Abstract
BackgroundFive-year overall survival rate of TESCC after surgery is low (approximately 30% to 60%), so it is meaningful to discuss the significance of PORT.MethodsWe retrospectively collected the data of 227 patients with PT3N0M0 esophageal cancer (EC). The failure pattern after surgery was analyzed. Difference of adjuvant PORT in patients with PT3N0M0 TESCC and the appropriate population were explored based on the relevant studies.ResultsThere were 58 cases with intrathoracic locoregional recurrence (LRR) after radical surgery and 27 cases with distant metastasis, including 10 cases of recurrence. The recurrence rate of mediastinal lymph nodes in the thoracic cavity was 50.0%. Univariate analysis revealed that compared with patients with middle and lower thoracic EC, the 3/5-year survival rate of patients with upper thoracic EC was significantly lower, accompanied with remarkably higher thoracic LRR. Compared with those with moderately- and well-differentiated TESCC, the 3/5-year survival rate of patients with poorly differentiated TESCC was significantly lower, whereas the distant metastasis rate was notably higher. Multivariate analysis revealed that different lesion locations and different pathologic differentiation were the independent prognostic factors. The lesion location and degree of differentiation were the independent influencing factors for thoracic LRR and distant metastasis, respectively.ConclusionThe intrathoracic LRR is the major failure pattern for patients with PT3N0M0 TESCC after conventional two-field lymphadenectomy. In addition, recurrence rate of PT3N0M0 TESCC was significantly higher in upper thoracic EC than in middle and lower thoracic EC. PORT is recommended to patients with PT3N0M0 upper TESCC.
Highlights
Five-year overall survival rate of the article squamous cell carcinoma (TESCC) after surgery is low, so it is meaningful to discuss the significance of postoperative radiotherapy (PORT)
In China, it has been reported that adjuvant postoperative radiotherapy (PORT) or PORT combined with postoperative chemotherapy (POCT) contributed to the reduction of postoperative recurrence in clinical practice [1, 6]
Analysis of failure pattern in the whole group In the last follow-up, there were a recurrence of intrathoracic locoregional in 58 patients (LRR; recurrence rate of 25.6% and median recurrence time of 16.4 months, ranging from 2.2 to 81.9 months), distant metastasis in 27 patients, and recurrence with distant metastases in 10 patients
Summary
Five-year overall survival rate of TESCC after surgery is low (approximately 30% to 60%), so it is meaningful to discuss the significance of PORT. In China, it has been reported that adjuvant postoperative radiotherapy (PORT) or PORT combined with postoperative chemotherapy (POCT) contributed to the reduction of postoperative recurrence in clinical practice [1, 6]. Few literatures reported whether adjuvant PORT or combined RCT can reduce recurrence rate of PT3N0M0. Yang et al [7] reported that compared with surgery alone, postoperative assisted three-dimensional conformal radiotherapy (3D-CRT) decreased postoperative recurrence rate of PT3N0M0 TESCC and increased the 5-year disease-free survival (DFS) and OS. Adjuvant PORT was recommended for patients with PT3N0M0 TESCC. To pinpoint the influencing factors of postoperative recurrence of PT3N0M0 TESCC, we investigated the failure pattern of PT3N0M0 TESCC and explored the extent and feasibility of irradiation target after surgery
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