Analysis Of Prognostic Factors And Values Of Adjuvant Chemotherapy In Patients Who Were Demonstrated With Lymph Nodes Metastasis After Esophagecto My For Squamous Cell Carcinoma

Objective:There is a high incidence of esophageal cancer in our country and surgery is the main treatment for esophageal cancer,but the 5-year survival rate is only about 30% in the patients after surgery.Postoperative radiotherapy or chemotherapy has become the main mean to improve the prognosis in patients.In the NCCN guidenlines for esophageal cancer,patients with esophageal adenocarcinoma need adjuvant chemoradiotherapy if lymph node metastasis was demonstrated after surgery and the patients with esophageal squamous carcinoma are adviced to be treated with chemoradiotherapy or observation.It is well known that there are few primary esophageal adenocarinoma in China,and more than 90% of them are esophageal squamous carcinoma,and the research object of NCCN are mostly foreign patients with esophageal adenocarcinoma,so it can not fully guide the treatment of esophageal cancer in our country.The results of many scholars about the effect of adjuvant chemoradiotherapy on patients after radical resection of esophageal cancer are not consistent.The purpose of this study is to evaluate the value of adjuvant chemotherapy and prognostic factors in patients with esophageal squamous carcinoma,to further explore how to prevent postoperative recuurence of esophageal cancer and improve postoperative long-term survival.Methods:This study retrospectively analyzed the data of 284 patients with esophageal squamous carcinoma who were demonstrated with positive lymph nodes after radical resection in the Fourth Hospital of Hebei Medical University from January 2008 to February 2012.All patients had no previous treatment and no distant metastasis,and their postoperative pathology wereprimary squamous carcinoma with positive lymph nodes.The prognostic factors of this study included gender,age,tumor location,tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation,the number of lymph node dissection,postoperative chemotherapy,smoking history,and drinking history.The above data were analyzed by SPSS21.0 statistical software:Kaplan-Meier survival curve and Log-Rank test were used for univariate survival analysis,and Cox regression was used for multivariate survival analysis.Results:Follow-up was carried out to death of patients or to end of March 2017.The 3-year and 5-year DFS was 28.9% and 21% for all 284 patients after surgery,respectively,and the median survival time was 15months(rang from1 to 110 months).Univariate analysis showed that tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation and postoperative adjuvant chemotherapy were associated with DFS(P<0.05).The tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation and postoperative adjuvant chemotherapy were fit into Cox regression multivariate analysis,the result was showed that N stage(P=0.000<0.05),the depth of tumor invasion(P=0.007<0.05),and postoperative adjuvant chemotherapy(P=0.007<0.05)were the independent prognostic factors for DFS in these patients.The 3-year and 5-year OS was35.2% and 23.9% for all 284 patients,respectively,and the median survival time was 23 months(rang from 1 to110 months).Univariate analysis showed that tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation and postoperative adjuvant chemotherapy were associated with OS(P<0.05).The tumor size,the number of positive lymph nodes(N stage),the depth of tumor invasion,the degree of tumor differentiation and postoperative adjuvant chemotherapy were fit into Cox regression multivariate analysis,the result showed that N stage(P=0.000<0.05),the depth of tumor invasion(P=0.017<0.05),and postoperative adjuvant chemotherapy(P=0.001<0.05)were the independentprognostic factors for OS in these patients.Among the 119 patients who received adjuvant chemotherapy,the differences of chemotherapy regimens was not associated with DFS(P=0.049>0.05),OS(P=0.656>0.05)in patients of esophageal squamous carcinoma with positive lymph nodes after surgery.Conclusions:1 The result of surgical treatment in patients with esophageal squamous carcinoma and lymph node metastasis after surgery is disappointing and the prognosis is poor.The postoperative N staging is an independent prognostic factor for DFS and OS in patients with esophageal squamous carcinoma and lymph node metastasis after surgery.The survival rate decreases with the increase of the number of positive lymph nodes.2 The depth of tumor invasion is an independent prognostic factors for DFS and OS in patients of esophageal squamous carcinoma with positive lymph nodes after surgery.The deeper the tumor invasion is,the worse the prognosisis.3 Postoperative adjuvant chemotherapy could improve DFS and OS of patients with ESCC and LN metastasis,therefore it is suggested that these patients should be treated with adjuvant chemotherapy.4 The different chemotherapy regimens were no significant difference with the survival in patients of esophageal squamous carcinoma with positive lymph nodes after surgery,and we still need large sample to explore.