The Relationship Between Tumor Location And Survival Time For The Patients With Esophageal Squamous Cell Carcinoma

1Background and objectiveEsophageal cancer (EC) is one of the six common malignant tumor. At clinicaldiagnosis for the first time, more than ninety percent patients are in advanced stagethat with very poor prognosis, and the five years survival rate is only about tenpercent. Currently the main clinical indicators of TNM staging for measure theprognosis of EC patients include infiltration degree of tumor (T), lymph nodemetastasis (N), distant metastasis (M). TNM classification is the method forprognosis of tumor by grade assessment based on surgical anatomy. Differentcountries, regions, units should be formulate the corresponding clinical guidelinesbased on their own characteristics of disease and medical level, so as to improve thelevel of diagnosis and treatment. Recent studies show that the survival time ofpatients with advanced EC more than ten years is not rare, and hint that the traditionalTNM staging of EC cannot fully reflect the prognosis of the EC.2009InternationalUnion Against Cancer (UICC) seventh version staging for EC had larger changes fordivision standard of T, N, M. The guiding significance of the new added tumor location for the prognosis of thoracic esophageal squamous cell carcinoma (ESCC) inour country should carry out clinical verification. The aim of this study are tounderstand the influence of tumor location on survival situation and verify whether asa prognosis index through survival follow-up on more than twelve thousands patientsof ESCC.2Materials and methods2.1SubjectsIn12,945patients of EC, all were confirmed as ESCC by histopathology. Amongthem,8,005cases were male,4,940cases were female, the ratio male to female was1.6:1, and the median age was60years (26~94years). The middle thoracicesophageal carcinoma were most common (70.1%).2.2MethodsThe face-to-face questionnaire investigations were adopted. The content ofinvestigation mainly included general epidemiology data, cancer incidence of upperdigestive tract, the condition of disease treatment, family history, living habits, et al.The clinical information of each patient were reviewed by the treatment informationof patients (operation time, treatment hospital). The information were includedpathological diagnosis, TNM stage, pathological type, tumor location, differentiationdegree, et al. Regular survival follow-up for these patients were adopted throughhome visits and telephone return. The information of survey and follow-up were putinto the computer. The survey data were to deal with by SPSS19.0statistical software.Age, gender, Tumor location and other clinical pathological features were analyzed by chi-square test. Single factor and survival differences of patients with EC wereanalyzed by Log-rank test. The independent factors for survival were screened byCox hazard proportional model. The test level was α＜0.05.3Results3.1The basic information of the subjectsIn12,945ESCC patients,8,005cases were male,4,940cases were female, and theratio of male to female was1.6:1. The proportion of women: the upper thoracicportion（42.2%）＞the mid-thoracic portion（38.7%）＞the lower thoracic portion（31.2%）, distributions between tumor locations were obviously different（P＜0.001）； the median age was60years old（26~94years old）.The patients at＜50years old (10.1%) were less than≥50years patients (89.9%), The proportion of thepatients at＜50years old: the upper thoracic portion（8.2%）＜the mid-thoracicportion（9.5%）＜the lower thoracic portion（10.7%）. In the gross type, ulcer type(42.6%) were the most, medullary type (38.3%) were second, There was no differencebetween general type distribution of tumor locations（P＞0.05）. In the degree oftumor invasion, T3and T4stage (60.4%) were the most, T2stage (27.2%) were thesecond. The proportion of Tis+T1: the upper thoracic portion（14.9%）＞themid-thoracic portion（12.2%）＞the lower thoracic portion（10.5%）.Distributionsbetween tumor locations were obviously different（P＜0.001）.Lymph node negativemetastasis patients were more than positive patients (61.7%v. s38.3%). Lymph nodepositive metastasis patients: the upper thoracic portion（30.3%）＜the mid-thoracicportion（38.9%）＜the lower thoracic portion（44.2%）.Distributions between tumorlocations were obviously different（P＜0.001）. The most number of lymph node metastasis was1to2（62.1%）, There was no difference between general typedistribution of tumor locations（P＞0.05）. Middle-late tumor patients （TNM-stage：II-IV）90.8%，early cancer rate: the upper thoracic portion（11.2%）＞themid-thoracic portion（9.2%）＞the lower thoracic portion（7.3%）.Distributionsbetween tumor locations were obviously different（P＜0.001）.3.2The influence of clinical and pathologic characteristics on survival ofpatients with ECThe survival time of upper thoracic esophageal cancer patients was significantlyworse than the middle thoracic and lower thoracic patients (χ2=18.3, P＜0.001). Thesurvival time in patients with middle thoracic and lower segment were notsignificantly different (P>0.05). The survival time of male patients with the upperthoracic EC was worse than that with mid-thoracic and lower thoracic EC（χ2=21.1，P＜0.001）. The survival time of female patients between the three groups weresimilar（χ2=4.5，P＞0.05）. The survival time of EC patients at <50year between thethree groups were similar（P＞0.05）. The survival time of patients with the upperthoracic tumor at≥50years old was significantly worse than the middle and lowerthoracic tumor patients (χ2=18.1, P＜0.001). The survival time of the upper thoracicEC patients with different infiltrating degree was worse than that with mid-thoracicand lower thoracic EC（P＜0.05）. The survival time of lymph node negativemetastasis patients with the upper thoracic EC was significantly worse than that withmid-thoracic and lower thoracic EC（χ2=51.0，P＜0.001）. The survival time of lymphnode positive metastasis patients between the three groups were similar（P＞0.05）.The survival time of different clinical stage patients with the upper thoracic EC wassignificantly worse than that with mid-thoracic and lower thoracic EC（P＜0.05）. Through COX multivariate analysis, the results were showed that tumor locationwas one of the independent factors affecting the survival of patients with EC (HR=0.8,P=4.6, E-9; HR=0.8, P=8.0E-9).4Conclusion1) The survival time of EC patients at upper thoracic are significantly worse thanthe middle and lower section.2) The tumor location is one of independent factors that affecting survival time ofpatients with EC.