cycle,2 cycles completed during radiotherapy,and another 2 cycles of consolidation chemotherapy after the end of concurrent radiotherapy and chemotherapy.Postoperative immunohistochemical staining showed positive expression of ki-67,EGFR,and Cyclin D1 in 46 cases,38 cases,and 59 cases,respectively.3.Analysis of overall survival timeAfter evaluating the follow-up data of the 72 patients enrolled by life table method,it was found that at the end of the 3-year follow-up,a total of 17 cases died and 55 cases survived,including 4 cases not completing the follow-up,and 51 cases survived at the end of the follow-up.The average postoperative survival time of patients with esophageal squamous cell carcinoma was 30.57 months,suggesting that none reached the median survival.The 1-year,2-year,and 3-year cumulative survival rates were 89.42%,79.26%,and62.50%,respectively.4.Pathological characteristics of esophageal carcinoma in Kazak nationality in XinjiangOf the 72 patients enrolled,46 were males and 26 were females,aged from 41 to 72years old,with an average age of（57.38±7.03）years,tumor diameter（3.91±0.74）cm,body mass index（BMI）（23.73±2.55）)kg/m².83.33%（60/72）of the patients were under65 years old.Having smoking and drinking history,lesions concentrated in the middle and lower esophagus,tumor diameter≤5 cm,histological type dominated by ulcer,pathological type of squamous cell carcinoma,low and moderate differentiation,nerve invasion,lymph node metastasis,blood vessel invasion,TNM staging dominated by stageⅡ～Ⅲwere main pathological characteristics.5.Prognostic factors of esophageal carcinoma in Kazak nationality in XinjiangMultivariate logistic regression analysis found that age,drinking history,tumor diameter>5 cm,low differentiation,nerve invasion,lymph node metastasis,TNM stageⅢ～Ⅳ,esophageal diverticulum,and preoperative elevated FIB were independent prognostic factors of esophageal carcinoma after operation,while PNI and postoperative adjuvant therapy were protective factors（P<0.05）.ConclusionEsophageal carcinoma in Kazak nationality in Xinjiang has certain clinical characteristics.Its pathological type dominated by squamous cell carcinoma,low and moderate differentiation,nerve invasion,lymph node metastasis,blood vessel invasion,and TNM stage III～IV;Age,drinking history,tumor diameter>5 cm,low differentiation,nerve invasion,lymph node metastasis,TNM staging,esophageal diverticulum,and preoperative FIB are independent factors affecting the prognosis of patients with esophageal carcinoma in Kazak nationality in Xinjiang.