| Part one Prognostic factors for patients of stage pN0 esophageal carcinoma after resectionObjective: To retrospectively investigate the prognostic factors and the value of postoperative adjuvant therapy in patients of stage pN0 thoracic esophageal carcinoma(EC)after resection.Methods: From Jan 2008 to Dec 2012,1250 cases of EC patients which had treated with esophagectomy,postoperative pathological stage pN0 and survival time more than 1 months after surgery were enrolled in this study.Among them,828 males and 422 females.The median age was 61 years old(range 31-86 ys).There were 311 patients had mediastinal small lymph node(diameter <1cm)before surgery.Also,1214 cases were treated with two-field esophagectomy and 36 cases were treated with three-field esophagectomy.As for the site of primary tumor,there was 167 cases located in upper-,863 cases in middle-,and 220 cases in lower-thoracic esophagus.The median length of lesion was 5cm(range 0.2-14cm).The adhesion degree at surgery was record as no adhesion in 120 cases,mild adhesion in 563 cases,severe adhesion in 415 cases,and undefined in 152 cases.Site of stoma was located at cervical in 157 cases,pleural top in 62 cases,above the aortic arch in 907 cases,and 124 cases under the aortic arch.The median of dissection lymph node at surgery was 9(range 0-35).Type of pathology was as following: moderately or well differentiated squamous cell carcinoma in 1042 cases,poorly differentiated squamous cell carcinoma in 121 cases,non squamous cell carcinoma in 87 cases.As for postoperative pathological stage T,stage pT1 in 185 cases,pT2 in 276 cases,pT3 in 755 cases,and pT4 in 34 cases.13 cases were treated with neoadjuvant chemotherapy.622 patients were treated with postoperative adjuvant therapy,49 with postoperative radiotherapy(PORT),547 with postoperative chemotherapy(POCT),66 cases with postoperative radiochemotherapy(POCRT)and 588 patients with surgery alone.The statistical analysis was used with SPSS21.0 statistical software.Results: The follow-up ended at December 1,2016.17 cases was lost to follow-up,the follow-up rate was 98.64%.There were 450 patients(36.0%)had occurred with tumor progression.Among them,there were 287 pts(23.0%)with loco-regional recurrence,102 pts(8.2%)with distant metastasis,and 61 patients(4.9%)with both loco-regional recurrence and distant metastasis.After surgery,the 1-,3-,5-year overall survival(OS)rates was 92.7%,72.6% and 62.1%.Univariate analysis showed that gender,age,tumor site,mediastinal small lymph node before surgery,style of surgery,adhesion degree at surgery,the number of dissected lymph nodes,type of pathology,positive stump,vascular tumor embolus,postoperative stage T,postoperative adjuvant therapy were associated with OS(P<0.05).With multivariate analysis,gender,age,tumor site,mediastinal small lymph node before surgery,adhesion degree at surgery,the number of dissected lymph nodes,type of the pathology,stage pT,postoperative adjuvant therapy were independent factor for OS.The 1-,3-,5-years progression free survival(PFS)was 83.8%,63.9% and 56.9%.Univariate analysis showed that,gender,age,tumor site,small lymph node in the mediastinum(diameter <1cm)before surgery,lymph node dissection type,adhesion degree at surgery,the number of dissected lymph nodes,type of pathology,stump positive or not,vascular tumor embolus,stage pT,postoperative adjuvant therapy were associated with PFS(P<0.05).Multivariate analysis showed that,age,tumor site,small lymph node in the mediastinum(diameter <1cm)before surgery,adhesion degree at surgery,the number of dissected lymph nodes,type of pathology,stage pT,postoperative adjuvant therapy were independent factors for PFS.The 1-,3-,5-years OS rates were 89.5%,69.7%,59.1% for patients with surgery alone,83.7%,59.2%,39.6% for patients with PORT and 94.3%,76.6%,68.4% for patients with POCT,respectively.The 1-,3-,5-years PFS rates were 80.9%,62.2%,55.2% for patients with surgery alone,71.4%,44.9%,34.3% for patients with PORT and 87.8%,68.7%,62.5% for patients with POCT,respectively.Compared with surgery alone,POCT could increase the OS and PFS(P<0.05),but PORT could decrease the OS and PFS(P<0.05).Further analysis showed that,compared with surgery alone,there were more patients with pT3-4 or severe adhesion at surgery in group of PORT(P<0.05).Conclusions: For patients of stage pN0 esophageal cancer after resection,female,younger ages,middle or lower thoracic EC,no mediastinal small lymph node before surgery,more dissected lymph nodes,no or mild adhesion at surgery,stage pT1-2,moderately or well differentiated squamous cell carcinoma or with POCT,the prognosis was better;and vise verse.But the value of PORT needs to be confirmed furtherly.Part two The pattern of recurrence for patients of stage pT1-3N0M0 esophageal squamous-cell carcinoma after radical resection.Objective: To retrospectively analysize the patterns of recurrence and its related factors for patients of stage pT1-3N0M0 esophageal squamous cell carcinoma(ESCC)after two-field radical resection.Methods: From Jan 2008 to Dec 2012,488 ESCC patients which were treated with radical two-field esophagectomy,postoperative pathology stage as pT1-3N0M0,and the survival time 3 months or more than after surgery were enrolled in this study.Among them,303 were males and 185 were females.The median age was 62 years old(range 34-86 ys).As for the tumor site,61 cases were located in the upper-,344 cases in the middle-,and 83 cases in the lower-thoracic esophagus.According with 7th AJCC TNM criterion for esophageal carcinoma,there were 102 patients in stage pT1,126 in pT2 and 260 patients in stage pT3.The statistical analysis was used with SPSS21.0 statistical software.Results: For stage pT1-3N0M0 ESCC patients after radical resection,total recurrence rate was 36.9%,loco-regional(LR)rate was 21.5%,the distant metastasis was 6.8%,both loco-regional and distant metastasis was 8.6%,respectively.Chi square test shows that,tumor site,the number of dissected lymph nodes,small lymph node in the mediastinum(diameter <1cm)before surgery,stage pT were associated with total recurrence(P<0.05).With Logistic multivariate analysis,tumor site,the number of dissected lymph nodes,small lymph node in the mediastinum(diameter<1cm)before surgery,stage pT were independent factors for relapse in patients of stage pT1-3N0M0 ESCC after radical resection.The total LR rate was 30.1% in those patients.The rates of LR at cervical,mediastinum,abdomen accounted for the total LR were 21.1%,80.3%,7.5%,respectively.Chi square test shows that tumor site,small lymph node in the mediastinum(diameter <1cm)before surgery,stage pT were associated with LR(P<0.05).With Logistic multivariate analysis,tumor site,the number of dissected lymph nodes,and stage pT were independent factors for LR in patients of stage pT1-3N0M0 ESCC after radical resection.Conclusions: The recurrence rate was very high in patients of stage pT1-3N0M0 ESCC after radical resection,most of it was LR,and mainly occurred in mediastinum.Tumor site,the number of dissected lymph nodes,and stage pT were independent risk factors for the total recurrence and LR;For patients of upper thoracic ESCC,less dissected lymph nodes,stage pT3-4,the recurrence rate was very high.For patients of mediastinal small lymph node before surgery,the recurrence rate was increased. |
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