| 1Background and PurposeEsophageal cancer (EC) is one of the six most common malignant tumors in the world. Only10%to15%of the EC patients may survive more than5years. Esophageal cancer is a disease that very difficult to discover in early stage, more than95%of EC patients are diagnosed in middle or advanced stage. One of the main reasons for high mortality is the lack of effective method of early detection and screening of the high-risk population.Over the past decades, we have performed large-scale field work (mass survey and follow-up) in high incidence areas for EC in Henan work and found that the EC patients who could survive more than10years or even over20years after esophagectomy, are not uncommon. These patients with survival time of more than10years are named as ultra long-term survival (ULS) by us and those with survival of less than5years are named as short-time survival (STS).To explore the relevant factors for ULS patients, we here conducted the comparative analysis on the clinicopathological changes and family history on the patients with ULS and STS.2Materials and Methods2.1PatientsAll the ULS and STS patients were from the high incidence area for EC in Henan province. Clinical data were recorded, such as gender, age, date of birth, onset date, etc; and the clinicopathological information was tracked from the pathological departments of the treated hospitals, including TNM and clinical stages, differentiation, lymph node metastasis (the dissected total number and positive number of lymph nodes), gross classification, tumor location, and infiltration, etc.2.2Follow-upAll the data were collected from the large-scale follow-up and questionnaire survey on the patients in high-incidence area for EC based on a9million population from nine counties and one city.2019EC patients with ULS and1989patients with STS were finally enrolled in this study based on the records of the survival and clinical information.2.3StatisticsAll the data were analyzed using SPSS19.0software. Chi-square tests and multi-factor unconditional logistic regression analysis were applied to survival and clinicopathological data. P<0.05was considered as significant.3Results3.1Follow-upA total of2019EC patients with ULS were identified, including1126males with a mean diagnosed age of53±8.7and893females with a mean diagnosed age of54±8.4. A total of1989EC patients with STS were identified, including1344males with a mean diagnosed age of61±8.8and645females with a mean diagnosed age of61±8.8.3.2ULS in patients with in patients with clinicopathology features of distribution3.2.1Gender Two sets of incidence are male dominated, STS vs. ULS (67.6%vs.55.8%, χ2=59.01,P<0.05, OR=1.65,95%CI=1.45-1.88).3.2.2Age of onsetULS patients in morbidity (<40years) are5times than STS (<40years).3.2.3Family historyULS patients of positive family history higher than STS (40%vs.28%,X2=43.25, P<0.05, OR=1.67,95%CI=1.13-1.94).3.2.4TherapyULS patients of surgical treatment significantly more than the STS (80.3%vs.69%,X2=72.94,P<0.05).3.2.5Clinical stagesULS patients were predominating diagnosed at advanced stage. Comparing with STS patients, the ratio of the patients with middle and advanced stage was lower in the ULS patients than in patients (87%vs.96%, X2=69.09, P<0.05); in contrast, the ratio of the patients in the early stage in the group with ULS was3-folds higher than in STS group (13%vs.4%); the patients with early stage comparing with the patients with middle and advanced stage in different survival, both the biggest difference is that in STS. With prolonged survival, this difference is gradually reduced until almost unanimously.3.2.6Tumor locationSTS and ULS patients the tumor location overall distribution differences have statistical significance (Χ2=8.78, P<0.05).3.1.7Gross classificationThe ULS in patients with esophageal early stage erosive type significantly more than STS (7.4%vs.3%). In patients with esophageal middle and advanced stage, STS narrow the type more obvious in the ULS (5.4%vs.2.9%,Χ2=42.00, P<0.05).3.1.8Lymph node metastasisThe patients with ULS rate was significantly lower than the lymph node metastasis of the STS patients (23%vs.53%, Χ2=223.40, P<0.05, OR=0.265,95%CI=0.22-0.32). Lymph node metastasis is mainly one in a lymph node as positive (ULS vs. STS:56%vs.32%). And STS in patients with3and above3lymph node metastasis number is given priority to (STS vs. ULS:45%vs.23%, Χ2=35.45, P<0.05). STS of lymph node resection from the10-the number of lymph node12pieces,13to15, more16in proportion to respectively (20%),(10%),(10%), while the ULS respectively (11.7%),(4.2%),(3.6%), take more than10lymph node lymph node number than ULS are two to three times (Χ2=167.23, P<0.05).3.1.9Infiltration depthBased on T classification of cancer cell infiltration degree, T2was predominant in ULS patients, and T3was more common in STS patients (47%vs.64%,Χ2=228.57, P<0.05).3.1.10Differentiation degreeWell-differentiated (ULS vs. STS:31.4%vs.13%), poorly-differentiated (ULS vs. STS:11.1%vs.34.5%), STS and ULS patients the differentiation degree overall distribution differences have statistical significance (Χ2=191.57, P<0.05).3.3Multiple factors Logistic regression analysis of the comprehensive factors affect in survival periodLogistic regression model analysis indicated that lymph node metastasis and resection number of lymph nodes and esophageal cell differentiation degree with ULS closely related (P<0.05). After the adjustment of the clinical stage and lymph node metastasis positive number and gross classification, Tumor location, lymph node metastasis, resection number of lymph nodes, differentiation degree, infiltration depth, gender, age of onset, family history is the main factors that significantly affect the survival of patients (P<0.05).4Conclusions4.1Cancer cell differentiation and infiltration depth, lymph node metastasis, family history and different treatments are the important factors for ESCC prognosis;4.2The key favorable factors for ULS patients are well-differentiated, without lymph node metastasis, positive family history and early onset. |
PDF Full Text Request