Analysis Of Prognostic Factors In Patients With Esophageal Squamous Cell Carcinoma And The Influence Of Minimally Invasive And Open Esophagectomy On Prognosis

Objective:Esophageal cancer is one of the fatal tumors in China,while China is the high incidence area of esophageal cancer in the world.Nearly half of esophageal cancer in the world occurs in China,and the disease-related survival rate is only 20.9%^[1].At present,the main treatment of esophageal cancer is still surgery.With the development of minimally invasive surgery in recent years,it is used more and more in the surgical treatment of esophageal cancer.Therefore,there are increasing researches on results of minimally invasive esophagectomy?MIE?and traditional open esophagectomy?OE?for esophageal cancer,but the existing large group of retrospective studies do not show obvious survival advantages of MIE over OE^[2-3].In this study,we analyzed the prognostic factors of esophageal cancer,and compared the effects of MIE and OE on long-term survival of esophageal cancer patients.Methods:This study was a retrospective study.From January 2011 to January 2015,862 patients with esophageal squamous cell carcinoma were selected from the Fourth Hospital of Hebei Medical University,among which92 patients were treated with MIE.All patients with distant metastasis were excluded before operation,and the postoperative pathology was squamous cell carcinoma.Clinico-pathological information were obtained through check the medical records and follow up.Twelve covariates such as sex,age,cancer location,depth of tumor invasion,length of tumor,number of dissected lymph nodes,number of positive lymph nodes,smoking history,drinking history,invasion of stump,vessel invasion and postoperative adjuvant treatment were included in propensity score matching analysis.The caliper value was 0.05.Ninety-two patients who underwent MIE and 770 patients who underwent OE were matched by 1:3 matching method and 77 MIE patients and 196 OE patients were successfully matched,thus,273 patients were included in the study.Univariate analysis was performed with Kaplan-Meier method and assessed with log rank test.Multivariate analysis was conducted with Cox regression method.Chi square test was used for counting data,and the test level was bilateral?=0.05.When p<0.05,there was statistical difference.Results:In the entire group,3-year and 5-year OS were 65.2%and57.8%respectively,and 3-year and 5-year DFS were 62.2%and 56.0%respectively.Univariate analysis showed that smoking,drinking,long menstrual lesion,depth of tumor invasion,operation mode,number of positive lymph nodes,and postoperative adjuvant therapy were associated with OS.while gender,age,tumor location,number of lymph nodes to be cleaned,stump condition,vascular tumor thrombus,all have no statistical differences,not influence Related factors of OS in patients with esophageal cancer.Multivariate analysis demonstrated that drinking alcohol,depth of tumor invasion,operation methods,number of positive lymph nodes,postoperative adjuvant treatment were independent prognostic factors of OS.Following factors were associated with DFS by univariate analysis:smoking history,drinking history,length of tumor,operation method,depth of cancer invasison,number of positive lymph nodes,adjuvant treatment,while gender,age,tumor location,number of lymph nodes to be cleaned,stump condition,vascular tumor thrombus,all have no statistical differences,not influence Related factors of DFS in patients with esophageal cancer.Followings were demonstrated to be the independent prognostic factors of DFS by multivariate analysis:drinking alcohol,depth of tumor invasion,operation methods,number of positive lymph nodes,adjuvant therapy.The 3-and 5-year OS was 75.3%and 67.5%,respectively,in MIE patients,and the corresponding figure were 61.2%and 42.8%,respectively,in OE patients?P<0.05?.There were 17 complications in MIE group and 49 in OE group,with a rate of 25%??²=0.094,P=0.759>0.05?.Hoarseness occurred in 24 patient in MIE group and 32 patients in OE group??²=6.586,P=0.010<0.05?.Conclusion:1 Drinking,depth of tumor invasion,operative methods,number of positive lymph nodes,and postoperative adjuvant therapy are independent factors affecting OS and DFS of esophageal squamous cell carcinoma.2.Minimally invasive surgery can improve OS and DFS of patients with pTNM stage?and?,which is statistically significant,but it is easy to damage the recurrent laryngeal nerve and cause postoperative vocal cord paralysis.It is suggested that attention should be paid to protecting the recurrent laryngeal nerve during operation.