A Preliminary Study On The Effect Of COVID-19 On Postoperative Adjuvant Therapy Compliance And Prognosis Of Patients With Esophageal Squamous Cell Carcinoma

Objective:A preliminary study on the effect of COVID-19 on postoperative adjuvant therapy compliance and prognosis of patients with esophageal squamous cell carcinoma.Methods:The patients who underwent radical resection of esophageal squamous cell carcinoma in the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital from October,2019 to February 2020(observation group)and from April 2019 to August 2019(control group)were retrospectively analyzed.The patients in the observation group received adjuvant treatment during COVID-19,and adjuvant treatment of the patients in the control group were mostly completed before the epidemic.The compliance of adjuvant therapy and prognosis were compared between the two groups.Results:(1)In the observation group and control group,patients with good,moderate and poor compliance to postoperative adjuvant therapy accounted for 22.30%,20.14%,57.55%and 61.31%,7.87%,25.98%,respectively,with significant difference(P<0.001).(2)The 1-,2-year DFS were 64.5%,46.8%in the observation group and 69.2%,52.0%in control group,with the median DFS were 21 months in the observation group and 28 months in the control group,and there was no significant difference between the two groups(P=0.236).The 1-,2-year OS were 82.5%,60.6%in the observation group and 89.5%,68.5%in control group,the two groups did not reach median OS,and there was no significant difference between the two groups(P=0.148).(3)The effect of COVID-19 on DFS and OS were analyzed according to the presence of lymph nodes metastasis:of the patients with negative lymph node metastasis,the 1-,2-year DFS were 81.4%,73.3%in the observation group and 83.3%,72.2%in control group,and the 1-,2-year OS were 89.2%,78.2%in the observation group and 94.4%,77.8%in control group,both with no significant difference(P=0.948,P=0.975);of the patients with positive lymph node metastasis,the 1-,2-year DFS were 58.2%,36.1%in the observation group and 66.8%、48.6%in control group,and the 1-,2-year OS were 80.1%,53.0%in the observation group and 88.7%,67.0%in control group,both with significant difference(P=0.039,P=0.038).(4)Effect of adjuvant therapy compliance on the DFS and OS of the observation group:the 1-and 2-year DFS of good,moderate,poor compliance subgroup were 80.6%and 58.1%,71.4%and 60.7%,55.6%and 38.8%.There was no significant difference in DFS between the good and the moderate compliance subgroups(P=0.970);there was significant difference in DFS between the good and the poor compliance subgroups(P=0.039);there was no significant difference in DFS between the moderate and the poor compliance subgroups,but the P values tended to be significant(P=0.050).The 1-and 2-year DFS of the good+the moderate compliance subgroup were 76.3%and 59.3%,with significant difference in DFS between the good+the moderate compliance subgroup and the poor compliance subgroup(P=0.009).The 1-and 2-year OS of good,moderate,poor compliance subgroup were 87.1%and 74.2%,85.7%and 71.4%,79.6%and 52.5%.There was no significant difference in DFS between the good and the moderate compliance subgroups(P=0.785);there was significant difference in DFS between the good and the poor compliance subgroups(P=0.046);there was no significant difference in DFS between the moderate and the poor compliance subgroups(P=0.100).The 1-and 2-year DFS of the good+the moderate compliance subgroup were 86.9%and 73.2%,with significant difference in DFS between the good + the moderate compliance subgroup and the poor compliance subgroup(P=0.017).Conclusion:(1)COVID-19 had a significant effect on the compliance of postoperative adjuvant therapy for patients of esophageal squamous cell carcinoma.(2)COVID-19 had a significant effect on DFS and OS in patients with lymph node positive after radical resection of esophageal squamous cell carcinoma.(3)During COVID-19,adjuvant therapy compliance was a prognostic factor for esophageal squamous cell carcinoma patients that were recommended to receive adjuvant treatment.After the epidemic entered the era of regular epidemic prevention and control,patients that received supplementary adjuvant treatment still had better survival benefits than that did not receive adjuvant treatment.