Clinicopathologic Features And Prognosis Of Esophageal Squamous Cell Carcinoma At The Circumferential Resection Margin

Objective: The purpose of the study was to analyze the relationship between the circumferential resection margin of esophageal squamous cell carcinoma and postoperative survival and prognosis,and to investigate the correlation between the circumferential resection margin and clinicopathologic features of esophageal squamous cell carcinoma.Methods: To collect the Fourth Hospital of Hebei Medical University in October 2017 to March 2019 after esophageal cancer radical resection of patient information,all of the patients with complete clinical and medical records of postoperative pathology were squamous cell carcinoma and gross pathologic classification according to the domestic points for the medulla,mushroom umbrella,ulcer,narrow type and in cavity type.Acquisition and follow-up of patients with gender,age,T stage,N stage,tumor location,length,gross pathologic lesion type,the vascular tumors,neural invaded,circumferential cutting edge and other clinical data,a total of 328 cases,using SPSS 20.0 statistical software,application of Kaplan Meier survival curve and the Log-rank test of single factor analysis,multi-factors Cox regression method.the survival analysis.The enumeration data were analyzed by chi-square test and Fisher’s exact test.When P<0.05,statistical difference was considered.Results: By the follow-up date,the 1-year and 2-year overall survival rates of 328 patients with esophageal squamous cell carcinoma were 91.9% and 84.8%,respectively.The overall lifetime value is 16 months(ranging from 2 to 25 months).Single factor analysis showed that T stage,vascular tumor thrombus and nerve invasion were the influencing factors of the overall survival rate.Multivariate analysis showed that nerve invasion was an independent risk factor affecting the overall survival rate.Stratified analysis showed that the circumferential margin of patients < 60 years old was correlated with the overall survival rate(P=0.006 < 0.05),the circumferential margin of patients with general pathological type of ulcer was correlated with the overall survival rate(P=0.002 < 0.05),and the circumferential margin of patients with tumor length ≥4cm was correlated with the overall survival rate(P=0.046 < 0.05).The 1-year and 2-year disease-free survival rates of 328 patients with esophageal squamous cell carcinoma were 89.7% and 67.8%,respectively.The median disease-free survival was 16 months(ranging from 2 to 25 months).Single factor analysis showed that N stage was the influencing factor of postoperative disease-free survival rate of patients with esophageal squamous cell carcinoma.Stratified analysis showed that the disease-free survival rate in the negative circumferential margin group with gross pathological types of ulcerative type(P=0.002 < 0.05)was better than that in the positive circumferential margin group,and the disease-free survival rate in the negative circumferential margin group with tumor length ≥4cm was better than that in the positive circumferential margin group(P=0.015 < 0.05).There were 328 patients in the whole group,including 66 patients with positive circumferential margin,and the positive rate of circumferential margin was 20.1%.Univariate analysis showed that T stage,N stage,vascularized thrombus,nerve invasion and gross pathological type were the influencing factors of circumferential resection margin.Multivariate Logistic regression analysis showed that T stage,vascularized thrombus,and gross pathological type were the influencing factors of circumferential resection margin.Conclusion:1.No effect of circumferential resection margin on the prognosis of esophageal squamous cell carcinoma was found using CAP criteria.2.It was only found that the positive circumferential resection margin of esophageal squamous cell carcinoma was associated with T stage,blood vessel invasion and pathological classification,but not with other clinicopathological characteristics.