Salvage therapy for postoperative recurrence or metastasis in stage T3N0M0 thoracic esophageal squamous cell carcinoma

Abstract

Objective To analyze the efficacy of salvage therapy for postoperative recurrence or metastasis in patients with stage T3N0M0 thoracic esophageal squamous cell carcinoma (ESCC) and its influencing factors. Methods A retrospective analysis was performed in 108 patients with postoperative recurrence or metastasis in stage T3N0M0 thoracic ESCC who were admitted to our hospital from 2008 to 2009. In those patients, 59 had locoregional recurrence (LR), 26 distant metastasis (DM), and 23 both LR and DM. After recurrence, 53 patients received supportive therapy, 32 salvage radiotherapy, 9 chemotherapy, and 14 chemoradiotherapy. The overall survival (OS) rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The univariate and multivariate prognostic analyses were performed using the log-rank test and the Cox regression model, respectively. Results The follow-up rate was 100%. In all patients, the 1-, 3-, and 4-year OS rates were 29.9%, 16.5%, and 14.4%, respectively; the median OS time was 6 months. The univariate analysis showed that recurrence pattern and salvage therapy were associated with OS after recurrence (P=0.017; P=0.000). The multivariate analysis showed that salvage therapy was the only independent factor for OS after recurrence (P=0.000). Compared with supportive therapy, the risk of death after chemotherapy, radiotherapy, or chemoradiotherapy was reduced by 76.7%, 76.7%, and 86.1%, respectively. Conclusions The treatment outcomes are poor in patients with postoperative recurrence of stage T3N0M0 thoracic ESCC. Salvage therapy can substantially improve OS after recurrence. Key words: Neoplasms recurrence, esophagectomy; Salvage radiotherapy; Salvage chemotherapy; Prognosis