| Objective: To analyze the clinicopathological characteristics and prognostic factors in patients with esophageal adenocarcinoma, and to explore its treatment strategies, so as to provide a reference for evaluation of prognosis and choice of reasonable treatment modality.Methods: A total of 201 cases of esophageal adenocarcinoma who accepted radical resection had been selected in the fourth hospital of Hebei medical university from January 1, 2004 to December 31, 2013. Among those, including 120 cases of resection alone, 63 cases of postoperative chemotherapy, 18 cases of postoperative radiochemotherapy. Survival and local control conditions were analyzed, and the effects of pathological stage and treatment modality on survival and local control condition were explored. Besides, prognostic factors were analyzed.Results:1 Diagnosis: 201 cases were examined by gastroscope / esophagoscopy before surgery, only 115 cases were diagnosed as esophageal adenocarcinomas. Microscopically confirmed rate was only 57.2%. 2 Lymph node metastasis:(1) 90 cases had lymph node metastasis, and the rate of lymph node metastasis was 44.8%(90/201). A total of 2026 lymph nodes were dissected. Among those, 322 cases had lymph node metastasis, and lymph node metastasis ratio was 15.9%(322/2026).(2) For 11 cases of upper thoracic esophageal adenocarcinomas, lymph node metastasis ratio in superior mediastinum was 6.7%(1/15), none of the mediastinum, lower mediastinal and abdominal cavity lymph node metastasis; For 102 cases of middle thoracic esophageal adenocarcinomas, lymph node metastasis ratios were 31.6%(6/19), 11.8%(50/423), 13.5(36/267) and 18.8%(69/367) in the superior mediastinum, middle mediastinum, inferior mediastinum andabdominal cavity respectively; For 88 cases of lower thoracic esophageal adenocarcinomas, lymph node metastasis ratios were 1.5%(3/199), 10.9(25/229) and 33.7(132/392) in the middle mediastinum, inferior mediastinum and abdominal cavity respectively, and there was no superior mediastinum metastasis.(3) Lymphatic metastasis rate and positive lymph nodes ratio at stage T1, T2, T3, T4 were of great difference(c2 = 35.861,P = 0.000; c2 = 125.783,P = 0.000), and the highest was at stage T4,respectively 69.4% and 26.6%.(4) Lymphatic metastasis rate and positive lymph nodes ratio in patients with tumor ≤ 3 cm, 3 to 5 cm, and > 5 cm had significant differences(c2 = 25.533,P = 0.000; c2 = 94.985,P = 0.000), tumor > 5 cm was the highest, respectively 65.7% and 24.2%.(5) Lymphatic metastasis rate and positive lymph nodes ratio in patients with different pathological types had significant differences(c2 = 17.111,P = 0.001; c2 = 55.832,P = 0.000), pure adenocarcinoma was the highest, respectively 56.8% and 20.8%.(6) Vascular invasion patients had higher lymphatic metastasis rate and positive lymph nodes ratio than the patients without(c2 = 8.917,P = 0.003; c2 = 58.150,P = 0.000), respectively 73.9% and 32.9%.(7) The main factors of lymph node metastasis above into Logistic regression showed that lesion length, depth of invasion and vascular invasion were independent factors for lymph node metastasis(P = 0.001; P = 0.000; P = 0.015). 3 Over survival and local control conditions:(1) the 1-, 3- and 5-year local control rates were 87.6%, 78.8% and 67.4% respectively, and the 1-, 3- and 5-year survival rates were 82.0%, 49.2% and 31.2% respectively.(2) The 1-, 3-, 5-year local control rates in tumor maximal diameter ≥ 5 cm group lower than in < 5 cm, but there was no significant difference between the two groups of the overall survival rate(c2 = 7.640,P = 0.006;c2 = 2.601,P = 0.107).(3) Survival rates at stage I and II were both higher than that at stage III, stage III higher than stage Ⅳ, but there was no significant difference between I and II stage(c2 = 15.330,P = 0.000;c2 = 11.756,P = 0.001;c2 = 3.922,P = 0.048;c2 = 0.741,P = 0.389). Compared with local control rates, there was no significant difference between stage I, II,III and(Ⅳ c2 = 7.734,P = 0.052).(4) The 1-, 3-, 5-year overall survival rates in patients with adenoid cystic carcinoma were significantly better than the other three types(c2 = 7.902,P = 0.048), but the other three types including pure adenocarcinoma, adenoacanthoma cell carcinoma and mucoepidermoid carcinoma had no significant difference about the survival rate(c2 = 0.256,P = 0.613;c2 = 0.428,P = 0.513;c2 = 0.061,P = 0.805). There was no significant difference between the four different types about the local control rate(c2 = 0.960,P = 0.811).(5) The 1-, 3-, 5-year overall survival rates in patients without vascular invasion were 83.7%, 52.9% and 35.0% respectively,higher than those with the vascular invasion 69.3%, 15.8% and 0.0% respectively, and there was no significant difference between the two groups of the local control rate(c2 = 12.989,P = 0.000; c2 = 2.568,P = 0.109).(6) The 1-, 3-, 5-year survival rate in postoperative patients with negative lymph node metastasis were 88.3%, 64.3% and 43.2%, significantly higher than in patients with positive lymph node metastasis 74.4%, 29.6% and 15.7%(c2 = 22.810,P = 0.000).The 1-, 3-, 5-year local control rate in postoperative patients with negative lymph node metastasis were 94.3%, 85.2% and 71.8% respectively, higher than in patients with positive lymph node metastasis 78.6%, 69.0% and 63.2%(c2 = 5.200,P = 0.023). The 1-, 3-, 5-year local control rate in patients with 1~4 lymph node metastasis were 87.3%, 80.1% and 72.9%, higher than 58.2%, 44.1% and 44.1% in patients with the number of >4, but there was no significant difference between the two groups about the survival rate(c2 = 10.519,P = 0.001; c2 = 3.755,P = 0.053).(7) The survival rate and local control rate in the groups which were operated surgery alone and postoperative adjuvant therapy, both had no significant difference(c2 = 0.970,P = 0.325;c2 = 0.016,P = 0.900).(8) The survival rate of ≥ 4 cycles of chemotherapy group was significantly higher than that of < 4 cycle group, and there was no significant difference between the two groups about the local control rate(c2 = 5.013,P = 0.025;c2 = 1.511,P = 0.219).(9) There was no significant difference between FP group, FOLFOX group and TP groups about the survival rate and local control rate(c2 = 1.423,P = 0.491;c2 = 1.826,P =0.401).(10) Of the 90 patients with positive lymph node metastasis, the 1-, 3-, 5-year survival rate in postoperative comprehensive therapy were 79.9%, 42.0% and 27.5%, higher than 68.9%, 19.8% and 6.8% in surgery alone, but there was no significant difference between the two groups about the local control rate(c2 = 6.059,P = 0.014;c2 = 1.625,P = 0.202).(11) The 1-, 3-, 5-year survival rate in the group lymph node metastasis ratio >10% were 80.3%, 48.9% and 32.1%, higher than surgery alone group 70.3%, 24.9% and 7.3%, there was no significant difference of the local control rate(c2 = 6.552,P = 0.010;c2 = 2.453,P = 0.117). The survival rate and local control rate in the group lymph node metastasis ratio ≤10%,which were operated surgery alone and postoperative adjuvant therapy, had no significant difference(c2 = 0.158,P = 0.691;c2 = 0.287,P = 0.592).(12) The 1-, 3-, 5-year survival rate of stage Ⅲand Ⅳpatients with postoperative comprehensive therapy were 80.4%, 40.4% and 27.7%, higher than 65.0%, 16.8% and 6.7% in surgery alone group, but there was no significant difference between the two groups about the local control rate(c2 = 4.861,P = 0.027;c2 = 1.169,P = 0.280).The survival rate and local control rate in the stage I and II group which were operated surgery alone and postoperative adjuvant therapy, had no significant difference(c2 = 0.029,P = 0.865;c2 = 0.117,P = 0.733). 4 Prognostic factors analysis: tumor length was an independent factor for local control in patients with esophageal adenocarcinomas(c2 = 7.001,P = 0.008), Lymph node metastasis, vascular invasion and chemotherapy or not were independent factors for survival. Patients with positive lymph node, vascular invasion, and no postoperative chemotherapy had poor prognosis(c2=19.889 P = 0.000; c2 = 6.897, P = 0.009; c2= 5.144, P = 0.023).Conclusions:1 Esophageal adenocarcinoma diagnosis by microscopy is relatively low. 2 Lymphatic metastasis rate and positive lymph nodes ratio in patients with esophageal adenocarcinoma are similar to esophageal squamous cell carcinoma. The middle thoracic esophageal adenocarcinoma may tend to be extensive lymph node metastasis. Upper mediastinal lymph nodes metastasisis quite common in upper thoracic esophageal adenocarcinoma, while lower mediastinal and abdominal lymph node metastasis are common in lower thoracic esophageal cancer. 3 Tumor length, depth of invasion, and vascular invasion are the independent factors for lymph node metastasis. 4 Lymph node metastasis, vascular invasion and chemotherapy or not are independent factors for survival. Tumor length is an independent factor for local control in esophageal adenocarcinoma patients. 5 The postoperative comprehensive therapy can improve survival in patients with positive lymph node metastasis, the lymph node metastasis ratio >10%,the patients’ survival at stage III and can also be improved. Patients Ⅳwith chemotherapy cycle ≥ 4 cycles have a better survival rate than that with < 4 cycle. There is no significant difference between FP, FOLFOX and TP chemotherapy about the survival or local control rate. |
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