| Objective: To retrospectively analysis of the curative effect of phase III thoracic esophageal carcinoma after radical resection. Analyze the value of postoperative adjuvant therapy and the laws of postoperative recurrence. In the meantime investigate postoperative radiotherapy target range.Methods: We collected the clinical data of 504 cases of patients who suffered from esophageal cancer were treated with radical resection and its clinical stage was proved UICC Stage III after sugery in the Fourth Hospital of Hebei Medical University From Jan 2008 to Dec 2011. Among them, 388 were male and 116 were female. The median age was 60 years old(range 37-83 ys). Also, 476 cases were treated with two field lymph node dissection and 28 cases were treated with three field lymph node dissection. The location of lesions: there was 44 cases located in the upper-, 334 cases in the middle-, and 126 cases in the lower- thoracic esophagus. The median length of primary tumor was 6cm(range 1.5~16cm). Intraoperative adhesion degree: no adhesion in 10 cases, mild adhesion in 170 cases, 237 cases of severe adhesion, the other 87 cases did not record the adhesion degree. Anastomotic location: cervical anastomosis in 43 cases, pleural top anastomosis in 26 cases, aortic arch anastomosis in 348 patients, and 87 cases under the aortic arch. The median lymph node of dissection was 10(range 1-34). The postoperative pathology: The T staging : T3 type in 427 cases, T4 type in 77 cases; The N stage: N0 type in 25 cases, N1 type in 300 cases, N2 type in 148 cases, N3 type in 33 cases. The clinical stage: IIIa stage in 292 cases, IIIb stage in 128 cases, IIIc stage in 84 cases. Type of the postoperative pathology: squamous cell carcinoma in 444 cases(88.1%), adeno carcinoma in 19 cases(3.8%), other type in 41 cases(8.1%). After surgery, adjuvant therapy was used in 367(64cases with postoperative radiotherapy, 264 cases with postoperative chemotherapy, 39 cases with postoperative radiatherapy and chemotherapy) and without in 137 pts. The statistical analysis used SPSS13.0 statistical software.Results:Follow-up ended on September 31, 2014. The 1-,3-, 5-year overall survival rates was 73.0%,34.4% and 26.7%, and the median was 22 months. With univariate analysis, the site of lesion, N and clinical staging, lymph node of metastasis degree(0/≤25%/25%~50%/>50%), field of lymph node of metastasis(0/1/>1), method of operation(two field/ three field), postoperative adjuvant therapy was related with OS(p<0.05). With multivariate analysis,the site of lesion, method of operation, N staging, postoperative adjuvant therapy were the independent factor on postoperative of Stage III thoracic esophageal carcinoma on OS. The 1-,3-,5- years progression free survival,(PFS) was 57.9%、32.7% and 27.1%, and the median was 16 months. With univariate analysis, the site of lesion, pathological stump, N and Clinical staging, lymph node of metastasis degree, field of lymph node of metastasis and postoperative adjuvant therapy was related with PFS(p<0.05). With multivariate analysis, method of operation, the number of lymph nodes,pathological stump,N staging and postoperative adjuvant therapy were the independent risk factors on PFS. The 1-,3-,5- years local recurrence rates was 24.0%,53.6% and 59.0%, With univariate analysis, the site of lesion, pathological stump, N, Clinical staging and, lymph node of metastasis degree, field of lymph node of metastasis and postoperative adjuvant therapy was related with local recurrence(p<0.05).With multivariate analysis, The pathological type, pathological stump, N staging and postoperative adjuvant therapy were the independent risk factors on local recurrence.The 1-,3-, 5-year overall distant metastasis rates was 15.5%, 27.5% and 31.6%. With univariate analysis, the site of lesion, pathological stump, N, lymph node of metastasis degree and field of lymph node of metastasis are related with distant metastasis. The pathological type, pathological stump, lymph node of metastasis degree and field of lymph node were the independent risk factors on distant metastasis.The 1-,3-, 5-year overall survival rates was 85.4%,45.6%,36.4% and 69.8%,31.5%,24.1% for with or without postoperative adjuvant radiatherapy respectively(p=0.002). The 1-,3-, 5-year overall survival rates was 78.2%,37.5%,30.6% and 65.2%,29.7%,21.1% for with or without postoperative adjuvant chemotherapy respectively(p=0.004).With subgroup analysis, Postoperative radiotherapy and chemotherapy all could increase survival rate in the middle-thoracic esohuageal cancer and with lymph node of metastasis postoperatively( p<0.05).The adjuvant radiotherapy could effectively reduce the postoperative local regional recurrence rate(p=0.000).However with/without postoperative adjuvant chemotherapy resembled postoperative local regional recurrence(p=0.986). During the date of follow-up, progress of the disease appeared in 339 patients(67.3%): with locoregional recurrence alone in 220 pts, with distant meatastases alone in 93 pts, with both locoregional recurrence and distant metastases 26 pts.There are 401 pts did not Postoperative radiation. With locoregional recurrence in 210pts(41.7%), among them 183 pts are evaluable, altogether 223 recurrent lesions. with neck/supraclavicular area in 54pts(24.2%), with mediastinum in 113pts(50.7%), with lower mediastinum in 16pts(7.2%), with upper abdomen in 40pts(17.9%)(χ2=122.182,p=0.000). The recurrence rate of neck/supraclavicular area of upper, middle and lower are 23.1%(3/13), 33.3%(43/129) and 19.5%(8/41),(p>0.05). The recurrence rate of mediastinal area of upper, middle and lower are 61.5%(8/13), 62.0%(80/129) and 70.0%(25/41),(p>0.05). The recurrence rate of abdominal area of upper, middle and lower are 30.8%(4/13), 17.1%(22/129) and 34.1%(14/41),(p=0.05). Further compared the lower-thoracic abdomen area recurrence rate with middle-thoracic abdomen area recurrence rate, result showed former was significantly higher than the later(p<0.05).Conclusion:The postoperative overall prognosis of phase III esophageal carcinoma was not so good. The site of lesion, method of operation, N staging, postoperative adjuvant therapy were the independent factor on OS. The prognosis effect on lower-, upper- and middle-thoracic cancer was from best to worst in a row. Thoracic abdomen Three field postoperative prognosis was better than two field. The prognosis was getting worse while the N staging was getting later. Postoperative adjuvant radiatherapy could improve the prognosis of phase III esophageal carcinoma and reduce the local regional recurrence rate, but couldn’t lower distant metastasis rate. Postoperative adjuvant chemotherapy could improve the prognosis of phase III esophageal carcinoma, but it couldn’t reduce the local regional recurrence rate and lower distant metastasis rate. The relapse position of patients with local regional recurrence was mainly upper mediastinum and then cervical locked area. The recurrence rate of lower-rhoracic cancer abdomen local regional area was higher. |
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