| Objective: To analysis of prognosis and the value of the adjuvantradiatherapy and/or chemotherapy in patients of pT3N0M0thoracicesophageal carcinoma after radical resection.Method: From Jan2008to Dec2009,262cases of patients who sufferedfrom esophageal cancer were treated with radical resection and its clinicalstage was proved UICC Stage pT3N0M0after sugery in the Fourth Hospital ofHebei Medical University. Among them, male in181and female in81cases;the median age was60years old(range33-78ys); there was61patients(pts)with cancer-related family history and201pts without; bad habits: smokers in130pts, drinkers in95pts. In preoperation,the median value of hemoglobinwas139g/L(range97-168g/L); preoperative chest CT scan was examinated in227cases, among which52cases had small lymph nodes in mediastium.There was40cases located in the upper-,177cases in the middle-were, and45cases in the lower-thoracic esophagus. The median length of primarytumor was5cm(range2-12cm); the degree of adhesion with the surroundingnormal tissue: no adhesions in37cases, mild adhesions in94cases, andsevere adhesions in131cases; anastomotic location: cervical anastomosis in26cases, pleural top anastomosis in17cases, pleural anastomosis top in17cases; on the aortic arch anastomosis in195patients, other24cases underthe aortic arch; the median lymph node of dissection was8(range1-27); typeof the postoperative pathology: medullary type in118cases, ulcer type in110cases, and other34cases did not describe; postoperative histopathologicalclassification: middle and high differentiated squamous cell carcinoma in213cases (81.3%), other type in49cases (18.7%); After surgery, adjuvantchemotherapy was used in136and non-chemotherapy in126pts;43caseswith adjuvant radiotherapy and219cases not. The statistical analysis used SPSS19.0statistical software.Follow-up deadline was July2013. The1-,3-,5-year overall survivalrates was89.3%，67.2%and53.3%, and the median was48months. The1-,3-,5-years free progression survival rates was82.1%，61.6%and53.3%.With univariate analysis, gender, preoperative hemoglobin level (≤139g/Land>139g/L), anastomotic location, the site of lesion (upper-/middle-/lower-thoracic segment), pathological classification was related withprognosis in patients of pT3N0M0esophageal cancer after radical resection(p<0.05);. With multivariate analysis, the site of lesion (upper/middle/lower-thoracic segment) was the only independent prognostic factor.The1-,3-,5-year survival rates of adjuvant and no radiotherapy were89.0%,60.5%,35.7%and89.0%,68.5%,56.3%respectively(p>0.05). With subgroupanalysis, postoperative adjuvant radiotherapy reduced survival rate in themiddle-thoracic esohuageal cancer (p=0.027), but it had a tendency to improvesurvival rate in upper-and lower-thoracic segment (p>0.05). With or withoutadjuvant radiotherapy，the local recurrence rates were similar(p>0.05). Withsubgroup analysis, in group of upper-thoracic esophagus,≤5cm length ofprimary tumor,>18cm length of resected esophagus,>8lymph nodes ofrection, adjuvant radiotherapy could reduced the relapse rates (p<0.05); but ithad a tendency to reduce the relapse rates in group of mild and severeadhesion with surrounding tissue, middle and high-differentiated squamouscell carcinoma. Distant metastasis rate was obviously higher in group ofpostoperative radiotherapy than in non-radiotherapy (p<0.05). The1-,3-,5-year survival rates in group of adjuvant chemotherapy and non-chemotherapy was93.4%,71.3%,57.0%and84.9%,62.7%,48.8%(p>0.05).With subgroup analysis, postoperative adjuvant chemotherapy could improvesurvival rate in group of age>60years old, small mediastinal lymph nodes inpreoperative chest CT scan,type of ulceration, no adhesion with surroundingtissue,(p<0.05). With or without djuvant chemotherapy，the local recurrencerates was similar(p>0.05). With subgroup analysis, for group of age>60years,small mediastinal lymph nodes in preoperative chest CT scan, type of ulceration, tumor length≤5cm, no adhesion with surrounding tissue, adjuvantchemotherapy significantly reduced the local recurrence rate(p<0.05); it had atendency to reduce the local recurrence rate for resected esophageallength>18cm,≤8lymph nodes of rection, middle and high-differentiatedsquamous cell carcinoma(p>0.05). With or with djuvant chemotherapy，thedistant metastasis rates was similar(p>0.05). Subgroup analysis showedadjuvant chemotherapy significantly reduced distant metastasis rate insubgroup of mild adhesions (p <0.05). During the date of follow-up, progressof the disease appeared in115patients：with locoregional recurrence alone in45pts(17.2%), with distant metastases alone in42pts(16.0%), with bothlocoregional recurrence and distant metastases in28pts(10.7%). Afterlocoregional recurrence, the median survival in group of remedial treatmentand non-remedial treatment was3months and13.5months(x2=6.841,p=0.009）. After distant metastases, the median survival in group of remedialtreatment and non-remedial treatment was4months and7.5months(x2=11.558, p=0.001). After locoregional recurrence and distantmetastases, the median survival in group of remedial treatment andnon-remedial treatment was2.5months and14months (x2=12.872, p=0.000).Conclusions: For patients of pT3N0M0esophageal cancer, the desiredeffect was ideal after radical resection. Primary tumor location is theindependent prognostic factors. The prognosis was best in lower thoracic-,better in middle thoracic-and worst in upper thoracic-segment esophagealcarcinoma after surgery. Adjuvant radiotherapy failed to improve survival, didnot significantly reduce the rate of locoregional recurrence, but increasesdanger of distant metastasis. Postoperative adjuvant chemotherapy had nosurvival benefit, neither significantly reduced the rate of locoregionalrecurrence no distant metastasis rates. Once disease progression after radicalrection, remedial radiotherapy, chemotherapy or radiotherapy combined with chemotherapy had a survival benefit. |
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