Analysis Of Prognostic Factors In 184 Patients With Stage ? Esophageal Squamous Cell Carcinoma After Radical Resection

Objectives:The clinicopathological data of patients with stage ? esophageal squamous cell carcinoma after radical resection were analyzed retrospectively to explore the related factors affecting the postoperative prognosis of patients with stage ? esophageal squamous cell carcinoma,and to establish a predictive model of overall survival rate according to the risk factors,in order to improve the postoperative survival rate and prolong the time of disease-free progression after operation.It is expected to find some improvements in the treatment mode of this kind of patients in this study.Materials and methods:The clinicopathological data of patients who underwent radical resection of esophageal squamous cell carcinoma in stage ?(pT1N2M0,pT2N1-2M0,pT3N1-2M0,pT4aN0-1M0)in the Department of Thoracic surgery of *** Hospital from January 2014 to December 2018 were collected,including sex,age,family history of tumor,location of tumor,length of tumor,mode of operation,location of anastomosis,vascular tumor thrombus,number of dissected lymph nodes,degree of differentiation,T stage,N stage,postoperative pathological stage and postoperative adjuvant treatment.After screening with inclusion and exclusion criteria,184 patients were finally included.SPSS22.0 and R3.5.1 software were used to analyze the factors affecting the prognosis of radical resection of stage ? esophageal squamous cell carcinoma.Chi-square test was used for counting data,Kaplan-Meier was used to draw survival curve,Log-rank was used for univariate analysis,and significant variables in univariate analysis were included in Cox model to identify independent risk factors for prognosis after radical resection of esophageal squamous cell carcinoma in stage ?.Based on the results of multivariate Cox regression model,the prediction model of overall survival rate was established.The calibration degree predicted by the model is verified by the calibration curve,and the discrimination degree is verified by CIndex.It was directly displayed in the form of line chart by R software,and the difference was statistically significant(P < 0.05).Results:A total of 184 patients were included,including 145 males and 39 females,with a median age of 62 years old(range from 48 to 79 years old).There were 20 cases with family history,164 cases with no family history.7,158,19 cases with tumor located in the upper,middle and lower segments.7 cases in the neck,12 cases in the parietal pleura,145 cases in the supraarch and 20 cases under the arch.163,21 cases in the second field and third field operation.The median length of the tumor was 6.0cm(range 1.2~9.0cm).The median number of lymph node dissection during operation was 10(range 8~32).115 cases with vascular tumor thrombus,69 cases without vascular tumor thrombus.Postoperative pathological T stage:10 cases with pT1,23 cases with pT2,151 cases with pT3,and postoperative pathological N stage: pN1 stage99 cases,pN2 stage 85 cases.The postoperative clinical stages were stage ?A(n=23),stage ?B(n=161).Simple operation(n=46),postoperative adjuvant radiotherapy(n=21),postoperative adjuvant chemotherapy(n=69)and postoperative adjuvant cheoradiotherapy(n=48).As of December 31,2019,a total of 118 patients died and 66 survived.The 1-,3-and 5-year OS of the patients were 78.8%,30.9% and 19.8%,and the median survival time was 28 months.Univariate analysis showed that tumor length,number of lymph nodes dissected,degree of differentiation,T stage,N stage,postoperative pathological stage and postoperative adjuvant therapy were related to postoperative OS.Multivariate analysis showed that tumor length,differentiation,T stage,N stage and postoperative adjuvant therapy were independent influencing factors of OS in patients with ? stage esophageal squamous cell carcinoma after radical resection.Based on the independent influencing factors of patients OS,a predictive score system(CIndex=76.73%)was established,and the OS of patients was directly displayed by R software.Esophageal tumor progression occurred in 145 cases and no progression occurred in 39 cases,including local recurrence(86.9%),distant metastasis(7%)andmixed metastasis(local recurrence + distant metastasis)(6.1%).The PFS of the patients at 1,3 and 5 years after operation were 67.5%,18.6% and 3.2%,and the median time of no progression was 20 months.Univariate analysis showed that family history,mode of operation,tumor length,degree of differentiation,number of lymph nodes,T stage,N stage,postoperative pathological stage and postoperative adjuvant treatment were related to postoperative PFS.Multivariate analysis showed that the mode of operation,tumor length,degree of differentiation,T stage,N stage and postoperative adjuvant therapy were independent influencing factors of PFS in patients with ? stage esophageal squamous cell carcinoma after radical resection.Conclusions:(1)The single center analysis of 184 patients with ? stage ESCC after radical resection showed that the 5-year OS was 19.8%.Tumor length,degree of differentiation,T stage,N stage and postoperative adjuvant therapy were independent influencing factors of OS after radical resection of ? stage ESCC In this group.Tumor length < 5cm,T stage N stage early,high differentiation,postoperative chemotherapy and cheoradiotherapy may improve OS,while the value of postoperative radiotherapy alone remains to be further confirmed;(2)All the factors affecting OS can affect PFS,and it is also found that the mode of operation is also an independent factor affecting PFS.The mode of operation is three fields,tumor length<5cm,early T stage,N stage,high differentiation and postoperative chemotherapy can significantly improve PFS;(3)The predictive model based on the independent influencing factors of OS can accurately predict the survival rate of patients with esophageal squamous cell carcinoma after radical resection of stage ?,which is feasible and reliable,and can be directly displayed in the form of line chart.It is worth further verification by multiple centers.(4)Neoadjuvant therapy is rarely used in this group of patients with ? ESCC at the same time,which is worthy of future study.25% of the patients did not receive postoperative adjuvant therapy.This study suggests that postoperative chemotherapyor cheoradiotherapy are beneficial to the survival of patients,and the importance of postoperative adjuvant therapy should be further strengthened.