| Objective: Esophageal cancer is one of the most common malignant tumors in the China.The 5-year survival rate is about 30.0% to 55.5%.But the 5-year survival rate of patients with stage IIA to III esophageal squamous cell carcinoma undergoing surgical resection alone is only 20.6% to 34.0%.Therefore,it is currently advocated that comprehensive treatment based on surgery be performed.The purpose of this study was to analyze the prognostic factors of patients with thoracic esophageal carcinoma in the advanced stage and the significance of different adjuvant treatment methods.Methods: This study collected data from patients with advanced thoracic esophageal cancer between January 2008 and January 2016 in the Fourth Hospital of Hebei Medical University.The patients were staged according to the AJCC’s eighth edition of the TNM staging criteria.According to the inclusion criteria and exclusion criteria to select patients divided into three groups: neoadjuvant chemotherapy,surgery alone,and adjuvant chemotherapy.The statistical software used was SPSS 23.0.Propensity Score Matching was self-biased and use it to match.The neoadjuvant chemotherapy group was used as the baseline group to be matched with the adjuvant chemotherapy group and the surgery alone group,and the cases that were successfully matched in the matching data of both groups were included in this study.Kaplan-Meier survival curve and Log-rank test were used for univariate survival analysis;Cox regression was used for multivariate survival analysis;other observations were compared: the measurement data were tested by rank sum test,and the count data were analyzed by chi-square test.The test level was Bilateral α=0.05.Statistical differences were considered when P<0.05.Results: During the follow-up period up to April 2017,83 patients in each group were matched,and 249 patients were included.the 3-year OS of the whole group was 51.0%,and the 5-year OS was 33.4%;the 3-year DFS was 44.2%,the 5-year DFS was 32.7%.Univariate analysis showed that the positive number of lymph nodes,stump invasion,vascular tumor thrombus or nerve invasion,treatment methods had statistically significant differences in the OS of patients(P < 0.05).Multivariate analysis showed that the depth of tumor invasion,positive number of lymph nodes,lymph node dissection number,stump invading condition,treatment method which is an independent prognostic factor that affects OS in patients.Univariate analysis showed the positive number of lymph nodes,stump invasion,vascular tumor thrombus or nerve invasion,treatment methods had statistically significant differences in patients’ DFS(P<0.05).Multivariate analysis showed that the positive number of lymph nodes,vascular tumor thrombus or nerve invasion,treatment methods were independent prognostic factors affecting DFS in patients.Among the different treatment methods,the neoadjuvant chemotherapy group had a 3-year OS of 48.6% and a 5-year OS of 32.2%.The adjuvant chemotherapy group had a 3-year OS of 66.3%,a 5-year OS of 50.9%,and a simple surgery group had a 3-year OS of 38.8%.The 5-year OS was 19.5%;in the neoadjuvant chemotherapy group,the 3-year DFS was 39.2%;the 5-year DFS was 31.3%;the adjuvant chemotherapy group had 3-year DFS of 57.0%,5-year DFS of 43.8%;and the simple surgery group 3-year DFS of 36.0.%,DFS for 5 years is 24.3%.The adjuvant chemotherapy group’s OS and DFS were significantly different from the neoadjuvant chemotherapy group and the surgery alone group(P <0.05).In the neoadjuvant chemotherapy group,a total of 83 cases were treated,of which 20 cases(24.1%)were degraded after neoadjuvant chemotherapy,and 63 cases had no apparent remission(75.9%).The incidence of surgical complications in the neoadjuvant chemotherapy group was 9.6% compared with 19.2% in the surgery alone group and the length of hospital stay between two groups were not statistically different(P>0.05).Conclusions:1.The positive number of lymph nodes is an independent predictor of prognosis in patients with advanced thoracic esophageal squamous cell carcinoma,and the prognosis is negatively correlated with the number of positive lymph nodes.2.Patients with advanced thoracic esophageal squamous cell carcinoma have poor prognosis of surgery alone and need adjuvant therapy to improve their prognosis.3.Postoperative adjuvant chemotherapy can significantly improve the prognosis of patients with advanced thoracic esophageal squamous cell carcinoma,suggesting adjuvant chemotherapy after surgery.4.Preoperative neoadjuvant chemotherapy has a reliable effect of reducing the time,the incidence of surgical complications is lower than the simple surgery,safety is better,suggest that neoadjuvant chemotherapy in patients with advanced thoracic esophageal squamous cell carcinoma before surgery.5.The prognosis of neoadjuvant chemotherapy for patients with advanced thoracic esophageal squamous cell carcinoma is better than that of surgery alone,but there is no statistical difference.It may be related to the small sample size.It is suggested that the sample size should be increased for further study. |
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