| Background and purpose:This investigation aimed to establish a model to predict survival individually for patients with node positive or stage III Thoracic Esophageal Squamous Cell Carcinoma after Esophagectomy.Materials and Methods:A retrospective review of 3,636 patients diagnosed as esophageal carcinoma and received estophagectomy in Chinese Academy of Medical Science, Cancer hospital between January 2004 and December 2011 was performed. A database compiling 1,004 patents with node positive and stage Ⅲ (stage Ⅱb-Ⅲ 7th version UICC/AJCC stage) thoracic esophageal carcinoma after surgery with or without adjuvant treatment was created. A dataset from high-leveled cancer hospital was used for external validation. The predictive accuracy and discrimination were measured by concordance index (c-index) and calibration plot.Results:The median follow-up in primary cohort was 67.5 months. The median survival and five year overall survival rate in training cohort were 30.9 months and 34.2%. Six factors were taken into account:T stage, differentiation grade, tumor location, embolus, lymph nodes metastatic ratio, and adjuvant treatment. We developed a nomogram with c-index 0.70, and stratified patients into four groups based on total score of nomogram (≤100,101-140,141-169,≥170).5-year overall rates were 52.9%,38.8%, 23.9% and10.2%(P<0.001). Each group demonstrated distinctive prognosis in both primary and validation cohort.Conclusion:We initially established and validated a nomogram to predict survival in stage Ⅲ or node positive esophageal carcinoma. This model will facilitate further trial design and clinical decision-making.Background and purpose:Surveillance was recommended for patients after esophagectomy by National Comprehensive Cancer Network (NCCN) guidelines. The present study aimed to determine whether adjuvant treatment improved survival for stage node positive or stage Ⅲ thoracic squamous cell carcinoma.Materials and Methods:A retrospective review of patients diagnosed as esophageal carcinoma in Chinese Academy of Medical Sciences, Cancer hospital between January 2004 and December 2011 was performed. A database compiling 975 patents with node positive or stage Ⅲ thoracic esophageal carcinoma after surgery with or without postoperative radiation/chemoradiation was created. A 1:1 matched study group was created by Greedy method after propensity score matching (PSM) analysis. Survival curves were calculated by Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate analyses were using the Cox proportional hazards regression model.Results:975 patients were enrolled into the study,510 patients (52.3%) did not receive any postoperative treatment after surgery and 465 patients had either postoperative chemoradiation or radiotherapy,331 patients had radiotherapy and 134 had postoperative chemoradiotherapy. Median follow-up was 69.2 months (95% CI 67.1-71.4 months). The 3-year,5-year survival rates and median survival were 43.3%,32.8%, 28.9 months. DFS rates 37.7%,31.7% and 22.5 months; and 52.3%,40.3%,41.8 months, respectively (P=0.000). After PSM,222 well-balanced patients in each group. The 3-year, 5-year survival rates and median survival were 33.0%,26.4%,24.4 months; and 52.3%, 40.3%,41.8 months, respectively (P=0.002).33.0%,26.4%,24.4 months and 48.3%, 37.1%,34.3months. N stage and adjuvant treatment are independent prognostic factors. Comparing with radiotherapy, postoperative chemoradiation did not improve DFS and OS.Conclusion:Adjuvant treatment could improve survival for patients with stage node positive or stage Ⅲ thoracic squamous cell carcinoma. Further investigation is warranted.Background and purpose:Our previous studies have established the survival benefits of postoperative radiotherapy for patients in stage Ⅱb-Ⅲ, with high incidence of hematogenous metastasis. The aim of the study is to explore maximum tolerated dose (MTD) and the safety and feasibility of chemoradiation for patients after radical esophagectomy.Materials and Methods:Eligible patients (n=98) with pathologically diagnosed with thoracic esophageal squamous cell carcinoma after radical surgery were enrolled between July 2007 and December 2013.Patients received 5-6 weekly cycles of paclitaxel and cisplatinconcurrent with continuous course of intensity-modulated radiotherapy (IMRT).Results:Among enrolled patients,33patients were in dose escalation study,65 patients were in phase Ⅱ study. Median age was 55 year-old. ECOG PS 0-2. In phase Ⅰ study, in cohort 1,2 patients suffered dose limiting toxicities (DLT); in cohort 2, and allergic reaction to paclitaxel in one patient in the 54Gy/1.8Gy/30f group; grade 4 leukopenia and grade 3 thrombocytopenia in 3 patients of paclitaxel 50mg/m2/w and cisplatin 20mg/m2/w level. MTD was 5-6 weekly cycles of paclitaxel 40mg/m2 and cisplatin 20mg/m2 concurrent with 54Gy radiotherapy. No DLT was observed in 12 patients in 60Gy/2.0Gy/30f cohort. Volume of clinical target and mean dose of stomach were significantly reduced because of revision (P=0.006, P=0.015). No increase of out-field recurrence was observed.23 patients (35.4%) had 50 to 54Gy radiotherapy dose (50-54Gy group),42 patients (64.6%) had 54 to 60Gy (54-60Gy group).32 patients (49.2%) received full cycles of chemotherapy (5-6 weekly cycles),33 patients (50.8%) received one to four weekly cycles of chemotherapy(1-4 weekly cycles). Incidence of grade 3-4 toxicities was 21%-29%, no grade 5 toxicity was observed.3-year overall survival (OS) and 3-year disease-free survival (DFS) were 54.7% and 44.8%.In 50-54Gy group and 54-60Gy group,3-year overall survival were 60.1% and 51.2% (P=0.750),3-year disease-free survival were 38.9% and 49.0%(p=0.553). In 1-4 weekly cycles group and 5-6 weekly cycles group,3-year overall survival were 66.5% and 45.6% (p=0.218),3-year disease-free survival were 64.5% and 31.2%(p=0.007). Hematogenous metastasis in patients after postoperative chemoradiation was 36.7%.Conclusions:Lower dose and smaller volume of target might warrant completion of chemoradiation. Further comparison of radiation and chemoradiation is warranted.Objective:To analyze the value of postoperative radiation for middle thoracic esophageal squamous cell carcinoma (TESCC) with positive lymph nodes and to modify the radiation target.Materials and Methods:A total of 286 patients with node-positive middle TESCC underwent radical surgery in Chinese Academy of Medical Sciences, Cancer Hospital.90 patients received postoperative Intensity-Modulated Radiotherapy (IMRT). Survival was calculated by Kaplan-Meier method and log-rank test. The recurrence rates were calculated using Chi-square test.Results:The 5 year overall survival (OS) of surgery alone (S) group and surgery plus postoperative radiation (S+R) group was 22.9% and 37.8%, respectively. The median OS were 23.2 and 37.8 months (p=0.003). Patients with 1 or 2 lymph nodes metastasis (LNM),5-yOS in S group and S+R group was 27.3% and 44.8%, respectively (p=0.017). Patients with more than 3 LNM,5-yOS in S group and S+R group was 16.7% and 25.0%, respectively (p=0.043). Postoperative radiation reduced mediastinal lymph nodes recurrence (for patients with 1 or 2 LMN:S vs. S+R 35.3% vs.8.0%, and for more than 3 LNM:S vs. S+R 42.3% vs.10.0%, respectively) and prolonged the time for recurrence (S+R 25.1 vs. S 10.7 months, p=0.000).Conclusions:Patients with middle node-positive TESCC could gain benefit from postoperative radiation. As combined with chemotherapy for high hematogenous metastases, for patients with 1or 2 positive lymph nodes, target volume should be modified to reduce toxicities and for those with more than 3 lymph nodes, prescription dose should be modified. |
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