Prognostic Factors Of Postoperative Patients With Esophageal Squamous Cell Carcinoma

BackgroundEsophageal cancer（EC）is a malignant tumor of thedigestive system that occurs in the epithelial tissue ofthe Esophageal mucosa.ESCC is one of the most commonmalignant tumors in the world,and more than half of theannual new cases occur in China,where more than 90% of Esophageal cancers are squamous-cell carcinoma.Althoughthe survival of ESCC patients has improved with advancesin diagnostic and therapeutic techniques,the overallfive-year survival rate remains low.The factorsinfluencing the prognosis of esophageal carcinoma afteroperation are various and uncertain.PurposeTo find the related factors that may affect the prognosis of patients with esophageal cancer,selection of appropriate treatmentoptions to prolong the survival of patients to lay the foundation.Materials and methodsA total of 769 cases of esophageal squamous cell carcinoma were collected from January 2010 to October 2010 in Puyang People’s Hospital,The patients with complete clinicopathological data were followed up.Finally,the patients with complete follow-up data were enrolled.Kaplan-meiermethod was used to analyze 13 Related factors（sex,age,tumor site,gross type,tumor longest diameter,degree of differentiation,infiltration,lymph node metastasis,incisal margin,history of smoking,history of drinking,family history,Low incidence area of esophageal cancer）,the factors related to the prognosis of patients with esophageal squamous cell carcinoma were selected,These prognostic factors were incorporated into Cox proportional hazards model for multivariate analysis,and finally the independent influencing factors of postoperative prognosis were obtained.Results1.General data and follow-up results: a total of 769 cases,717 cases withcomplete clinicopathologic data,followed by telephone follow-up,the finalfollow-up data complete408 patients into the group.There were 241 males and167 females,aged 41 ～ 95 years with an average age of 58±7 years,33 with highdifferentiation,266 with middle differentiation and 109 with low differentiation.The mean survival time of 408 patients was47 months and the median survivaltime was 38 months.The overall 1,3 and 5 year survival rates were 86%,63%and 55%,respectively.2.Univariate Analysis:Age,gross type,maximum length diameter,degree of differentiation and lymph node metastasis were correlated with postoperative prognosis of esophageal squamous cell carcinoma（P < 0.05）.The survival time of patients over 60 years old after operation was 120 months,which was shorter than 69 months for patients under 60 years old.Among the gross tumor types,the median survival time of patients with erosive plaque was the longest（120 months）,and that of patients with constrictive plaque was the worst（61 months）.The median survival time of ≤3cm group,3-5cm group and >5cm group was 120 months,66 months and 45 months,respectively,the prognosis of patients under 3cm group was significantly better than the other two groups.The median survival time of patients in the low,medium and high differentiation groups was 33,111 and 120 months,the prognosis of patients in the low differentiation group was significantly worse than that in the middle and high differentiation group.The median survival time of N0,N1,N2 and N3 patients was 120,99,74 and 62 months,the smaller the N stage was,the longer the median survival time was and the better the prognosis was.There was no significant correlation between gender,smoking history,drinking history,family history,tumor location,invasion degree,margin status and low-incidence area and prognosis of patients（P > 0.05）.The median survival time was 69 months for males and 90 months for females.The median survival time of patients with and without smoking history was 69 and81 months.The median survival time of patients with and without drinking history was 69 months and 80 months.The median survival time of patients with positive and negative family history of esophageal cancer was 48 months and 77 months.The median survival time of patients with tumors located in upper,middle and lower esophageal segments was66,79 and 46 months.The median survival time of T1,T2,T3 and T4 patients was 120,99,74 and 62 months.The median survival time of patients with negative margin and positive margin was 79 and 33 months.Median survival time was 66 months in the low-incidence area and 79 months in other areas.3.Multivariate analysis: Maximum length diameter（≤3cm: P=0.000,OR=0.293,95%CI=0.186～0.463;3-5cm: P=0.016,OR=0.620,95%CI=0.421～0.914）,degree of differentiation（low differentiation: P=0.001,OR=3.462,95%CI= 1.706-7.023）,lymph node metastasis（N0: P=0.010,OR=0.506,95%CI= 0.302-0.848）were independent prognostic factors of postoperative esophageal squamous cell carcinoma.Age < 60 years:P=0.059,OR=0.666,95%CI =0.437～1.015,close to the evaluation criteria of independent influencing factors.Conclusions1.Age,gross type,longest diameter of tumor,degree of differentiation and lymph node metastasis were correlated with postoperative prognosis of esophageal squamous cell carcinoma（P<0.05）.2.Tumor size,degree of differentiation and lymph node metastasis were independent influencing factors of postoperative esophageal cancer.3.Age is likely to be an independent prognostic factor for patients with esophageal squamous cell carcinoma.