Clinical features of esophageal cancer patients with long-term survival and related factors for treatment

Abstract

Objective To investigate the clinical features of esophageal cancer patients with long-term survival after precise radiotherapy, related factors for treatment, and the conditions for survival benefits, and to provide a reference for clinical practice. Methods A retrospective analysis was performed for 913 patients with esophageal cancer who received single-dose radiotherapy from 2003 to 2009. The clinical features, related factors for chemoradiotherapy, adverse events, and short-term therapeutic effect were compared between long-term survival group (a survival time of ≥60 months) and non-long-term survival group, and a prognostic analysis was performed. The chi-square test was used for comparison between groups, the Kaplan-Meier method was used to calculate survival rates, the log-rank test was used for survival difference analysis, and the Cox proportional hazards model was used for multivariate prognostic analysis. Results There were 217 patients in the long-term survival group and 696 in the non-long-term survival group. There were differences in sex, tumor location, length of lesions, transverse diameter, surrounding invasion, non-surgical stage, and gross tumor volume (GTV) between the two groups (P=0.010, 0.002, 0.000, 0.000, 0.000, 0.000, 0.000). The 1-, 3-, 5-, 7-, and 9-year overall survival rates were 72.5%, 35.3%, 25.8%, 19.1%, and 13.9%, respectively, and the median survival time was 21 months. Compared with the non-long-term survival group, the long-term survival group showed a shorter course of radiotherapy and better dose-volume parameters including GTV and planning target volume, and GTV D100 and D95 showed differences between the two groups (P=0.024 and 0.024). Compared with the non-long-term survival group, more patients in the long-term survival group received concurrent chemotherapy and showed a higher degree of acute esophagitis and a better short-term outcome (P=0.018 and 0.000), while no patient experienced extremely severe pneumonia. The patients with a prescribed dose of less than 60 Gy showed worse survival rates than those with a prescribed dose of ≥60 Gy (P=0.027), and the patients receiving concurrent chemoradiotherapy showed better survival rates than those who did not receive concurrent chemoradiotherapy (P=0.076). The multivariate analysis with the Cox proportional hazards model indicated that tumor location, non-surgical stage, GTV, cycles of chemotherapy, and short-term therapeutic effect were independent prognostic factors. Conclusions There are complex prognostic factors for non-surgical treatment for esophageal cancer, and the stage of disease progression determines the prognosis to a large extent. Meanwhile, radiotherapy with a dose of ≥60 Gy, high-quality treatment plan, concurrent chemotherapy, and good tumor response to treatment are factors for survival benefit. Key words: Esophageal neoplasms/three-dimensional radiotherapy; Esophageal neoplasms/chemotherapy; Prognosis