Effects of tumor diameter on the prognosis of patients with advanced esophageal squamous cell carcinoma after Ivor-Lewis surgical resection

Abstract

Objective To investigate the tumor diameter on the prognosis of patients with advanced esophageal squamous cell carcinoma(ESCC) after Ivor-Lewis surgical resection. Methods The clinical data of 254 patients with advanced ESCC who received Ivor-Lewis surgical resection at the Affiliated Hospital of Tianjin Medical University from January 2005 to December 2008 were retrospectively analyzed. All the patients were followed up via outpatient examination, telephone interview and correspondence till December 2013. Survival curve was drawn by the Kaplan-Meier method, and survival rate was analyzed using the Log-rank test. Receiver-operating-characteristic (ROC) curve analysis was used to determine the appropriate cutoff value of tumor size. Univariate and multivariate analysis were done using the chi-square test and COX regression model. Results Of 254 patients, 223 patients were followed up for a median time of 30 months (range, 3-108 months) with a follow-up rate of 87.80%(223/254). The median total survival time was 27 months, and the 1, 3, 5-year overall survival rates were 72.7%, 42.2% and 31.3%, respectively. ROC analysis showed that the appropriate cutoff value of tumor diameter was 3.5 cm. The median survival time and 5-year survival rate were 36 months and 39.3% in patients with tumor diameter≤3.5 cm and 18 months and 25.4% in patients with tumor diameter>3.5 cm, respectively, with a significant difference (χ2=9.494, P 3.5 cm, lymph node metastasis and no postoperative adjuvant therapy were the independent factors affecting the prognosis of patients with advanced ESCC after Ivor-Lewis surgical resection (HR=1.631, 1.681, 0.677, 95% confidence interval: 1.151-2.312, 1.198-2.358, 0.487-0.942, P 3.5 cm, respectively, with a significant difference (χ2=6.412, P<0.05). Conclusions The tumor diameter>3.5 cm, lymph node metastasis and no postoperative adjuvant therapy are the independent factors affecting the prognosis of patients with advanced ESCC after Ivor-Lewis surgical resection, meanwhile there is an assessed value of tumor diameter on the prognosis of patients without lymph node metastasis. Key words: Esophageal neoplasms; Ivor-Lewis; Tumor diameter; Prognosis