| Part one Patterns of failure and pathological characteristics after the complete resection of thoracic esophageal squamous cell carcinomaObjective: To analyze the influencing factors of different pathological characteristics and failure modes of patients with esophageal cancer after operation,Based on the failure modes,to explore the indications of radiotherapy after radical surgery.And further standardize the scope of postoperative radiotherapy.Methods: From January 2007 to December 2010,1367 patients who met the eligible patients were retrospectively analyzed.To analysis the clinical and pathological characteristics,treatment failure mode and prognosis of patients with esophageal cancer after operation.And stratified analysis of the serial correlation indicators,mainly to observe the prognostic factors,the specific failure mode and the site of the first failure,analysis of the different subgroups of patients with different types of failure mode.SPSS19.0 software was used for statistical analysis.Result: 1 The 1-,3-,5-years overall survival rate(OS)were 87.5%?61.3%and 51.3%,respectively,median 64.0 months.The 1-,3-,5-years disease-free survival(DFS)were 76.6% ? 53.2% and 45.5%,respectively,median 45.2months.2 Within the whole group of patients with a total failure rate of 40.2%,the chest-regional recurrence rate was 31.9%,the distant metastasis rate was16.8%,To see more,in areas such as the lung,liver and bone,The incidence of esophageal carcinoma,lung metastasis was significantly higher than that in middle and inferior thoracic cancer.According to the analysis of the position of the lesion,there was a high rate of supraclavicular lymph node metastasis(22%),middle upper mediastinal lymph node metastasis(35.6%)and anastomotic recurrence(22%)with upper thoracic esophageal carcinoma.There was a high rate of supraclavicular lymph node metastasis(24.3%)and middle upper mediastinal lymph node metastasis(51.4%)with middle thoracic esophageal carcinoma.There was a high rate of total mediastinal lymph node metastasis(31.8%)and celiac lymph node metastasis rate(23.5%)with lower thoracic esophageal carcinoma.The chest-regional recurrence rate and distant metastasis rate were 47.1% and 27.9% in patients with postoperative lymph node positive(LN+),and significantly higher than the patients with negative postoperative lymph node(LN-)(?2=73.301,60.441,P=0.000,0.000).There was no significant difference in the recurrence rate and distant metastasis rate between LN+ and LN-in patients with upper thoracic cancer.For the middle thoracic cancer patients,the chest-regional recurrence rate and distant metastasis rate in the LN+ group were significantly higher than that of group LN-(?2=17.434,22.901,7.130,59.063,P=0.000,0.000,0.008,0.000).For the lower thoracic cancer patients,the supraclavicular lymph nodes,abdominal lymph recurrence rate and distant metastasis rate in the LN+ group were significantly higher than that of group LN-(?2=5.951,18.371,8.742,P=0.015,0.000,0.003),but the intrathoracic recurrence rate was no significant difference between two groups.3 The more late T stage,the number of positive lymph nodes and the number of metastasis were more lager,the longer the length of the lesion,the higher recurrence rate and distant metastasis rate,and the difference was significant.Postoperative residual positive patients had a significantly higher rate of intrathoracic-regional recurrence.Different surgical methods also had a significant impact on the recurrence of thoracic-region.The older patients,the a history of hypertension,preoperative CT showed mediastinal lymph node enlargement,the later of T stage and late TNM stage were the independent prognostic factors of patients with OS and DFS.History of smoking,history of swallowing and longer length of lesions were the independent prognostic factors of patients with OS.Upper thoracic esophageal cancer,intraoperative adhesion heavier,fewer negativelymph nodes were removed,and more regional transfer were the independent prognostic factors of patients with DFS.Conclusion: 1 To upper and middle thoracic esophageal cancer postoperative patients,The rate of lymph node metastasis of supraclavicular area and the upper-middle mediastinal were higher,and the prevention of postoperative irradiation should include the corresponding area.The positive lymph node metastasis rate was higher in the postoperative patients with positive lymph nodes,So the prevention of postoperative irradiation should also include the left gastric and celiac lymphatic drainage area.The lower thoracic carcinoma patients,the mediastinum and abdomen had a higher recurrence rate,Prevention of postoperative irradiation should include the mediastinum,postoperative tumor bed area and the left of the stomach,celiac lymphatic drainage area,and the lymph node positive postoperative patients had a higher rate of supraclavicular lymph node metastasis,It should also include supraclavicular area.2 Lymph node positive and residual positive patients should be routinely treated with prophylactic irradiation in order to reduce the recurrence and metastasis of tumor.3 Age,previous history of hypertension,preoperative CT showed mediastinal lymph node enlargement,pathological T stage and TNM stage were the independent influencing factors of OS and DFS of postoperative patients with esophageal cancer.Part two Analysis of efficacy and failure modes of postoperative adjuvant therapy in patients with thoracic esophageal squamous cell carcinomaObjective: To compare the different postoperative adjuvant therapy(radiotherapy or chemotherapy)and failure modes after radical resection of thoracic esophageal squamous cell carcinoma,To provide clinical reference for the selection of adjuvant therapy for esophageal cancer after radical operation.Methods:From December 2010 to January 2007,a total of 836 patients with thoracic esophageal squamous cell carcinoma were available for analysis,all of the patients received postoperative adjuvant therapy.To observe the effect of postoperative adjuvant therapy on the prognosis and the failure mode after treatment.The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test.Multivariate prognostic analysis was performed using the Cox proportional hazard model.PSM method was used to analyze the propensity matching grouping.Results: 1 1-,3-,5-year overall survival rate(OS)and disease-free survival(DFS)were 89.7%,62.1%,51.7% and 76.8%,52.1%,44.2%,the median survival was 67 months and 42 months.The 1-,3-,5-year of OS and DFS of S+CRT group,S+CT group and S+RT group were significant difference(P=0.009,0.001).2 The degree of adhesion,TNM stage and number of positive lymph nodes as independent prognostic factors of OS and DFS,the independent prognostic factors of OS also includes gender and number of negative lymph nodes.the independent prognostic factors of DFS also includes previous drinking history,stump positive and treatment.3 The thoracic-region recurrence rate was 36.5%,and the distant metastasis rate was 23.6%.The thoracic-region recurrence rate of S+CRT,S+CT and S+RT were28.0%(30/107),39.7%(252/635)and 43.0%(54/121),respectively,There was significant difference(P=0.042)in the three groups.The distant metastasis rate of them was 30.8%(33/107),20.5%(130/635)and 39.7%(48/121),respectively,the difference was also significant(P=0.001).4 The part of the clinical and pathological data in the three groups aer different,after PSM pairing method,the result of univariate analysis showed that the 1-,3-,5-years of OS and DFS of S+CRT group,S+CT group and S+RT group also were significant difference(P value are 0.000).Conclusions : 1 Esophageal lesion degree of adhesion,TNM staging,number of positive lymph nodes were the independent prognostic factors of DFS and OS,The independence prognosis factors of the OS include gender and negative lymph node number,The independence prognostic factors of the DFS include the history of drinking,the positive side and treatment model.2 The chest-regional recurrence and distant metastasis rate is still high in thoracic segment esophageal squamous carcinoma patients with postoperative adjuvant treatment,And in two years,the recurrence of chest is the main failure mode.3 Compared with S+RT and S+CT,S+CRT can significantly improved the OS and DFS of thoracic esophageal squamous cell carcinoma after radical operation.Part three A efficacy and failure modes analysis of different adjuvant therapy for resected thoracic esophageal squamons cell carcinomaObjective: To compare the efficacy and the failure mode of postoperative chemoradiotherapy(S+CRT)and postoperative radiotherapy only(S+RT)in patients with II and III stage esophageal squamous cell carcinoma after radical operation.To clarify the specific reasons for the failure of postoperative adjuvant therapy in patients with II and III stage,and to choose the best adjuvant therapy for patients with different stage.Methods: From January 2007 to December 2010,216 patients with esophageal cancer who underwent radical resection and received adjuvant chemoradiotherapy or radiotherapy alone in our hospital were collected.The prognostic factors and treatment failure modes were analyzed,The effect of different treatment methods and the specific failure modes of different subgroups were compared.SPSSl9.0 software was used for statistical analysisResults: 1 There was no significant difference between S+CRT and S+RT group.The 1-,3-,5-years overall survival rate(OS)was 94.0%,61.6%,49.5% and 75.0%,53.5%,46.9%,respectively.Preoperative CT showed lymph node enlargement,intraoperative esophageal lesions adhesion,the number of positive lymph node and treatment modality were the independent prognostic factors of patients with OS and DFS,staging,vascular tumor throm,and postoperative stump were the independent prognostic factors of patients with OS and DFS,respectively.intraoperative esophageal lesions adhesion and treatment modality were the independent prognostic factors of ?stage patients with OS and DFS,preoperative CT showed lymph node enlargement were the independent prognostic factors of ?stage patients with DFS.Intraoperative esophageal lesions adhesion,vascular tumor thrombus,the number of positive lymph node and transfer areas were the independent prognostic factors of ?stage patients with OS,Preoperative CT showed lymph node enlargement,post operative stump and the number of positive lymph node were the independent prognostic factors of ? stage patients with DFS.2 The OS and DFS of S+CRTgroup were significantly better than that of S+RT group(P<0.05).The result of tratified analysis showed that the DFS of group of S+CRT group was significantly higher than that of group S+RT in ? stage patients(?2=6.486,P=0.011),There was no significant difference in OS and DFS between S+CRT and S+RT group for ? stage patients P>0.05).There was no significant difference in OS and DFS between S+CRT and S+RT group for N0 stage patients P>0.05),the DFS of group of S+CRT group was significantly higher than that of group S+RT in N1 stage patients P<0.05).3 In the whole group,the thoracic-regional recurrence rate was 24.1%,and the distant metastasis rate was 23.1%.The thoracic-regional recurrence rate and the distant metastasis rate were 25.7%,30.7% and 40.9%,35.7% in S+CRT and S+RT group,respectively.Compared with S+RT,S+CRT can significantly reduce the intrathoracic-region recurrence rate in patients with N1 and stage II(P < 0.05).Their intrathoracic-region recurrence rate was significant difference(?2=9.611,P=0.002).The thoracic-regional recurrence rate and the distant metastasis rate were 23.3%,22.1% and 42.5%,40.7% in ? and ? stage patients,respectively.The lymph node recurrence rate of superclavicle,abdominal cavity and distant metastasis were higher in the patients with stage III than stage?(P<0.05).Conclusion: 1 Patients with stage II and III thoracic esophageal squamous cell carcinoma,The overall survival rate and disease-free survival rate were significantly better in the S+CRT treatment group than in the S+RT treatment group.2 For patients with stage II and lymph node positive,Postoperative adjuvant CRT can significantly reduce the recurrence rate in the chest region,and the OS and DFS can be significantly improved. |
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