Survival Analysis Of Esophagectomy Patients With Esophageal Squamous Cell Carcinoma

Background and Objectives Esophageal carcinoma(EC)is a serious threat to human health,which can be divided into two types:esophageal squamous cell carcinoma and esophageal adenocarcinoma.The main type of esophageal cancer is esophageal squamous cell carcinoma in China.The new cases of esophageal cancer reached 477 thousand and the number of deaths reached up to 375 thousand in a year according to China's cancer statistics in 2015.The incidence of esophageal cancer is about twice as much in men than in women.Besides,EC is more likely to occur in areas with relatively backward economic development.This study was conducted in Taixing City,Jiangsu Province,which belongs to one of the seven highest incidence areas of EC.The incidence and mortality of EC is the highest in all cancers in Taixing City which bring heavy burden of disease to the local economic development.There are a variety of treatment methods for esophageal cancer and surgical treatment is the most effective method till now.Many factors can affect the prognosis of patients with EC,including the patient's own basic health status,clinical treatment,the severity of the tumor and postoperative care.So many factors are huge challenges for researching the prognosis of EC and it's difficult to get a consistent conclusion due to the different qualities in different studies.So,we collected the clinical data,pathological data and follow-up data of patients with esophageal squamous cell carcinomabetween 2010?2013 in Taixing City to explore the factors affecting the survival of patients,improve patients' life quality,and provide reference for clinical treatment of esophageal cancer.Materials and MethodsWe collected cases of esophageal cancer from October 2010 to September 2013in Taixing people's Hospital,Huangqiao Hospital and Taixing Hospital of traditional Chinese medicine.The strict inclusion and exclusion criteria were established in the research and the data we neededincluded three parts:general demographic data,clinical pathological data and follow-up data.Quality control runs through the whole research,including the design of the project,the implementation of the investigation,the data processing and the data analysis.Gender,age,education level,family history of EC,history of chronic disease,previous history of surgery,esophageal reflux,smoking,drinking alcohol,drinking tea,BMI were considered when we analyzed the general demographic data.The amount of intraoperative bleeding,operation time,surgical method,tumor length,chest tube drainage,postoperative complications,pulmonary function,blood type,health insurance,hospitalization time,lymph node metastasis,number of lymph node dissection,tumor location,pathology type,degree of differentiation,depth of invasion,TNM stage were considered when we analyzed the clinical pathological data.Stata 13.0 was used for data analysis.Log-rank test was used to compare the survival curves of patients in different groups.Cox proportional hazards regression model was used for univariate and multivariate analysis.P<0.05 was considered to be statistically significant.ResultsA total of 467 patients with esophageal squamous cell carcinoma were included in this study.Among them there were 329 males and 138 females.The average age and median age of all included patients was 64 years old.The overall median survival time was 59.3 months and the 1-,3-,5-year overall survival rates were 89.22%,62.33%,and 49.99%,respectively.Log-rank test results showed that age,BMI,intraoperative blood loss,operative time,length of tumor,postoperative complications,pulmonary ventilation function,hospitalization time,lymph node metastasis,tumor location,degree of differentiation,depth of invasion,TNM stage could affect the survival of patientswho underwent surgical resection.In multivariate survival analysis,age,BMI,intraoperative blood loss,complications and TNM stage were found to be independent prognostic factors.ConclusionsAge,BMI,intraoperative blood loss,operative time,length of tumor,postoperative complications,pulmonary ventilation function,hospitalization time,lymph node metastasis,tumor location,degree of differentiation,depth of invasion,TNM stage were closely related to the prognosis of patientswith resected esophageal squamous cell carcinoma.Older age,more blood loss,postoperative complications,the advanced TNM stage could increase the risk of death for the patients with resected esophageal squamous cell carcinoma.