Association of local factors with treatment failure patterns in esophageal squamous cell carcinoma without clinical metastasis

Abstract

Objective To investigate the association of local factors with local recurrence (LR) and distant metastasis (DM) in patients with esophageal squamous cell carcinoma (ESCC) who do not experience clinical metastasis. Methods A total of 236 eligible ESCC patients were analyzed retrospectively, and the association of lesion length on esophagography, maximum tumor diameter, and tumor volume with survival and treatment failure pattern was analyzed. Kaplan-Meier test and Cox regression were used for survival analysis and to identify prognostic factors. Results The 1-, 3-, and 5-year overall survival rates, LR rates, and DM rates were 88.6%, 52.4%, 30.2%, 15.5%, 35.6%, 45.8%, and 9.0%, 22.2%, 30.6%, respectively. The multivariate analysis showed that short-term treatment outcome and maximum tumor diameter were independent prognostic factors for overall survival rate (P=0.000, 0.019); sex, maximum tumor diameter, irradiation method, and short-term treatment outcome were independent prognostic factors for LR (P=0.039, 0.003, 0.045, 0.000); maximum tumor diameter was the independence factor for DM (P=0.035). In the patients receiving elective nodal irradiation and involved-field irradiation, the maximum tumor diameter was the prognostic factor for LR (P=0.008, 0.001), and the lesion length on esophagography, maximum tumor diameter, and tumor volume were prognostic factors for DM (P=0.009, 0.023, 0.014). Conclusions In ESCC patients without clinical metastasis, local factors are significantly associated with LR and DM, among which maximum tumor diameter is the most important factor. Key words: Local factors; Treatment failure mode; Esophageal neoplasms/radiotherapy; Esophageal neoplasms/chemotherapy