The Analyses Of Prognostic Factors And Multidisciplinary Treatment In Patients With Esophageal Squamous Cell Carcinoma

Objective:To retrospectively analyze the clinical pathological data and survival in esophageal squamous cell carcinoma patients after esophageal operation, chemotherapy, to explore the relationship between the clinical-pathologic characteristics and prognosis of these patients, and further analysis of long term curative effect of different chemotherapy regimens in advanced esophageal squamous cell carcinoma patients. We expect to find some effective reference to evaluate the prognosis and clinical treatment.Methods:(1)Clinical and pathological data of 188 esophagectomy patients with esophageal squamous cell carcinoma selected from January 2008 to December 2010 were retrospectively analyzed, and all the patients were available for follow-up.1,3,5 years survival rates and median survival time were collected. And analyze the relationship between the clinical-pathologic characteristics and prognosis of these patients.(2) Clinical and pathological data of 139 advanced ESCC patients who received first-line chemotherapy in our hospital from January 2009 to August 2014 were retrospectively analyzed. Kaplan-Meier method was used to calculate the overall survival (OS). Univariate analysis and Cox regression analysis were used to detect the influence factors of survival and prognosis. (3)Clinical data about advanced esophageal squamous cell carcinoma patients from January 2013 to October 2014 who received gemcitabine or fluorouracil combined with cisplatin as second-line chemotherapy in our hospital after failure to chemotherapy were retrospectively analyzed, its adverse reactions and curative effect were evaluated.Results:(1)1,3,5 years survival rates of esophagectomy patients with esophageal squamous cell carcinoma were 88.3%,54.7%,44.4%, respectively, and the median survival period was 42.5 months (95% CI:29.04-55.96 months). Univariate analysis showed that vascular cancer embolus, surgical margins, N classification, TNM classification, significantly correlated with 5-year survival rates (P<0.05).There is a lower 5-year survival rate in patients of vascular cancer embolus or positive surgical margins or later N classification or later TNM classification. Mulitivariable analysis showed that N classification was an independent prognostic factor of esophagectomy patients with esophageal squamous cell carcinom.(2) The response rate (RR) of 139 ESCC patients with chemotherapy was 46.8% with 1-year,3-year,5-year survival rates of 55.4%,15.8%, 4.5%, respectively. The median OS of advanced ESCC in first-line chemotherapy was 13.9 months. According to the results of univariate and COX multivariate analysis, OS of advanced ESCC was closely associated with liver metastasis (P=0.028), curative effect of first-line chemotherapy (P=0.001) and thoracic radiotherapy (P=0.000). (3) Fifty-seven advanced esophageal squamous cell carcinomapatientswho received gemcitabine or fluorouracil combined with cisplatin as second-line chemotherapy after failure to chemotherapy were retrospectively analyzed. The RR were 19.4% and 19.2%, the disease control rates(DCR) were 58.1% and 53.8%, the median progression free survival(PFS) were 3.0 (2.39-3.69) months and 4.4(2.69-6.03) months, and the median overall survival (OS) were 6.0 (4.87-7.21) months and 7.6(3.88～11.93) months in gemcitabine group and fluorouracil group, respectively, with no significant difference (P>0.05). Toxicity was tolerable, major adverse events were myelosuppression, gastrointestinal disorders in two groups.Conclusion:(1) Vascular cancer embolus, surgical margins, N classification, TNM classification could affect the survival of esophagectomy patients with esophageal squamous cell carcinoma. N classification was the major prognostic factor that could affect the survival of esophagectomy patients with esophageal squamous cell carcinoma. (2)Liver metastasis, curative effect of first-line chemotherapy and thoracic radiotherapy have significant effects on the prognosis of advanced patients with ESCC. The patients who absence of liver metastasis have better prognosis. It is beneficial to survival if the curative effect of first-line chemotherapy is effective, receive thoracic radiotherapy.(3)Gemcitabine or fluorouracil combined with cisplatin as the second-line chemotherapy is effective in patients with advanced esophageal squamous cell carcinoma.