| Objectives: Esophagus cancer is one of the most common malignant tumors of digestive tract for human. 480000 newly esophagus cancer are diagnosed around the world every year, which ranks 8th among all malignant tumors. North America, Caucasus area, middle Asia and east Asia are high prevalence areas, especially 49.9% of the total patients are found in china. There is an average of 150000 patients died of esophagus every year, which ranks 4th in for all malignant tumors. Most patients in treatment are patients in middle or late stage. Survival rate 5 years after the surgery is less than 25%. With the extensive application of regular inspections and early cancer screening in esophagus cancer high prevalence area, determination rate of cancer in Tis phase and T1 phase is significantly increased. The patients that are pathologically diagnosed as T1 phase esophagus cancer after surgery are increased. In order to further analysis the relationship among invasion depth of tumor, lymph gland metastasis status and long term survive for patients with T1 phase esophagus cancer, histological specimen of patient with T1 a esophagus cancer are classified according to tumor infiltration degree by some foreign scholars. The situation that lesion is limited in epithelium mucosae is phase m1. The situation that lesion has invaded into lamina propria is phase m2. The situation that lesion has invaded into muscularis mucosa is phase m3. The situation that tumor has invaded into upper 1/3 of sub mucosa is called phase sm1. Additionally, phase sm2 for middle 1/3 and phase sm3 for down 1/3. Progress has been made by research on clinic feature of patients with different invasion level of tumors. Since majority of esophagus cancer for foreign patients are adenocarcinoma, few research has performed on phase T1 esophageal squamous cancer. In order to understand the influencing factors for prognosis of phase T1 esophagus cancer and the effect of tumor infiltration depth on its prognosis, retrospective study and analysis on its clinic features are performed in this study.Methods: Clinic data of 212 patients pathologically diagnosed as phase T1 primary esophageal cancer after surgery from Jan 2001 to Dec 2009 in Heber Medical University are summarized in this research. Statistical analysis on its clinical features and prognosis are performed. Including those patients, 148 are male patients(69.8%) and 64 are female patients(30.2%). Age of patients ranges from 25 to 77. Median age is 62. Swallow discomfort is found as initial symptom in 71 patients. 39 are sour regurgitation. 77 are found during physical examination. 10 are hiccup. 15 are abdominal discomfort. Onset time for disease ranges from 3 days to 4 years. Among all the patients, 27 patients are found with family history of gastrointestinal tumors. Among those 27 patients, 15 are found with family history of esophagus cancer. After confirming by gastroscopy, lesion located in locus superior is found in 20 patients(9.4%), lesion located in locus medialis is found in 131 patients(61.8%) and lesion located in locusinferior is found in 61 patiens(28.8%). No neo adjuvant chemoradiotherpy is performed in any patients. Resection of esophageal carcinoma with surrounding lymph nody excision is performed. Esophagectomy and stomach anastomosis of left neck through left neck, right chest and superior belly are performed in 21 patients. Esophagectomy and aortic arch anastomosis for stomach through left chest are performed in 141 patients. Esophagectomy and pleural stomach anastomosis are performed through left chest in 9 patients. Esophagectomy and stomach anatomosis in right chest are performed in 41 patients through right chest and upper abdominal. Regular lymph nody excision for chest and abdominal is performed in all patients. 208 cases of esophageal squamous cancer, 2 cases of adenocarcinoma of esophagus, and 2 cases of large cell neuroendocrine carcinoma for esophagus are pathologically diagnosed. 12 cases are diagnosed with high differentiation(5.7 %). 155 cases are diagnosed with medium differentiation(73.1%). 45 cases are diagnosed with low differentiation(21.2%). Disease are classified as phase m1(30 cases), phase m2(17 cases), phase m3(44 cases), phase sm1(26 cases), phase sm2(40 cases) and phase sm3(44 cases) according to different infiltration depth of lesions. 2289 excised specimens including 45 cervial lymph node, 1001 chest lymph node(average=4.7, minimum = 1, maximum = 15) and 1243 abdominal lymph node(average = 5.9, minimum=1, maximum = 14) are found. Lymphatic metastasis is found in 32 patients. Metastasis rate is 15.1%. 83 metastatic lymph nodes are found. Ratio of lymph nodes metastatic is 3.6%. 180 cases of p N0(84.9%), 18 cases of p N1(8.5%) and 14 cases of p N2(6.6%) are diagnosed by lymphatic metastasis. Adjuvant chemotherapy is performed in 80 patients including 11 patients in phase T1 a and 69 patients in phase T1 b.Double drug joint scheme contain platinum drugs and single drug scheme are included in chemotherapy scheme. Lifetime is calculated from surgery date to last visiting date or death time. Deadline of visiting is 1st Feb 2015. Minimum of lifetime is 27 months. Maximum of lifetime is 108 months. Average of lifetime is 76.7 months. Median lifetime is 80.8 months. Analysis of data is performed by SPSS 13.0 software. Test of significance for survival rate is performed by Logrank method. Survival rate is calculated by Kaplam-meier method. Single factor and multi-factor analysis is performed by Cox proportional hazards regression model. Lifetime is calculated by life table method.(Significance could be found if P<0.05)Results: Survival rate for patients with lifetime of 1 year, 3 years and 5 years is 100%, 96.7% and 83.0%. Survival rate for T1 a patients with lifetime of 1 year, 3 years and 5 years is 100%, 97.8% and 94.5%, respectively. Median lifetime is 86.8 months. Survival rate for T1 b patients with lifetime of 1 year, 3 years and 5 years is 100%, 95.9% and 74.4%, respectively. Median lifetime is 76.2 months. Ratio for metastatic lymph node is 15.1%. Metastatic ratio for lymph node in patients with lesion invaded into m1, m2 or m3 is 0%. Metastatic rate for 121 patients with phase T1 b esophagus cancer is 26.4%. Among those, metastatic rate for sm1 subgroup, sm2 subgroup and sm3 subgroup is 11.6%, 15.0% and 41.8%. No significance could be found in metastatic rate between patients from sm1 subgroup and sm2 subgroup.(P=0.973) Metastatic rate for patients with lesion infiltrated to sm3 is significantly higher than those in sm1 subgroup and sm2 subgroup.(P=0.002) Among all patients, no significance of survival rate could be found in family history(P=0.729); no significance of survival rate could be found in gender(P=0.402); no significance of survival rate could be found in lesion location(P=0.680); no significance of survival rate could be found in differentiation(P=0.483). Significance could be found in survival rate between patients in phase T1 a and phase T1 b.(P=0.000) No significance could be found in prognosis among patients from m1, m2 and m3 subgroup.(P=0.701) No significance could be found in survival rate between sm1 subgroup and sm2 subgroup.(P=0.994) No significance could be found between patients in sm1/sm2 subgroup and T1 a group.(P=0.059) Survival rate of patients in sm3 patients is significantly lower than that in sm1/sm2 patients. Significance could be found in survival rate between patients in N0 group and N+ group. No significance could be found between patients in N1 subgroup and N2 subgroup from N+ group.(P=0.582) No significance could be found between patients performed with adjunctive chemotherapy after surgery and patient without adjunctive chemotherapy after surgery.(P=0.351) No significance could be found in survival rate between two groups of patients in phase T1 a.(P=0.100) Significance could be found in survival rate between two groups of patients in phase T1 b.(P=0.017)Conclusion: Better long term lifetime for patients with phase T1 esophagus cancer could be achieved by surgery. Regular physical examination and the screening for high-risky people are helpful for the diagnosis of phase T1 esophagus cancer. Family history, gender, location of lesion and differentiation of tumor cell are not factors that could affect prognosis of phase T1 esophagus cancer. Higher lymph node metastasis rate and worse long term lifetime after surgery are found in sm3 subgroup of patients with phase T1 esophagus cancer. Endoscopic resection of lesion could be performed in patients with phase T1 a esophagus cancer. Esophageal cancer radical resection and surrounding lymph node excision are advisable for patients with phase T1 b esophageal cancer. Benefits in survival rate after operation could be achieved by postoperative chemotherapy in patients with phase T1 b esophageal cancer, especially for those with surrounding lymph node excision. |
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