| Part1 The Significance and Prognostic Factors of Chemoradiotherapy in Patients with pT3N0MO Esophageal Carcinoma after Radical Resection.Objective:To analyze the survival time of patients after radical operation of pT3N0M0 thoracic esophageal carcinoma,to investigate the therapeutic effect and failure mode of different treatment plans, and to explore the factors influencing the prognosis and the value of adjuvant therapy.Methods:Our study covered 210 cases of esophageal carcinoma patients with thoracic esophageal carcinoma, all clinical cases were confirmed by postoperative pathology pT3N0M0 esophageal carcinoma in Weifang Medical University Affiliated Hospital, Weifang People’s Hospital, Weifang traditional Chinese Hospital and Chinese People’s Liberation Army Eighty-ninth Hospital from January 1st 2002 to December 31st 2009. According to the different treatment options, the patients were divided into simple operation group, postoperative radiotherapy group, postoperative chemotherapy group and postoperative radiotherapy combined with chemotherapy group. To analyze the progression free survival (PFS), the median survival time (MST), the recurrence and metastasis of the patients with different clinical and pathological data, and the value of retreatment after recurrence.Results:1. Overall survival (OS) The median survival time (MST) was 58.2 months in all 210 patients,90 patients received surgical treatment, and 120 patients received postoperative adjuvant therapy; of the 120 patients,60 cases of postoperative radiotherapy group,40 cases of postoperative chemotherapy group,20 cases of postoperative radiotherapy combined with chemotherapy group. For the entire group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 58.2 months,90.5%,69.5% and 50.0%, respectively; simple operation group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 51.9 months,88.9%,65.6% and 47.8%, respectively; postoperative radiotherapy group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 60.0 months,93.3%,73.3% and 53.3%, respectively; postoperative chemotherapy group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 58.6 months,90.0%,70.0% and 50.0%, respectively; and postoperative radiotherapy combined with chemotherapy group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 54.5months,90.0%,75.0% and 50.0%, respectively. There was no significant difference in the total survival rate between the four groups (p>0.05). The simple operation group, postoperative radiotherapy group, postoperative chemotherapy group and postoperative radiotherapy combined with chemotherapy group, the 1-,2-, and 3-year progress free survival (PFS) rates were 77.8%, 50.0%,14.4%; 90.0%.56.7%,30.0%; 85.0%,52.5%,22.5%'90.0%,55.0%, 20.0%、respectively. Among them, the PFS of the postoperative radiotherapy group was longer than the operation group, and the difference was statistically significant p<0.05), and the PFS of the postoperative chemotherapy group and postoperative radiotherapy combined with chemotherapy group were longer than the operation group, respectively; but the difference was not statistically significant (p>0.05).2 Prognostic factors of pT3N0M0 patients after radical resection of thoracic esophageal carcinoma 210 cases of pT3N0M0 stage thoracic esophageal carcinoma patients, single factor analysis and prognosis related factors:the method of anastomosis, the location of esophageal tumor and histological grade (p<0.05). The factors such as sex, age, preoperative hemoglobin level, preoperative CT show mediastinum lymph nodes or not, the number of lymph nodes, the length of the tumor tissue, the pathological type and so on were not related to the prognosis (p>0.05). Multivariate analysis showed that the tumor location are independent prognostic factors of esophageal carcinoma. The prognosis of the patients with the upper part of the thoracic esophageal patients was poor.3 Effect of adjuvant therapy on the survival rate of patients with pT3N0M0 thoracic esophageal carcinoma after radical operation Simple operation group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 51.9 months,88.9%,65.6% and 47.8%, respectively; postoperative radiotherapy group (postoperative radiotherapy group and postoperative radiotherapy combined with chemotherapy group), the median survival time (MST) and the 1-,2-, and 3-year survival rates were 58.4 months,92.5%,73.8% and 52.5%, respectively; there was no significant difference between the two groups (p>0.05). Postoperative chemotherapy group (postoperative chemotherapy group and postoperative radiotherapy combined with chemotherapy group), the median survival time (MST) and the 1-,2-, and 3-year survival rates were 56.1 months,90.0%,71.6% and 50.0%, respectively; there was no significant difference in the total survival rate between the simple operation group and postoperative chemotherapy group (p>0.05). The results showed that:sex, age, preoperative hemoglobin level, preoperative CT show mediastinum lymph nodes or not, location of the tumor, the length of the tumor tissue, number of lymph nodes, histological grade and so on which were not significantly different between simple operation group, postoperative radiotherapy group and postoperative chemotherapy combined with radiotherapy group were not significantly different (p>0.05).4 Analysis of recurrence and metastasis of pT3N0M0 thoracic esophageal carcinoma after radical resection In 210 patients,166 patients had disease progression, and the median survival time was 12.9 months. Among them,106 cases (50.5%) were local regional recurrence,66 cases (31.4%) were local regional recurrence simply,100 cases (47.6%) were distant metastasis, and 60 cases (28.6%) were distant metastasis simply. The number of lymph nodes dissection and postoperative radiotherapy were related with local recurrence in patients (p<0.05). The cumulative 5 year local recurrence rate were 35.5% and 18.8% of the patients who treated with surgery simply and postoperative radiotherapy (including the combined radiotherapy and radiotherapy group), respectively (p<0.05). The cumulative 5 year local recurrence rate were 35.5% and 30.0% of the patients who treated with surgery simply and postoperative chemotherapy (including the combined chemotherapy and chemotherapy group), respectively (p>0.05).Sex and histological grading were related to the rate of distant metastasis after esophagectomy (p<0.05).The cumulative distant metastasis rate (including the combined local recurrence) was 30% and 27.5% respectively, for patients with simple surgical patients and postoperative radiotherapy (including the combined radiotherapy and radiotherapy group)(p>0.05).The cumulative distant metastasis rate (including the combined local recurrence) was 30% and 28.3% respectively, for patients with simple surgical patients and postoperative chemotherapy (including postoperative chemotherapy and radiotherapy group)(p>0.05).5 Salvage therapy of recurrence after radical resection of pT3N0M0 thoracic esophageal carcinoma After the disease progression,107 patients were treated with different salvage therapy according to their recurrence pattern. For the patients who simultaneous had local recurrence and distant metastasis, the survival time of the treatment group was significantly different from that of the untreated group (p<0.05).Conclusions:1 For the patients with pT3N0M0 after radical resection of esophageal carcinoma, the location of the primary tumor are independent prognostic factors. Tumor located in the lower part of the thoracic esophageal have the best prognosis while the worst appears in the upper part.2 Postoperative radiotherapy for radical resection of pT3N0M0 thoracic esophageal carcinoma patients which improved the progression free survival rate, and reduced the local recurrence rate, but failed to reduce the distant metastasis rate, and could not improve the overall survival rate.3 Postoperative chemotherapy can’t reduce the recurrence rate and distant metastasis rate in the patients with pT3N0M0 after radical resection of esophageal carcinoma, but also did not get the survival benefit.4 Local recurrence and distant metastasis occurred in esophageal carcinoma after radical resection of esophageal carcinoma. The number of lymph nodes, postoperative radiotherapy can reduce local recurrence rate, male, histological grade G3 or G4 patients more prone to distant metastasis. Recurrence and metastasis after active radiotherapy and chemotherapy can prolong the survival time.Part 2 Prognostic Analysis Of Chemotherapy With Involved-field Irradiation For Regional Recurrence In pT3N0M0 Esophageal Squamous Cell Carcinoma After Radical SurgeryObjective:To analyze the therapeutic effect of chemotherapy combined with involved field irradiation for local recurrence after radical resection of esophageal squamous cell carcinoma pT3N0M0 and the failure mode after treatment.Methods:Our study covered 88 patients who underwent chemotherapy combined with involved field irradiation for local recurrence after radical resection of esophageal squamous cell carcinoma pT3N0M0 in Weifang Medical University Affiliated Hospital, Weifang People’s Hospital, Weifang traditional Chinese Hospital and Chinese People’s Liberation Army Eighty-ninth Hospital from January 1st 2005 to December 31st 2011. According to the recurrence position located in or out of the target area of the radiotherapy, we divided the failure mode after treatment into three groups:recurrence in the irradiation field group, regional lymph node recurrence out of the irradiation field group and distant metastasis group. To analyze the overall survival (OS), the influence factors and the failure modes after treatment between these three groups in order to study the kinds of patients’ therapeutic effect of chemotherapy combined with involved field irradiation.Results:For the entire group, the median survival time (MST) and the 1-,2-, and 3-year survival rates were 15.2 months,56.8%,31.8% and 18.2%,respectively(table 2); the median progress free survival (PFS) and the 1-,2-, and 3-year PFS rates were 12.7 months,46.6%,21.6% and 13.6%, respectively, the time of recurrence after radical resection was related with the prognosis.78 patients were recurrence during the follow-up, with the rate of recurrence in the irradiation field group, regional lymph node recurrence out of the irradiation field group and distant metastasis group were 48 patients (54.55%), 19 patients (21.59%) and 30 patients (34.09%) respectively. Compared with the median survival time of patients who had one of three recurrence patterns, except 17 patients with two or two or more recurrence patterns, there were significant differences (p<0.05). Although the patients with the failure in the radiation field had a shorter survival than those who did not occur failure in the radiation field (11.1vs14.2), with no statistically significant difference(p>0.05). The total survival rate of patients with distant metastasis was significantly worse than that without the distant metastasis (8.2vs15.2), and there was significant difference between them (p<0.05). The patients with regional lymph node recurrence occurred in patients and without regional lymph node recurrence in the median OS were 14.2 months and 10.9 months respectively, with no statistically significant difference (p> 0.05).Conclusions:It was an effective treatment regimen that chemotherapy combined with involved field irradiation after radical resection of esophageal squamous cell carcinoma pT3N0M0. After treatment, the regional recurrence in the radiation field and distant metastasis were the main failure mode, shorten the survival time of the patients, and field regional lymph node metastasis did not affect the overall survival in patients, the longer of time to first recurrence after surgery, the better prognosis. However, due to the small number of patients, it needs to be further confirmed by future randomized controlled trials. |
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