Clinical study on postoperative recurrence in patients with pN0 esophageal squamous cell carcinoma

Xu-Feng Guo, Teng Mao, Zhi-Tao Gu, Chun-Yu Ji, Wen-Tao Fang, Wen-Hu Chen, Xu-Feng Guo, Teng Mao, Zhi-Tao Gu, Chun-Yu Ji, Wen-Tao Fang, Wen-Hu Chen

Abstract

Background: Despite increasingly radical surgery for esophageal carcinoma, many patients still develop tumor recurrence after operation. This study was designed to analyze the clinical and pathologic influencing factors of early recurrence in patients with histological node-negative (pN0 stage) esophageal squamous cell carcinoma (ESCC) after radical esophagectomy.

Methods: A retrospective study on 112 consecutive pN0 stage ESCC patients who underwent esophagectomy with lymphadenectomy by the same surgical team from January 2004 to December 2010. There were 92 male and 20 female patients, aging from 36 to 80 years with a mean age of 60.3 years. The Cox proportional hazards model was used to determine the independent risk factors for recurrence within 3 years after the operation.

Results: Recurrence was recognized in 45 patients (40.2%) within 3 years after operation. The median time to tumor recurrence was 17.4 months. Locoregional recurrence was found in 38 patients (33.9%) and hematogenous metastasis in 7 patients (6.3%). However, locoregional recurrence accounted for 84.4% of all relapse patients. Recurrence closely correlated with tumor location, grade of differentiation, primary tumor stage (pT) and pathologic stage (χ2 = 6.380 to 18.837, p < 0.05). The Cox multivariate analysis showed that upper/middle thoracic location (OR = 1.092, p = 0.049) and pT3-4a stage (OR = 3.296, p = 0.017) were independent risk factors for postoperative locoregional recurrence.

Conclusion: Locoregional recurrence was the most common recurrence pattern of patients with pN0 ESCC within 3 years after operation. Upper/middle thoracic location and pT3-4a stage were independent risk factors for locoregional recurrence of pN0 ESCC after radical esophagectomy.

Figures

Figure 1
Figure 1
Regional lymph node stations for staging esophageal cancer (JEOG).
Figure 2
Figure 2
The comparison of occurrence time between locoregional recurrence and hematogenous recurrence in pN0 ESCC patients.
Figure 3
Figure 3
Recurrence curve for the patients with different pT stage.
Figure 4
Figure 4
Recurrence curve for the patients with different tumor location.

References

    1. Chen W, He Y, Zheng R, Zhang S, Zeng H, Zou X, He J. Esophageal cancer incidence and mortality in China, 2009. J Thorac Dis. 2013;5:19–26.
    1. Mulligan CR., Jr Multidisciplinary management of esophageal cancer. Surg Oncol Clin N Am. 2013;22:217–246. doi: 10.1016/j.soc.2012.12.006.
    1. Li SH, Wang Z, Liu XY, Liu FY, Sun ZY, Xue H. Lymph node micrometastasis: a predictor of early tumor relapse after complete resection of histologically node-negative esophageal caner. Surg Today. 2007;37:1047–1052. doi: 10.1007/s00595-007-3548-y.
    1. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC Cancer Staging Manual. New York: Springer; 2009.
    1. NCCN practice guidelines in oncology, esophageal and esophagogastric junction cancers. (Version.2.2013). [EB/OL]. [2013-02-21]., []
    1. Zi-jiang Z, Xue-zhong C, Niu R, Xue JJ, Chen J, Zheng C. Risk factors for recurrence or metastasis of tumor in patients with esophageal carcinoma after esophagectomy. Chin J Clin Thorac Cardiovasc Surg. 2011;18:521–524.
    1. Tachimori Y, Nagai Y, Kanamori N, Hokamura N, Igaki H. Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system. Dis Esophagus. 2011;24:33–38. doi: 10.1111/j.1442-2050.2010.01086.x.
    1. Shim YM, Kim HK, Kim K. Comparison of survival and recurrence pattern between two-field and three-field lymph node dissections for upper thoracic esophageal squamous cell carcinoma. J Thorac Oncol. 2010;5:707–712. doi: 10.1097/JTO.0b013e3181d3ccb2.
    1. Fang Wen T, Zhang Zhan H, Chen Wen H, Jiang Y, Tao Ju W, Zhong Z y. Ultrasound surveillance of cervical lymph node metastasis in thoracic esophageal carcinoma. Chin J Surg. 2003;41:523–525.
    1. Fang WT, Chen WH, Chen Y, Jiang Y. Selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma. Dis Esophagus. 2007;20:206–211. doi: 10.1111/j.1442-2050.2007.00671.x.
    1. Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198:205–211. doi: 10.1016/j.jamcollsurg.2003.10.005.

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren