The Effect Of Lymph Node Metastatic Ratio With The Postoperative Adjuvant Treatment Of Thoracic Esophageal Cancer After Thoracic And Abdominal Lymph Node Dissection

Objective:The aim of this study was to analyze the influence of lymph node metastatic ratio of thoracic esophageal cancer on the postoperative failure patterns of patients and the adjuvant treatment modality,in order to provide the clinical reference frame of patients receiving postoperative adjuvant treatment.Methods:From January 2007 to December 2010,1416 patients with thoracic esophageal cancer who underwent esophagectomy and two-field lymph node dissection via left or right thoracic approach in our hospital were collected for retrospective analysis.The prognostic factors of the patients in the whole group were analyzed,the relationship between lymph node metastatic ratio and pathological staging were discussed,and the postoperative failure patterns and the efficacy of different adjuvant treatment modalities after esophageal cancer surgery were all investigated.SPSS 23.0 statistical software was used for statistical analysis.Results:(1)By the end of the follow-up period on January 31,2019,there were 508 survived and 908 died among the 1416 patients in the group.From the date of surgical treatment,the 1-,3-,5-and 10-year overall survival rates were 85.5%,59.5%,50.1%and 35.2%,respectively.The median survival rate was 61.00 months.The 1-,3-,5-and 10-year progression-free survival rates were 73.6%,52.2%,44.4%and 31.4%,respectively.The median progression-free survival was 42.00 months.Local-regional recurrence after treatment accounted for 32.9%(466/1416),distant metastasis accounted for20.8%(295/1416),and recurrence combined with distant metastasis accounted for 10.2%(144/1416)in the whole group.In the multivariate analysis,gender,postoperative pathological type,TNM stage and lymph node metastatic ratio were all independent factors for the OS and PFS of patients with thoracic esophageal cancer,but the number of lymph node dissection was not related to the prognosis of thoracic esophageal cancer.(2)The lymph node metastatic ratio of T1,T2,T3 and T4 were 3.8%,7.4%,11.1%and 16.6%,respectively.The lymph node metastatic ratio were 13.7%,32.0%and 58.5%when number of positive lymph nodes were 1-2,3-6and>7,respectively.The lymph node metastatic ratio of stage 0+I,stage II,stage III and stage IV were 0.0%,3.2%,21.2%and 31.1%,respectively.The differences of lymph node metastatic ratio between the groups were statistically significant.(3)The recurrence rate of lymph node metastatic ratio>20%was 50.2(124/247)higher than those25.2%(222/882)and 41.8%(120/287)of lymph node metastatic ratio 0 and0-20%,respectively.The distant metastasis rates were 13.4%(118/882),31.0%(89/287)and 35.6%(88/247)in the ratio 0,0-20%and>20%groups.The anastomotic recurrence was not related to the lymph node metastatic ratio(χ~2=4.581,P=0.101).Patients with pathological positive lymph nodes were more likely to have lymph node recurrence in the neck,supraclavicular and abdominal cavity than those patients with pathological negative lymph nodes.Regional recurrence of mediastinal lymph nodes was positively correlated with lymph node metastatic ratio.(4)The composition ratio of general clinical and pathological data of patients receiving different postoperative adjuvant treatment was significantly different.Propensity score matching(PSM)was used to remove some confounding factors.For patients without lymph node metastatis,the prognosis of patients with postoperative adjuvant chemotherapy was significantly better than those patients with surgery alone(χ~2=12.408,P<0.001),but the prognosis of postoperative radiotherapy and postoperative chemoradiotherapy were not significantly different from the prognosis of surgery alone(χ~2=1.347,0.692,P=0.692,0.405).When patients with lymph node metastatic ratio 0-20%,there were no significant difference between postoperative adjuvant treatment and suigery alone.When patients with lymph node metastatic ratio>20%,the 1-,3-and5-year overall survival of patients receiving postoperative chemoradiotherapy were significantly higher than those receiving surgery alone(χ~2=4.228,P=0.040).Conclusion:1.The lymph node metastatic ratio is an independent risk factor for OS and PFS of patients with thoracic esophageal cancer treated by surgery,and the number of lymph node dissection have no act on OS and PFS.2.The lymph node metastatic ratio of patients with definit esophagectomy was positively correlated with primary lesion infiltration,number of positive lymph nodes and TNM stage.3.There were more likely to have regional lymph node recurrence and distant metastasis of postoperative esophageal cancer patients with high lymph node metastatic ratio.For patients with lymph node metastatic ratio 0,postoperative adjuvant chemotherapy can significantly improve their long-term survival.For patients with lymph node metastatic ratio>20%,postoperative chemoradiotherapy can improve their long-term survival.