| Purpose:To explore the prognostic factors of pT2～3N0M0 TESCC after radical surgery and build a nomogram model predicting prognosis.Materials and Methods:A total of 820 pT2～3N0M0 TESCC patients who underwent initial radical surgery were retrospectively reviewed. Multivariate analysis of prognostic factors related to OS was performed by the Cox proportional hazard model. The nomogram model predicting 5-year OS was constructed including independent prognostic factors. The accuracy of prediction was quantified with the AUC value of time-dependent ROC curves and calibration plots that graphically displayed the nomogram’s performance characteristics. The predictive ability of the nomogram was compared with the prognostic grouping of the 7th AJCC/UICC edition by AUC value.Results:The median follow up for the cohort was 63.2 (95% CI 59.5～67.0) months. The 3- and 5-year OS rate was 70.0% and 59.9%, respectively. Multivariate analysis revealed that age, gender, body weight loss before surgery, tumor location, tumor length, differentiation, proximal margin length, number of node removed and lymphovascular invasion were all independently associated with OS. These 9 factors entered the nomogram model and calibration of the model showed good agreement between the predicted probability and the observed probability for 5-year OS. The AUC value of the nomogram model was 0.67, which was superior to that (AUC=0.60) of the prognostic grouping of the 7th AJCC/UICC staging. According to the total risk scores of the patients, the cohort was then stratified into three groups representing distinct prognosis (<100, low risk; 101～250, median risk;>250, high risk). The 5-year OS rate of low risk, median risk and high risk groups was 85.9%,67.9% and 37.4% respectively (low risk vs. median risk, P=0.015; median risk vs. high risk, P<0.001) respectively. The 5-year OS rate of IB, IIA and Ⅱb according to the 7th AJCC/UICC staging was 74.8%,64.5% and 53.8% (IB vs. ⅡA, P=0.242; ⅡA vs. IIB, P=0.020) respectively.Conclusion:This novel nomogram model can individually predict 5-year OS rate for pT2～3N0M0 TESCC, which could be helpful in clinical decision-making and design of clinical study.Purpose:To assess the clinical value of 3DRT in postoperative adjuvant therapy after initial radical surgery for pT2～3N0M0 TESCC.Materials and Methods:The recurrence, survival, and radiotherapy adverse events in 96 patients with pT2～3NoMo TESCC who received adjuvant 3DRT after radical surgery from a prospective nonrandomized phase Ⅱ clinical study from 2004 to 2011 were compared with those in 820 patients undergoing surgery alone. The survival rate was determined by the Kaplan-Meier method and analyzed using the log-rank test. Multivariate prognostic analysis was performed using the Cox proportional hazard model.Results:Postoperative 3DRT group had a significantly higher ratio of patients with tumor length≥5 cm and stage T3 than surgery alone group. The median follow up for the postoperative 3DRT and surgery alone groups were 63.2 (95% CI 59.5～67.0) months and 59.8 (95% CI 53.9～65.7) months respectively. The 5-year OS and DFS rates for the postoperative 3DRT versus surgery alone group were 74.3% vs 59.9% (P=0.010) and 71.0% vs 51.7%(P=0.002), respectively. Multivariate analysis revealed that 3DRT was independently associated with an improved OS (HR=0.566, P=0.011) and DFS (HR=0.528, P=0.002). The results were confirmed by PSM method. The overall recurrence rate, locoregional recurrence rate, and distant metastasis rate in the postoperative 3DRT group versus surgery alone group were 22.9% vs 42.6% (P<0.001), 18.8% vs 34.7% (P=0.002), and 11.5% vs 21.2% (P=0.025), respectively.Conclusions:Compared with surgery alone, postoperative adjuvant 3DRT reduces the recurrence rate and improves the 5-year DFS and OS in patients with pT3N0M0 TESCC. Prospective randomized phase Ⅲ clinical study is still needed.Purpose:The 5-year OS of pathological T2～3N0M0 TESCC after radical surgery is reported to be 28.5%-57.0%5 with an overall recurrence of 41.6%～51.8% and locoregional recurrence of 33.3%. This non-randomized phase Ⅱ study was designed to investigate the safety and feasibility of adjuvant 3DRT (IMRT/3DCRT) after radical surgery for pT2～3N0M0 TESCC, and preliminarily assess its efficacy.Materials and Methods:Ninety-six patients were enrolled from 2004 to 2011. The prescribed dose was 50～60 Gy in 1.8～2 Gy per fraction (5 days per week) to 95% of the PTV, encompassing tumor bed and lymphatic drainage regions at high risk according to primary tumor location.Results:The median follow-up for all and the patients alive was 52.0 and 58.0 months. The average PTV coverage of the prescribed dose was 94.9±0.7%. The median bilateral lung V20 was 23.6% (9.8%～29.7%), the median stomach V50 was 9.4% (0～39.2%). The median heart V30 and V40 were 33.3% (0～67.6%) and 17.1% (0～42.0%), respectively. The median maximal dose to spinal cord was 40.4Gy (32.9-45.5Gy). Grade 3 and 4-5 toxicities developed in 25 (26.0%) and 0 patients, respectively. Overall recurrence was recognized in 22 (22.9%) patients, of which 18 (18.8%) had locoregional recurrence. The 5-year OS and DFS rate was 74.3% and 71.0%.Conclusions:Adjuvant 3DRT for pT2～3N0M0 TESCC is tolerable and clinically feasible, and provides excellent local control and favorable survival. Further confirmation in a randomized trial is merited.Purpose:To explore the impact of adjuvant IMRT on survival of pT2～3N0M0 TESCC after radical surgery.Materials and Methods:Eligible patients were randomly assigned to surgery alone group or surgery plus adjuvant IMRT group. The prescribed radiation dose was 50.4 Gy (1.8 Gy per fraction in 28 fractions) to supraclavicular region and 56Gy (2.0 Gy per fraction in 28 fractions) to mediastinum region.Results:From September 2012 to September 2014, we enrolled 92 patients, of which 47 were randomly assigned to surgery alone group and 45 to adjuvant IMRT group. The median age was 59 years (40～72 years). There were 78 (84.8%) males and 14 (15.2%) females. The number of patients with tumor in upper, middle and lower thoracic esophagus were 21 (22.8%),51 (55.4%) and 20 (21.7%) respectively. Twenty-three (24.0%) patients were in pT2N0M0 stage and 69 (75%) patients were in pT3N0M0 stage. The median number of node removed were 25 (7～65). There were more males in adjuvant IMRT group than that in surgery alone group (P=0.025). For surgery alone group versus adjuvant radiotherapy group, the median follow-up was 20.3 (95% CI 17.4～23.3) months versus 17.8 (95% CI 16.0～19.6) months, with 1-year OS rate of 95.5% versus 95.3% (P=0.717) and 1-year DFS rate of 77.1% versus 85.9% (P=0.071). And the rate of overall recurrence, locoregional recurrence in surgery alone group versus adjuvant IMRT group was 27.7% (13/47) verus 11.1% (5/45) (p=0.045),25.5%(12/47) versus 2.2%(1/45) (P=0.001) respectively. Only one out of 41 (2.4%) patients receiving adjuvant IMRT did not complete radiation course for grade 3 acute esophagitis. The overall grade 3 acute and late toxicities occurred in 24.4%(10/41) patients, and no grade 4 to 5 toxicity was observed.Conclusions:Adjuvant IMRT reduces locoregional recurrence in pT2～3N0M0 TESCC, while its impact on survival need further study. |
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