Failure patterns of radical surgery in patients with T1-4N0-1M0 thoracic esophageal squamous cell carcinoma: implications for the target area design of postoperative therapy

Abstract

Objective To analyze the failure patterns and prognostic factors of radical surgery in patients with T1-4N0-1M0 thoracic esophageal squamous cell carcinoma (TESCC), and the implications for the target area design of postoperative therapy. Methods We retrospectively analyzed 1 191 patients with TESCC who underwent radical surgery at our institution. The failure patterns, the prognostic factors, as well as the effects of lesion locations and N stage on the failure patterns were analyzed. Results The thoracic-region recurrence rate and the distant metastasis rate was 31.7% and 16.4% in all patients. The multivariate analysis showed that the lesion locations, the degree of inflammatory adhesion, T staging, N staging and the rate of lymph nodes metastasis were independent factors affecting the regional recurrence (P<0.05). Gender, tumor differentiation and the rate of lymph nodes metastasis were independent factors affecting distant metastasis (P<0.05). The intrathoracic lymph nodes recurrence rate of upper/middle TESCC was significantly higher than that of the lower TESCC (χ2=6.179, P=0.046), while the abdomen lymph nodes recurrence rate of the lower was significantly higher than that of upper/middle TESCC (χ2=15.853, P<0.05). The recurrence rate and distant metastasis rate of stage N1 patients were significantly higher than that of N0 patients (χ2=7.764-56.495, P<0.05). The abdomen lymph nodes recurrence rate of stage N1 patients was significantly higher than that of N0 in upper TESCC (χ2=7.905, P<0.05). The supraclavicular and intrathoracic lymph nodes recurrence rates of stage N1 patients were significantly higher than that of N0 patients in middle TESCC (χ2=12.506, 18.436, P<0.05). The supraclavicular lymph nodes, anastomosis and abdomen lymph node recurrence rates of stage N1 were significantly higher than that of N0 patients in lower TESCC (χ2=5.272, 4.878, 18.006, P<0.05). The anastomotic recurrence rate of stage T3+ 4 was higher than that of T1+ 2 in middle/lower TESCC (χ2=4.341, 7.154, P<0.05), and the abdominal lymph nodes recurrence rate of stage T3+ 4 was higher than that of T1+ 2 in lower TESCC(χ2=5.366, P<0.05). Conclusions The lymphatic drainage regions for postoperative radiotherapy (PORT) are selective. We suggest that abdominal lymph nodes drainage area should be noted for the stage N1 patients with upper TESCC, and the supraclavicular lymph nodes drainage area should be noted for the N1 patients with lower TESCC. In addition, the anastomosis is suggested to be included in PORT target area for stage T3/T4 middle/lower TESCC patients. Key words: Esophageal neoplasms; Failure mode; Target area