Prognostic Analysis and Treatment Model of Newly Diagnosed Patients with Stage IVB Thoracic Esophageal Squamous Cell Carcinoma

Abstract

To retrospectively assess the clinical characteristics, short-term efficacy, and side effects of newly diagnosed stage IVB thoracic esophageal squamous cell carcinoma (ESCC). 199 patients with stage ⅣB (according to UICC / AJCC 8th edition) newly diagnosed thoracic ESCC, which had been treated in the fourth hospital of Hebei medical university between January 2010 to December 2016, were retrospectively investigated. The difference of TNM classification between Japanese Esophagus Society (JES) 11th edition and UICC/AJCC 8th edition in predicting the prognosis of patients with advanced ESCC. Short-term efficacy: The objective response rate of primary lesion (pORR) was 82.4%. Univariate analysis showed that the tumor location (χ2=7.882，P=0.019) and treatment modalities (χ2=24.218, P =0.000) were the main factors for pORR. The pORR of upper thoracic esophagus was significantly higher than that of middle and lower thoracic esophagus (χ2=7.846, P =0.005; χ2=6.236, P =0.013). The pORR of chemotherapy group, radiotherapy group, and radiochemotherapy group were 37.5%, 86.0%, and 86.5%, respectively. The improvement rate of dysphagia (DIR) was 77.2%. Univariate analysis showed that the type of metastasis (χ2=13.513, P=0.001) and treatment modalities (χ2=13.790, P=0.001) were the main factors for DIR. The DIR of distant lymph node metastasis only was significantly higher than that of solid organ metastasis only (χ2=12.812, P =0.000). The DIR of chemotherapy alone , radiotherapy alone and radiochemotherapy were 30.0%, 77.5%, and 81.5%, respectively. The median OS (mOS) of the entire cohort was 14.0 months (95% CI: 11.826-16.174m), and the survival rates for 1 year, 3 years, and 5 years were 53.2%, 15.8%, and 10.7%, respectively. Multivariate analysis showed that tumor length, the number of metastatic organs, and chemotherapy were independent prognostic factors for OS. According to TNM classification of esophageal cancer of JES 11th edition, there was no significant difference for OS between stage Ⅲ and stage Ⅳ(χ2=0.521, P=0.470). For metastatic esophageal cancer, compared with chemotherapy and radiotherapy alone, radiotherapy combined with chemotherapy could obtain good local control, improve dysphagia and might prolong survival. For patients with good performance status, radiotherapy could be considered on the basis of systemic chemotherapy to participate in the comprehensive treatment of stage Ⅳ esophageal cancer as far as possible, and individualized choice of sequential or simultaneous radiotherapy and chemotherapy mode.