| Objective: Esophageal Cancer is one of the most common malignant tumors in China, and its incidence is very high in Hebei Province. Nowadays, surgery remains the main option for the treatment of oesophageal cancer, particularly for early and middle stage patients. Clinical Practice Guidelines for the Diagnosis and Treatment of Esophageal Cancer, pubished by Esophageal cancer Professional Committee of Chinese Anti-Cancer Association, pointed out that N0 stage patients could be followed up only or given radiotherapy/chemotherapy, postoperatively. On the other hand, NCCN guidelines suggests that no addition treatment is needed for N0 stage patients after surgery. Currently, it is still in debate whether N0 stage patients need further interference. In the following research, two types of N0 stage postoperative candidates were analyzed, which were single-treatment of surgery and combined-treatment of surgery plus adjuvant chemotherapy. To investigate whether postoperative treatment is necessary and if the answer is yes, which plan should be considered.Methods: Clinical notes and follow up information of 238 patients who underwent esophagectomy for cancer in the Fourth Hospital of Hebei Medical University from Jan. 2008 to Feb. 2011 were collected and analysezd. They were randomly divided into surgery group and postoperative adjuvant chemotherapy group. Related factor including age, sex, medical history, history of smoking, drinking history, tumor location, tumor size, tumor histological type, pathological stage, depth of tumor invasion, the number of lymph node dissection and postoperative chemotherapy were investigated. Patient revisit information such as survival status, feeding state, living situation, positive symptoms, recent change in weight, the recent review time, the recent review sites, relevant content for inqyiry, results of review, the time of recurrence or metastasis, sites of recurrence or metastasis, the number of postoperative chemotherapy, time of death, cause of death, other notes were inquired. There were 160 males(67.2%), 78 females(32.8%), the ratio of males to females was 2: 1, ages ranging from 38 to 84 years with the median age 62 years. One hundred and three pations(43.1%) were?60 yeas old and 56.7% were >60 old the median length of 4cm(length range of 1-15cm), divided into two groups: 102(42.9%) cancers were ?5cm in length and 136(57.1%) were<5cm. 247 patients were examined with gastroscopy before surgery, and the remaining five patients did not undergo endoscopic examination. According to the results of endoscopic examination, cancer was located in the upper third in 28 patients(11.8%), middle third in 111 patients(46.6%). Well differentiated cancer was found in 1 ptient(0.4%), moderately differentiated in 44(18.5%), low differentiated in 189(79.4%), undifferentiated in 4(1.7%). Stage?B was demonstrated in 42 patientss(17.6%), stage?A in 78(32.8%), stage?B in 118(49.6%). According to the depth of invasion, there were stageT1 in 45 patients(18.9%), stageT2 in 58(24.4%), stageT3 in 135(56.7%). All patients were diagnosed by the upper gastrointestinal contrast radiography, gastroscopy, chest CT scan,abdominal CT scan and other auxiliary examination to learn more about the the infiltrating range of the lesions and distant metastasis. All patients were not given chemotherapy and radiotherapy before surgery. All operations were performed under general anesthesia. The number of intraoperative lymph node dissectin was equal or greater than 6, the number of lymph node metastasis was 0, the number of total retrieved lymph nodes was 2450, and the average number ofIntraoperative Lymph node dissectin was 10(range is 6~28). The number of intraoperative lymph node dissectin was ?12 in 78 patients(32.8 %), <12 in 160 patients(67.2%). According to the inclusion criteria, eligible patients were randomly divided into postoperative adjuvant chemotherapy group(n=118) and operation only group(n=120). Chemotherapy regimens was 3~4 cycles of "tegafur + platinum" for. According to the results of follow-up study, 3-year survival rate and 5-year survival rate were calculated. SPSS17.0 statistical software was used for statistical analysis, and the survival rate was analyzed by Kaplan-Meier method. Comparisons of the difference in survival rates between groups were assessed by Log-Rank test. The prognostic factors were analyzed by Cox proportional hazard model.Results: Follow-up ended on March 2016 and the follow-up rate was 94%. Three-year and 5-year DFS was 49.2% and 43.3% for all 238 patients, relatively, with a median of 33 months. The 3-year and 5-year OS was 55.5% and 45.0%, with a median of 46 months. With univariate analysis, tumor location, tumor histological type, pathological staging, depth of tumor invasion, the number of lymph node dissection ?12, postoperative chemotherapy were related with OS in patients of pT1-3N0M0 esophageal cancer after radical resection(P<0.05). Age, sex, past medical history, history of smoking, drinking history, tumor size ?5cm were not related with OS prognosis in patients of pT1-3N0M0 esophageal cancer after radical resection(P>0.05). With univariate analysis, tumor location, tumor histological type, pathological staging, depth of tumor invasion, the number of lymph node dissection?12, postoperative chemotherapy were related with DFS in patients with pT1-3N0M0 esophageal cancer after radical resection(P<0.05). Age, gender, past medical history, history of smoking, drinking history, tumor size ?5cm were not related with DFS prognosis in patients of pT1-3N0M0 esophageal cancer after radical resection(P>0.05). Multivariate analysis revealed that depth of tumor invasion(P=0.000<0.05), the number of lymph node dissection(P=0.000<0.05) were all independently associated with OS.Conclusions:1 Surgical treatment for esophageal carcinoma of pT1-3N0M0 would have an ideal effect. Depth of tumor invasion(P=0.000<0.05) was associated with OS and DFS independently. The deeper the tumor invasion is, the worse the prognosis is.2 Whether the number of lymph node ?12(P=0.000<0.05) was also associated with DFS and OS independently. Sufficient number of lymph node dissection would result in better survival rate and contribute to cancer staging, providing necessary reference for adjuvant therapy.3 Postoperative adjuvant chemotherapy was also associated with DFS and OS independently and can improve pT3N0M0 of esophageal carcinoma patients after DFS and OS, for pT1-2N0M0 of thoracic esophageal carcinoma patients, it showed no survival benefit, the patients with pT3N0M0 disease need adjuvant chemotherapy. |
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