Analysis Of Prognostic Factors In Patients With Local Recurrence Or Metastatic Esophageal Cancer

Background. Esophageal cancer has high morbidity and mortality. The number of patients with esophageal cancer in China accounts for about50percent of the world. Surgery is the major treatment to esophageal cancer. But local recurrence or distant metastasis is the main cause of treatment failure. The prognosis of patients with local recurrent or metastatic esophageal cancer is poor. However, it does not a standard about the treatment for local recurrent or metastatic esophageal cancer.Objective. The aim of this paper was to evaluate the treatment outcome of multimodal treatment for158patients with local recurrent or metastatic esophageal cancer and to determine the prognostic factors.Methods.158patients with local recurrent or metastatic esophageal cancer curatively treated in Shandong University Qilu Hospital were included in this study. Kaplan-Meier method was used to analyze the survival rate. Log rank test was used to evaluate the difference between the groups. Multivariate survival analysis was conducted using a Cox proportional hazard regression model with a backward stepwise procedure.Results. The overall1-,2-and3-year survival rates were36.9%,8.8%and2.4%,respectively, with a median survival time of9.1months. The univariate analysis showed that gender, PS, the interval between initial treatment and recurrence, the regimens of initial treatment and retreatment were independent prognostic factors. The multivariate analysis showed that PS and the regimens of retreatment were independent prognostic factors. Retreatment methods significantly influenced the survival. The median survival time of radiation therapy alone, chemotherapy alone, chemoradiotherapy and best supportive care were10.7,7.2,12.9and6.7months, respectively (P=0.000).Conclusions. Multimodal treatment including radiotherapy and chemotherapy may improve the long-term survival of the patient with local recurrent or metastatic esophageal cancer. PS is one of the main prognostic factors. A total radiation dose of>40Gy is recommended for secondary radiotherapy patients.