Abstract
Esophageal squamous cell carcinoma (ESCC) is the most common pathological type of esophageal cancer in China. Patients with ESCC have poor long-term survival, especially those with lymphatic metastasis (pN + ESCC). In this retrospective study, we evaluated the correlates of long-term survival time of patients with pN + ESCC. A total of 453 patients with pN + ESCC who underwent surgical R0 resection between Jan 2008 and Sep 2011 were enrolled. The follow-up ended on December 2019. The clinical, pathological, inflammation-related factors and general survival data of these patients were analyzed using SPSS 22.0 software. The 1-, 3-, and 5-year overall survival (OS) rates were 73.7%, 34.6%, and 25.6%, respectively; the 1-, 3-, and 5-year disease-free survival (DFS) rates were 45.0%, 26.3%, and 20.4%, respectively. The median OS and DFS were 23 and 14 months, respectively. On multivariate analyses, gender, site of lesion, number of dissected lymph nodes, stage pTNM, adjuvant therapy, and neutrophil lymphocyte ratio were independent predictors of OS. Site of lesion, stage pTNM, and adjuvant therapy were independent predictors of DFS. Recursive partitioning analysis (RPA) scores of each patient were calculated based on the independent predictors of OS, and the patients were divided into 3 classes: low-risk, medium-risk, and high-risk. The OS, DFS, and local recurrence-free survival were significantly different among these three RPA classes (P < 0.001). Several factors showed an independent association with long-term postoperative survival of pN + ESCC patients after radical surgery. RPA scores can potentially be used to predict the prognosis of ESCC.
Highlights
Esophageal cancer (EC) is the fifth most commonly occurring cancer and the fourth leading cause of cancer-related deaths in China [1]
Esophageal squamous cell carcinoma (ESCC) is the most common pathological type of EC in China; in contrast, esophageal adenocarcinoma is the predominant type in the Western World [2]. e National Comprehensive Cancer Network (NCCN) guidelines recommend neoadjuvant chemoradiotherapy for EC patients [3]
The five-year survival rates of Chinese patients with ESCC are not satisfactory. e NCCN guidelines recommend only regular follow-up for EC patients who have undergone radical surgery [3]. e difference between the therapeutic strategies employed in China and other countries may influence the general outcomes of ESCC
Summary
Esophageal cancer (EC) is the fifth most commonly occurring cancer and the fourth leading cause of cancer-related deaths in China [1]. E difference between the therapeutic strategies employed in China and other countries may influence the general outcomes of ESCC. Pathological, and inflammatory indices are known to impact survival of patients with local advanced ESCC [4,5,6,7,8,9,10,11,12,13,14,15]. Many studies have demonstrated the influence of neutrophil lymphocyte ratio (NLR) and the lymphocyte monocyte rate (LMR) on the general outcomes of ESCC [13,14,15]. We retrospectively evaluated the long-time survival outcomes and identified their correlates in patients with stage pT2-4N1-3M0 ESCC. Comparison of our results with those reported from other countries may facilitate stratification of patients based on survival risk and help direct postoperative adjuvant therapeutic strategy for these patients
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