Patterns of failure after radical surgery among patients with stage T2-3N0M0 esophageal squamous cell carcinoma——potential value of postoperative radiotherapy
Liu Xiao*, Zhang Wencheng, Yu Shufei, Xiao Zefen, Zhou Zongmei, He Jie, Gao Shugeng, Cheng Guiyu, Liu Xiangyang, Sun Kelin, Mao Yousheng, Xue Qi, Zhang Hongxing, Chen Dongfu, Feng Qinfu. Liang Jun
*Department of Radiation Oncology,Cancer Hospital,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China
Abstract：Objective To determine the patterns of failure and recurrence rate in patients with stage T2-3N0M0 esophageal squamous cell carcinoma (ESCC) after radical surgery and the potential value and target field of postoperative radiotherapy. Methods We retrospectively analyzed 3480 patients initially diagnosed with ESCC from 2004 to 2009 in our hospital. Among 581 patients with stage T2-3N0M0 ESCC, 543 underwent radical surgery alone (S group), and 38 received intensity-modulated radiotherapy after R0 surgery (S+R group). A total of 150 patients (26.3%) were in stage T2N0M0 and 428 patients (73.7%) were in stage T3N0M0. The survival rate was calculated by Kaplan-Meier method, and the difference wasanalyzed by log-rank test. The Cox regression model was used for multivariate prognostic analysis. Results In the clinical data, T stage and clinical stage were not comparable between the two groups. The follow-up rate was 94.7%. In the S group, recurrence developed in 43.6% of stage T2N0M0 patients and 39.0% of stage T3N0M0 patients (P=0.329). The recurrence rate was 40.3% in the S group and 15.8% in the S+R group (P=0.003). The most frequent site of recurrence was mediastinum (18.5%), followed by supraclavicular region and blood metastasis (10.7% for both), and recurrence occurred rarely at the anastomosis and celiac region (3.8% and 3.0%, respectively). The 5-year diseases-free survival (DFS) was significantly higher in the S+R group than in the S group (65.3% vs. 50.8%, P=0.044). There was no significant difference in overall survival (OS) between the two groups. The Cox regression model revealed that the upper margin of tumor and vascular invasion were independent prognostic factors for OS and DFS, while sex and histological grade were predictors of OS. Conclusions For patients with stage T2-3N0M0 ESCC, the recurrence rate after radical surgery is higher in those treated with radical surgery alone than in those treated with radical surgery and postoperative radiotherapy. Postoperative radiotherapy significantly reduces infield recurrence and increases DFS. The value of postoperative radiotherapy should be investigated in larger studies.
. Patterns of failure after radical surgery among patients with stage T2-3N0M0 esophageal squamous cell carcinoma——potential value of postoperative radiotherapy[J]. Chinese Journal of Radiation Oncology, 2015, 24(1): 19-24.
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