Prognostic Factors in Patients with Squamous Cell Cancer of the Esophagus Undergoing Transthoracic En Bloc Resection

Abstract

Identification of tumor characteristics which may limit survival in patients with squamous cell carcinoma of the esophagus is critical for the selection of those patients who may benefit from surgical resection and the choice of the radicality of the procedure. We evaluated the tumor characteristics which independently influenced survival in 204 consecutive patients with squamous cell carcinoma of the esophagus who had undergone en bloc resection and extensive lymphadenectomy. Multivariate analysis in the entire patient population identified the presence of residual tumor after resection, i.e., a R1 or R2 resection, and the presence and more than seven mediastinal lymph node metastases as the only independent factors influencing survival time. In a second multivariate analysis of 75 patients who survived the procedure for at least 30 days, who had a R0 resection, and who did not have preoperative neo-adjuvant therapy, only the pN category and the ratio between positive and removed mediastinal lymph nodes independently influenced survival. These data suggest that only a R0 resection, i.e., complete macroscopic and microscopic tumor removal, can increase survival in patients with squamous cell carcinoma of the esophagus. In patients with a limited number of positive mediastinal lymph nodes, the prognosis may be improved by an extensive lymphadenectomy if the number of removed mediastinal lymph nodes exceeds the number of positive nodes by a factor of at least five.