Patterns Of Failure After Radical Surgery And Comparison Of Different Adjuvant Treatment Among Patients With Stage PT2-3N0M0 Esophageal Squamous Cell Carcinoma

Objective:To determine the patterns of failure and the rate of recurrence in patients with p T2-3N0M0 esophageal squamous cell carcinoma(ESCC)after radical surgery and the potential value of postoperative therapy.Methods:From January 2009 to January 2010,155 patients with p T2-3NOMO esophageal squamous cell carcinoma after radical surgery were included in this study.Among them,90 underwent radical surgery alone,34 received radiotherapy after radical surgery,31 received chemtherapy after radical surgery,Among the received radiotherapy of patients,21 received postoperative conformal radiotherapy,and 14 received postoperative intensity-modulated radiotherapy.Results:A total of 84 patients were recurrence,Among them,55 patients ware Intrathoracic regional recurrence(including mediastinal lymph node metastasis, tumor bed and anastomotic recurrence),29 patients were supraclavicular region recurrence,16 patients were celiac region recurrence,9 patients were blood metastasis.The number of recurrence patients underwent radical surgery alone were 56,37 patients ware Intrathoracic regional recurrence, 20 patients were supraclavicular region,12 patients were celiac region,6patients were blood metastasis.The number of recurrence patients radiotherapy after R0surgery were 13, 10 patients ware local failure(including double supraclavicular,mediastinal and abdominal lymph node metastasis, tumor bed ang anastomotic recurrence,intensity-modulated radiotherapy was 2, conformal radiotherapy was 8),blood metastasis was 3(1 for intensity-modulated radiotherapy both,2 for conformal radiotherapy).The number of recurrence patients chemtherapy after R0 surgery were 15,9 patients ware Intrathoracic regional recurrence,5 patients were supraclavicular region,2patients were celiac region,1 patients were blood metastasis. In both univariate and multivariate analyses, Age, esophageal tumor location, the number of removed lymph nodes were an independent prognostic factor for PFS. Esophageal lesion site, the number of removed lymph nodes, the T stage were an independent prognostic factor for OS.The prognosis of lower thoracic esophagus carcinoma is best.The1?3? 5-year PFS rates were 79%?56.8%?45.8% for all patients,Median progression free survival was 44.9months.In simple operation?radiotherapy and chemtherapy, the 1?3?5-year PFS rates were 78%?55.8%?44.8%vs85.3% ?70.6%?58.8%vs80.6%?58.0%?54.8%(P>0.05)?In intensity-modulated radiotherapy and conformal radiotherapy,the1 ? 3 ?5-year progression free survival(PFS) rates 93.3%?86.7%?73.3%vs78.9% ?57.8%?47.3%(P=0.046). Further analysis showed,postoperative adjuvant IMRT can be better improved PFS than simple operation(P<0.005).The1?3? 5-year OS rates were 90%?71%?55% for all patients,Median OS was 53 months.In simple operation?radiotherapy and chemtherapy, the1?3? 5-year overall survival rates were 88.0%?69.0%?53.0%,94.1%?76.4%?64.7%vs90.3%?70.0%?61.0%(p>0.05)?In intensity-modulated radiotherapy and conformal radiotherapy,The 1?3? 5-year overall survival rates were 100%?93.3%?73.3%vs89.5%?63.2%?57.9%(P=0.265).postoperative adjuvant IMRT can be better improved OS than simple operation(P<0.005).Conclusion:1.Age, esophageal tumor location, intraoperative removed lymph node number were an independent prognostic factor for PFS.2.Esophageal lesion site, the number of intraoperative removed lymph nodes, the T stage were an independent prognostic factor for OS.3.Supraclavicular and intrathoracic cavity showed high rate of relapse in p T2-3N0M0 ESCC.4.For patients with stage T2-3N0M0 ESCC, The postoperative of IMRT may be effectively control of the local recurrence rate and prolong the survival period.