| Objective:To retrospectively assess the clinical features,short-term efficacy,survival and toxicities of stage IVB thoracic esophageal squamous cell carcinoma(ESCC)at initial diagnosis and to analyze prognostic factors and explore their therapeutic strategies.Methods:199 patients with stage ⅣB(according to UICC/AJCC Eighth Edition esophageal and esophagogastric junction cancer TNM staging)thoracic ESCC at initial diagnosis,which had been treated in the fourth hospital of Hebei medical university between January 2010 to December 2016,were retrospectively investigated.130 patients(65.3%)had distant lymph node metastasis,of which 121 patients had supraclavicular lymph node metastasis;51 patients(25.6%)had parenchymal organ metastasis only;18patients(9.0%)had both solid organs and distant lymph node metastasis.16patients(8.0%)were treated with chemotherapy alone;50 patients(25.1%)were treated with radiotherapy alone;133 patients(66.8%)were treated with radiochemotherapy,of which 81 patients were treated with concurrent radiochemotherapyand52patientsweretreatedwithsequential radiochemotherapy.Response to treatment,overall survival(OS)and toxicities were evaluated.The difference of TNM classification of Japanese Esophagus Society(JES)11th edition and UICC/AJCC 8th edition to evaluate the prognosis of patients with advanced ESCC was compared.Results:1.Short-term efficacy:The objective response rate of primary lesion(pORR)was 82.4%.Univariate analysis showed that the tumor location(χ~2=7.882,P=0.019)and treatment modalities(χ~2=24.218,P=0.000)were the main factors for pORR.The pORR of upper thoracic esophagus was significantly higher than that of middle and lower thoracic esophagus(χ~2=7.846,P=0.005;χ~2=6.236,P=0.013).The pORR of chemotherapy group,radiotherapy group,and radiochemotherapy group were 37.5%,86.0%,and86.5%,respectively.the pORR of radiochemotherapy group and radiotherapy group was higher than that of chemotherapy group(χ~2=22.439,P=0.000;χ~2=14.910,P=0.000).The improvement rate of dysphagia(DIR)was 77.2%.Univariate analysis showed that the type of metastasis(χ~2=13.513,P=0.001)and treatment modalities(χ~2=13.790,P=0.001)were the main factors for DIR.The DIR of distant lymph node metastasis only was significantly higher than that of solid organ metastasis only(χ~2=12.812,P=0.000).The DIR of chemotherapy alone,radiotherapy alone and radiochemotherapy were 30.0%,77.5%,and 81.5%,respectively.The DIR of radiochemotherapy and radiotherapy alone were significantly higher than that of chemotherapy alone(χ~2=13.747,P=0.000;χ~2=8.295,P=0.004).2.Survival:The median OS(mOS)of the entire cohort was 14.0 months(95%CI:11.826-16.174m),and the survival rates for 1 year,2 years,3 years,and 5 years were 53.2%,24.5%,15.8%,and 10.7%,respectively.Multivariate analysis showed that tumor length,the number of metastatic organs,and chemotherapy or not were independent prognostic factors for OS.Patients with tumor length≤3cm,single organ metastasis,and chemotherapy treated had significantly better OS than that with tumor length>3cm,multiple organ metastasis,and chemotherapy untreated.3.According to TNM classification of esophageal cancer of JES 11th edition:108(54.3%)were diagnosed stageⅢ,22(11.1%)were diagnosed stageⅣa,69(34.7%)were diagnosed stageⅣb.There was no significant difference for OS between stageⅢand stageⅣ(χ~2=0.521,P=0.470).Conclusions:1.Radiotherapy could increase the objective response rate of primary lesion(pORR)and improvement rate of dysphagia(DIR).2.Patients with tumor length≤3cm,single organ metastasis,and chemotherapy treated had significantly better OS than that with tumor length>3cm,multiple organ metastasis,and chemotherapy untreated.3.The TNM classification of JES 11th edition did not show significant advantages in the prognosis judgment of advanced ESCC compared with the UICC/AJCC 8th edition.For metastatic esophageal cancer,radiochemotherapy could achieve good local control,improve dysphagia and might prolong survival compared with chemotherapy alone or radiotherapy alone.For patients with good performance status,we should add radiotherapy to the systemic chemotherapy of patients with stageⅣas far as possible,and individually select sequential or concurrent chemoradiotherapy mode. |
