| Objective: Retrospective analysis of recurrence and metastasis after treatment of significance and operation assisted radical postoperative stage p T2N0-1M0 carcinoma of the thoracic esophagus rules.Method: From January 2008 to December 2011, 275 cases of stage p T2N0-1M0 thoracic esophageal cancer which were diagnosized and treated with radical resection. Among them, male in180 and female in 95 cases; median age was 61 years-old(range 39 to 79 years old); Site of primary tumor was located upper- in 32, middle- in 186, and low-thoracic in 57 cases. The degree of adhesions during surgery was no adhesion in 18 cases(51 cases which were not descriptive the degree of adhesion were included in this group), mild adhesions in 149 cases, and 57 cases in severe adhesions. The site of anastomosis was located neck in 28, pleural top in 12, above arch in 199 and under the arch in36 patients. The median of lymph node removal during surgery were 9(range from 0 to 33). There were 254 cases with squamous cell carcinoma(92.4%, 214 cases with well- or middle differentiated squamous cell carcinoma(SCC), 40 cases with poor differentiated squamous cancer), 21 cases with non-SCC(7.6%). There were 205 cases in stage N0 and 70 in stage N. The Primary tumor has invasion into the superficial musclar infiltration in 115 cases and deep muscular infiltration in 160 cases. There were 18 patients with positive stump. SPSS17.0 statistical software was used to statistical analysis.Result: The end of Follow-up was September, 2014. The 1-, 3-, 5-year overall survival(OS) rates were 95%, 72%, 68.0%; the 1-, 3-, 5-year rates of progression-free survival(PFS) were 87.0%, 64.0% and 54.0%, respectively. Univariate analysis showed, with or without small lymph nodes in preoperative CT, depth of invasion, pathological type, stage N, and numbers of metastatic lymph node were associated with OS and PFS; gender was associated with PFS also; with or without small lymph nodes in preoperative CT, N, the number of metastatic lymph nodes, and pathological type were relate with locoregional recurrence rate; N and the number of metastatic lymph nodes were related with distant metastasis, P<0.05. With multivariate analysis, site of primary tumor, pathological type, the number of metastatic lymph nodes, the status of stump were independent factors for OS; site of primary tumor, the number of metastatic lymph nodes, infiltration depth, postoperative adjuvant therapy were independent factors for PFS;site of primary tumor, pathological type, the number of metastatic lymph nodes were independent factors for local recurrence; the number of metastatic lymph nodes was the only independent factor for distant metastases. And radiotherapy(PORT) and postoperative chemotherapy(POCT) has failed to significantly improve OS, PFS, localregional recurrence and distant metastasis rate(P>0.05). The overall recurrence rates was 38.2%(105/275) for all patients; the rates of localregional recurrence, distant metastasis and combined recurrence were 64.8%(68/105), 19.1%(20/105), 6.7%(7/105); the rate of anastomotic recurrence was 9.5%(10/105). There were 75 cases occurred with localregional recurrence for all patients, 12.0%(9/75) in supraclavicular, 80.0%(60/75) in mediastinal and 10.7%(8/75)in intraperitoneal region. For patients of recurrence in mediastinum, there were 43.8%(14/32) in upper-thoracic, 26.9%(50/186) in middle-throacic and 19.3%(11/57) in low-thoracic esophagus. The recurrence of 89.3%(67/75) located in carinal and above and 10.7%(7/75) loacted below carinal. The rates of recurrence in carinal and above were 85.7%(12/14) in upper-, 90.0%(45/50) in middle- and 100%(11/11) in low-thoracic EC. The total rates of distant metastasis was 25.7%(27/105), 20 cases with distant metastases only, 8 cases with metastasis in lung, 4 in liver, 3 in bone, the remaining 12 cases were transferred to other sites.Conclusions: For patients of stage p T2N0-1M0 thoracic EC after radical resection, upper-thoracic EC has the lowest OS and the highest localregional recurrence rate; secondly by middle-thoracic EC; and low- thoracic EC has the highest OS and the lowest localregional recurrence rate. N1 and more numbers of metastatic lymph node has associated with poor OS and PFS,and higher rates of localregional recurrence and distant metastasis. The well- or middle-differentiated SCC was related with higher OS and lower localregional recurrence; but poor- differentiated SCC and no-ESCC was related with lower OS and higher localregional recurrence. PORT and POCT could not improved OS, PFS, localregional recurrence and distant metastasis. Postoperative recurrence was occurred about 30%, and localregional recurrence was the most common site of recurrence, especially in upper mediastinal and supraclavicular region, and those site may be the key target for PORT. |
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