| Objective:Retrospective analysis of prognosis,recurrence and metastasis after treatment of significance and operation assisted radical postoperative stage pT1 squamous cell carcinoma of thoracic esophagus.Method:From January 2010 to December 2014,131 cases of stage pT1 thoracic esophageal cancer which were diagnosized and treated with radical resection in Department of Thoracic Surgery,The Union Clinical Medical College of Fujian Medical University.Among them.Male in 96 and female in 35 cases;median age was 57 years-old(range 39 to 87 years old);The tumor has invasion into the T1 a in 34 cases and T1 b in 97 cases.21 cases with poor differentiated squamous cancer(SCC),110 cases with well-or middle differentiated squamous cell carcinoma.The median of lymph nodes removal during surgery were 27(range from 7 to 78),50 cases with less than 27 lymph nodes,81 cases with more than 27 lymph nodes.There were 97 cases in stage NO,25 cases in stage N1,7 cases in stage N2 and 2 cases in stage N3.Postoperative pathological classification: 13 cases in IA,85 in IB,24 in IIB,7 in IIIA,and 2 in IVA.Pathology indicated that there were 11 cases with vascular tumor thrombus,and 120 patients without vascular tumor thrombus.(If the postoperative pathology report does not mention the patient with the vascular tumor thrombus,we will default the patient without vascular tumor thrombus).Site of primary tumor was located upper-in 15,middle-in 51,and low-thoracic in 61 cases.The tumor length ≥ 2cm in 65 cases,and there > 2cm in 66 cases.SPSS 21.0 statistical software was used to statistical analysis.Results:The end of Follow-up was January,201 8.During the follow-up period,34(25.95%)patients died,27 died from the tumor itself,and 7 died from other causes.The overall recurrence rates was 21.4%(28/131)for all patients;the rates of locoregional recurrence,distant metastasis and combined recurrence were 53.6%(15/28),32.1%(9/28),14.3%(4/28).The 1-,3-,5-year overall survival(OS)rates were 96.9%,90.8%,86.3%;the 1-,3-,5-year rates of progression free survival(PFS)were 80.2%,71.0%,69.5 %,The median survival time was 52.0 months and 50.0 months,respectively.Univariate analysis showed stage N,vascular invasion,depth of invasion and drinking were the independent risk factors for local recurrence and(or)distant metastasis in patients with pT1 esophageal squamous carcinoma(P < 0.05),With multivariate analysis,vascular invasion and drinking were the independent risk factors for local recurrence and(or)distant metastasis in patients with pT1 esophageal squamous carcinoma(P < 0.05).The Kaplan-Meier method remind stage N,vascular invasion,drinking and tumor size were the independent risk factors for OS and PFS(P < 0.05);COX’S regression model remind vascular invasion,drinking,differentiation degree and tumor length were the independent risk factors for OS and PFS(P < 0.05).Univariate analysis showed tumor size and drinking were the independent risk factors for local recurrence and(or)distant metastasis in patients with pT1N0 esophageal squamous carcinoma(P < 0.05).Conclusions : For patients of stage pT1 squamous cell carcinoma of thoracic esophagus,after radical resection,There were still 21.4% of patients with local recurrence and/or distant metastasis.Postoperative pathology indicated that the tumor length > 2.0 cm,lymph node metastasis,infiltration depth of the submucosa,the vascular invasion and drinking patients were associated with treatment failure(P<0.05).This group of patients should develop more intensive follow-up strategies after surgery,and appropriate post-operative adjuvant treatment may help reduce the risk of recurrence and improve prognosis after surgery. |
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