Failure Pattern And Influencing Factors Of Simple Two-field Radical Resection For PT1-3N0M0 Thoracic Esophageal Squamous Cell Carcinoma

Objective:The incidence of local recurrence and/or distant metastas is after pN0 esophageal squamous cell carcinoma resection is still high,but the value of postoperative adjuvant therapy is still controversial.On the basis of previous researches,this study visited patients again to an alyze the failure reasons and influencing factors after thoracoabdominal r adical resection of stage pT_1-3N₀M₀ esophageal squamous cell carcinoma,so as to guide the option of postoperative adjuvant treatment.Methods:From Jan 2008 to Dec 2012,488 patients suffered with thoracic esophageal squamous cell carcinoma who underwent two-field R₀ esophag-ectomy,pathologically classified as stage pT_1-3N₀M₀,without adjuvant radiotherapy and/or chemotherapy before or after surgery and postoperative survival time?3 months were enrolled in this study,including 303 men and 185 women.The median age was 62?range from 34 to 86?.Them ediastinal lymph nodes with diameter?1cm were observed in 115 cases with preoperative CT scan.Primary tumors were found in 61 cases inthe upper thoracic segment,344 cases in the middle and 83 cases in the lower.The median tumor length was 4cm?range 0.2-10cm?.There were 62 cases without adhesion,243 cases with mild adhesion and 139 cases with severe adhesion.The median number of lymph nodes dissected was 9?range 1-32?.Postoperative pathological types:450 cases of moderately differentiated squamous cell carcinoma and 38 cases of poorly differentiated squamous cell carcinoma.After surgery,there were 102 in stage pT1,126 in pT2 and 260 cases in pT3,respectively.SPSS24.0 statistical software was used for data analysis.Results:The follow-up deadline was December 1,2019.By the end of foll ow-up,36 cases were lost,and the follow-up rate was 92.6%.The rate of follow-up 92.6%.In the whole group,275 patients survived,213 died,173?81.2%,173/213?died of tumor causes,and 40?18.8%,40/213?died of non-tumor causes.There were 231 cases with postoperative recurrence in the whole group,and total recurrence rate?TR?was 47.3%?231/488?.Locoregional recurrence?LR?and distant metastases?DM?accounted for 27.7%?135/488?and 9.0%?44/488?.Rate of LR combined with DM was 10.7%?52/488?.Overall,the total rate was 38.3%of LR and 19.7%of DM.In TR,the simple LR rate was 58.4%?135/231?,the DM rate was 19.0%?44/231?,rate of LR combined with DM was 2-2.5%?52/231?,and the total LR rate was 81%?187/231?.In LR patients,the recurrence of supraclavicular region,mediastinum and abdomen a-ccounted for 19.8%?37/187?,83.4%?156/187?and 7.0%?13/187?of th-e total local area recurrence,respectively.Recurrence of superior mediastinal,supraclavicular and subcarinal lymph nodes accounted for 91.71%?143/156?of mediastinal recurrence.Overall postoperative survival?O S?at 1,3 and 5 years were 93.2%,73.0%and 62.1%,respectively.Disease-free survival?DFS?at 1,3 and 5 years were 85.7%,68.0%and59.2%,respectively.The rates of TR at 1,2,3 and 5 years after surgery were 14.3%,22.6%,32.0%and 40.8%,respectively.The rate of recurrent TR was 29.9%,46.8%,65.4%and 82.7%,respectively.Results of univariate analysis showed that preoperative CT mediastinal lymphnode,tumor location and pT staging were related to TR rate?P<0.05?.Multivariate analysis showed that preoperative CT small mediastinal lymphnodes,tumor location,and pTstaging were independent risk factors for TR rate.The total LR rate was 12.5%,19.7%,26.7%and 34.4%at 1,2,3 and 5 years after operation,respectively.The percentage of LR in 1,2,3 and 5 years after operation was 32.1%,49.7%,66.3%and 83.4%,respectively.Univariate analysis showed that preoperative CT mediastinal lymph node,tumor location and pT staging were related to the total LR rate?P<0.05?.The results of multivariate analysis showed that small me diastinal lymph nodes,tumor location and pT staging were independent risk factors affecting the total LR rate.After 1,2,3 and 5 years,the total DM rate was 3.70%,7.20%,11.3%and 17.2%,respectively.The incidence of DM in 1,2,3 and 5 years was 18.8%,36.5%,57.3%and87.5%of the total DM,respectively.Univariate and multivariate analyses showed that tumor location was related to total DM?P<0.05?.Conclusions:The recurrence rate of pN0 thoracic esophageal squamous cell carcinoma was higher after two field radical resection and increased with extension of postoperative time.LR,especially the superior mediastinum and supraclavicular region,may be the focus of postoperative adjuvant radiotherapy.The tumor location was related to TR,LR and DM.The recurrence rate of upper thoracic squamous cell carcinoma was the highest,followed by middle thoracic squamous cell carcinoma,and lower thoracic squamous cell carcinoma was lower.Preoperative CT small mediastinal lymph nodes and pT staging were related to TR and LR.The TR and LR rates were lower in patients with no small lymph nodes and stage pT1 in the preoperative CT mediastinal,but higher in patients with small lymph nodes and stage pT3 in the preoperative CT mediastinal.