Analysis of postoperative failure in patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma and consideration of postoperative radiotherapy

Abstract

Objective To investigate the failure mode in patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma (TESCC) after surgery, and to discuss the significance and feasibility of postoperative radiotherapy according to the failure mode. Methods A retrospective analysis was performed on 227 patients with stage pT3N0M0 TESCC who met the inclusion criteria from January 2007 to December 2010. Their postoperative failure mode was analyzed, and, with reference to relevant research, the significance of postoperative radiotherapy and its target patients were explored. The Kaplan-Meier method was used to calculate overall survival (OS), local recurrence (LR), and distant metastasis (DM) rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox model was used for multivariate prognostic analysis. Results After surgery, there were 58 patients (25.6%) with LR in the thoracic cavity and 27 patients (11.9%) with DM, and 10 patients had both LR and DM. Twenty-nine (50%) of the 58 patients had recurrence in the thoracic mediastinal lymph nodes. The results of univariate analysis showed that the 3-and 5-year OS rates of patients with upper thoracic esophageal cancer were significantly lower than those of patients with middle and lower esophageal cancer (P=0.000), and the chest-regional recurrence rate was significantly higher in the former group than in the latter two groups (P=0.047); the 3-and 5-year OS rates of patients with poorly differentiated squamous cell carcinoma were significantly lower than those of patients with moderately and well differentiated squamous cell carcinoma (P=0.005), and the DM rate was significantly higher than in the former group than in the latter two groups (P=0.000). The results of multivariate analysis showed that lesion site and the degree of pathological differentiation were independent prognostic factors for OS (P=0.014 and 0.010); lesion site was the independent prognostic factor for chest-regional recurrence (P=0.046); the degree of pathological differentiation was the independent prognostic factor for DM (P=0.000). Conclusions For patients with stage pT3N0M0 TESCC after two-field esophagectomy, the most common failure mode is chest-regional recurrence, especially in patients with upper thoracic esophageal cancer. Therefore, postoperative radiotherapy is suggested for upper-thoracic TESCC. Key words: Esophageal neoplasms/surgery; Recurrence; Prognosis