Objective To analyze the risk factors for abdominal lymph node recurrence after radical surgery in patients with middle thoracic esophageal squamous cell carcinoma (TE-SCC),and to design the target volume for postoperative radiotherapy based on the results.Methods A retrospective study was performed among 913 patients with middle TE-SCC undergoing radical surgery who were admitted to our hospital from 2007 to 2012.Influencing factors were analyzed for abdominal lymph node recurrence after treatment.The efficacy was compared between different treatment methods in the high-risk population.Comparison of categorical data was made by chi-square test.The overall survival rates (OS) were calculated by the Kaplan-Meier method and analyzed by the univariate log-rank analysis.The influencing factors for abdominal lymph node recurrence were analyzed by the multivariate logistic regression equation.Results After treatment,37 patients had abdominal lymph node recurrence,yielding a recurrence rate of 4.1％.A total of 53 recurrent sites were found.The univariate analysis showed that no/low differentiation,pT3+4 stage,no less than 3 positive postoperative lymph nodes,and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P =0.032,0.001,0.009,0.000).The multivariate regression analysis showed that pathological T staging and positive postoperative abdominal lymph nodes were influencing factors for abdominal lymph node recurrence (P=0.011,0.000).For patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes,postoperative radiotherapy improved OS and local control rates but failed to reduce the distant metastasis-free rate.Conclusions T staging and positive postoperative abdominal lymph nodes are important risk factors for abdominal lymph node recurrence after radical surgery in patients with middle TE-SCC.Postoperative adjuvant therapy is recommended for patients with pT3+4 stage disease and positive postoperative abdominal lymph nodes.

Objective To analyze the failure patterns and prognostic factors of radical surgery in patients with T1-4N0-1M0 thoracic esophageal squamous cell carcinoma (TESCC),and the implications for the target area design of postoperative therapy.Methods We retrospectively analyzed 1 191 patients with TESCC who underwent radical surgery at our institution.The failure patterns,the prognostic factors,as well as the effects of lesion locations and N stage on the failure patterns were analyzed.Results The thoracic-region recurrence rate and the distant metastasis rate was 31.7％ and 16.4％ in all patients.The multivariate analysis showed that the lesion locations,the degree of inflammatory adhesion,T staging,N staging and the rate of lymph nodes metastasis were independent factors affecting the regional recurrence (P ＜ 0.05).Gender,tumor differentiation and the rate of lymph nodes metastasis were independent factors affecting distant metastasis (P ＜ 0.05).The intrathoracic lymph nodes recurrence rate of upper/middle TESCC was significantly higher than that of the lower TESCC (x2 =6.179,P =0.046),while the abdomen lymph nodes recurrence rate of the lower was significantly higher than that of upper/middle TESCC (x2 =15.853,P ＜ 0.05).The recurrence rate and distant metastasis rate of stage N1 patients were significantly higher than that of N0 patients (x2 =7.764-56.495,P ＜ 0.05).The abdomen lymph nodes recurrence rate of stage N1 patients was significantly higher than that of N0 in upper TESCC (x2 =7.905,P ＜0.05).The supraclavicular and intrathoracic lymph nodes recurrence rates of stage N1 patients were significantly higher than that of N0 patients in middle TESCC (x2 =12.506,18.436,P ＜ 0.05).The supraclavicular lymph nodes,anastomosis and abdomen lymph node recurrence rates of stage N1 were significantly higher than that of N0 patients in lower TESCC (x5 =5.272,4.878,18.006,P ＜ 0.05).The anastomotic recurrence rate of stage T3+4 was higher than that of T1+2 in middle/lower TESCC (x2 =4.341,7.154,P ＜ 0.05),and the abdominal lymph nodes recurrence rate of stage T3 +4 was higher than that of T1 +2 in lower TESCC (x2 =5.366,P ＜ 0.05).Conclusions The lymphatic drainage regions for postoperative radiotherapy (PORT) are selective.We suggest that abdominal lymph nodes drainage area should be noted for the stage N1 patients with upper TESCC,and the supraclavicular lymph nodes drainage area should be noted for the N1 patients with lower TESCC.In addition,the anastomosis is suggested to be included in PORT target area for stage T3/T4 middle/lower TESCC patients.

Objective To compare the prognosis of patients with squamous cell carcinona of the upper thoracic esophagus after radical resection with and without postoperative chemoradiotherapy (POCRT).Methods From January 2007 to December 2011,168 patients with upper thoracic esophageal carcinoma who were treated in the Fourth Hospital of Hebei Medical University were retrospectively included in this study.According to the different treatment method,they were divided into simple surgery group (86 cases) and POCRT group (82 cases) respectively.Based on SPSS statistical software,the group data composition,prognostic analysis and multivariate prognostic analysis were performed by x2 test,Log-rank method and Cox regression model,respectively.Results The 1,3,5 year-survival rate,recurrence rate and distant metastasis rate were 83.9％,52.4％,43.5％,26.5％,40.8％,43.4％ and 5.3％,11.4％,16.9％,respectively.The result of multivariate analysis showed that gender,T stage,N stage and treatment method were independent prognostic factors of overall survival (P =0.020,0.008,0.005,0.000);N staging and treatment method were the independent prognostic factors of local/regional recurrence (P =0.001,0.003);differentiation and T staging were the independent prognostic factors of distant metastasis (P =0.045,0.020).The intrathoracic regional recurrence rate of operation only group and POCRT group patients were 44.2％ (38/86) and 29.3％ (24/82) respectively,where the difference was statistically significant (x2 =7.110,P ＜ 0.05).The rate of metastasis were 19.8％ (17/86) and 13.4％ (11/82) respectively without significant difference (P ＞0.05).Conclusions The recurrence rate of patients with upper thoracic esophageal squamous cell carcinoma after radical resection was still high.Postoperative chemoradiotherapy can improve the overall survival rate and reduce the recurrence rate,but whether it can reduce the patient's distant metastasis rate needs further study.

Objective To investigate the effect of prophylactic radiotherapy after radical surgery on the long-term survival of patients with stage ⅡB-Ⅲ thoracic esophageal carcinoma. Methods We enrolled 336 stage ⅡB (n=65) and Ⅲ(n=271) thoracic esophageal carcinoma patients who underwent radical resection with (S+R, n=116) or without (S, n=220) postoperative prophylactic radiotherapy from 2007 to 2010. The median dose of postoperative radiotherapy was 50 Gy. The Kaplan-Meier method, Log rank test and Cox model were used for survival rate calculation, univariate analysis and multivariate analysis, respectively. Results The 5-year overall survival (OS) and disease-free survival rates were 29.3% and 25.6%, respectively. The 5-year OS of stage ⅡB patients in S and S+R groups were 30.1% and 48.6%, respectively (χ2=2.279, P=0.131). The 5-year OS of stage Ⅲ patients in S and S+R groups were 24.9% and 32.8%, respectively (χ2=5.865, P=0.015). The 5-year OS of lymph node-positive patients in S and S+R groups were 25.9% and 35.8%, respectively (χ2=7.663, P=0.006). Postoperative prophylactic radiotherapy resulted in significantly decreased intrathoracic and supraclavicular recurrence, and obviously delayed median local recurrence time in S and S+R groups (10.6 vs. 16.3 months; χ2=6.043, P=0.014). Conclusion Postoperative prophylactic radiotherapy reduces local recurrence and improves the survival of stage Ⅲ or lymph node-positive thoracic esophageal carcinoma patients.

Objective To compare the efficacy between different modalities in the treatment of positive lymph nodes after radical resection for squamous cell carcinoma of thoracic esophagus(TESCC),and to explore the best treatment mode. The Kaplan?Meier method was used to calculate survival rates. The log-rank test and Cox model were used for univariate and multivariate prognostic analyses,respectively. Methods A retrospective analysis was performed among 548 patients with TESCC who were admitted to our hospital and had positive lymph nodes after radical resection. The efficacy of different treatment methods was evaluated. Propensity scores(PSM)were used to make 1-to-1 patient matching between different treatment groups to further analyze and figure out the best treatment model for patients. The Kaplan?Meier method was used to calculate the overall survival(OS)and disease-free survival(DFS)rates. The log-rank test was used for survival analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients,the 1-,3-,and 5-year OS rates were 79.9%, 38.1% and 28.5%,respectively,while the 1-,3-,and 5-year DFS rates were 68.5%,39.8% and 32.5%, respectively. After 1-to-1 matching based on PSM,there were no differences in general clinical pathological data between the four groups. After PSM,there were significant differences in 1-,3-,and 5-year OS and DFS rates between the surgery alone group,the postoperative radiotherapy group,the postoperative chemotherapy group,and the postoperative chemoradiotherapy(POCRT)group(P=0.000,0.000).There were significant differences in OS and DFS rates between patients with stage N1,N2,and N3disease(P=0.000,0.000).The result of the Cox multivariate analysis showed that treatment method and N staging were two independent prognostic factors for OS and DFS(P=0.001,0.000,0.025,0.016). Conclusions Patients with positive lymph nodes after radical resection for TESCC have a poor prognosis. Moreover,the prognosis becomes worse with the increase in metastatic lymph nodes. POCRT may improve the survival in those patients. Prospective studies are needed to further confirm those conclusions.

Objective To analyze the effect of postoperative chemotherapy (POCT) on the prognosis of postoperative lymph node-positive thoracic esophageal squamous cell carcinoma (TESCC) patients. Methods We retrospectively analyzed the prognostic factors for 419 lymph node-positive TESCC patients. Results Compared with POCT group, the 1-, 3- and 5-year OS was significantly lower in patients with surgery alone(χ2= 12.802, P=0.000), while there was no significant difference in 1-, 3- or 5-year DFS (χ2=1.159, P=0.282). Multivariate analysis results showed that gender, age, location of lesion, TNM stage, POCT and chemotherapy cycles were the prognostic factors of OS (P < 0.05), and gender and N stage were the independent prognostic factors of DFS (P < 0.05). Hierarchical analysis results showed that POCT increased OS of male patients ≤60 years of age, lower thoracic lesions, lesions ≤5.0 cm and stage ⅢB, compared with surgery alone (P < 0.05), and also increased DFS of men ≤60 years of age (P < 0.05). Conclusion The prognosis of postoperative lymph node-positive TESCC patients is poor, POCT could improve the prognosis of some patients.

Objective To determine the prognostic factors in patients with stage pT3N0M0 thoracic esophageal squamous cell carcinoma (TSCC) after esophagectomy, and to compare the effects of different treatment modalities on the prognosis of patients.Methods A retrospective analysis was conducted on 480 patients with stage pT3N0M0 TSCC from 2007 to 2010 to determine the prognostic factors in the patients, and to compare the effects of different treatment modalities on their prognosis.Survival rate was calculated using the Kaplan-Meier estimator, and multivariate analysis of prognostic factors was performed using the Cox model.Results Of the 439, 333, and 278 patients who completed the 1-, 3-, and 5-year follow-up, respectively, the 1-, 3-, and 5-year overall survival (OS) rates were 90.0%, 68.7%, and 57.9%(median 87 months, 95% confidence interval (CI=74.7-99.4), respectively, and the 1-, 3-, and 5-year disease-free survival (DFS) rates were 82.3%, 60.4%, and 52.3%(median 71.3 months, 95%CI=55.1-87.5), respectively.In order to account for the different constituent ratios of some clinical and pathological data between the three groups of patients, 55 patients in each group were matched using propensity score matching (PSM)(all P>0.05).It was found that the post-PSM 1-,3-, and 5-year OS and DFS were significantly different between patients who received surgery only, postoperative chemotherapy (POCT), and postoperative chemoradiotherapy/radiotherapy (POCRT/RT)(P=0.000 and 0.006,respectively).Multivariate Cox analysis showed that age, lesion location, and treatment modality were independent prognostic factors for OS and DFS (P=0.029,0.004,0.000 and P=0.009,0.003,0.002), and the length of lesion was also an independent prognostic factor for DFS (P=0.003).Conclusions Although the rate of post-operative treatment failure is still high among patients with stage pT3N0M0 TSCC, POCRT/PORT can improve the prognosis and the 5-year OS and DFS of these patients.However, further large-sample prospective studies will be required to confirm these findings.

Objective To compare the failure modes of the patients with stage Ⅱ and stage Ⅲ thoracic esophageal squamous cell carcinoma (TESCC) treated with surgery,postoperative radiotherapy (PORT) and postoperative radiotherapy and chemotherapy (POCRT),and to explore the best treatment model for different subgroups.Methods We retrospectively analyzed 468 patients treated with different treatment with stage Ⅱ and Ⅲ TESCC after radical resection,and analyzed the relation between their clinicopathological characteristics and the failure modes.SPSS19.0 statistical software was used for statistical analysis.Results The thoracic-regional recurrence rate was 40.8％,and the distant metastasis rate was 27.4％ in the whole group.The 1,3,5 years-thoracic-regional recurrence rates were significantly different among the three groups.The distant metastasis rates were not significant among the three groups.Compared with surgery and PORT groups,POCRT group had lower intrathoracic recurrence rate;but,the surgery group had lower distant metastasis rate.Compared with stage Ⅱ patients,stage Ⅲ patients had higher distant metastasis rate.Compared with N0 stage patients,the patients with N1 stage had significantly higher supraclavicular and abdominal lymph node recurrence rate and higher distant metastasis rate.The intrathoracic recurrence rate of N0 stage patients who received postoperative adjuvant therapy were significantly lower than that in patients who received surgery alone,and N1 stage patients seemed to be able to benefit from POCRT.The supraclavicular lymph recurrence rate and intrathoracic recurrence rate of stage Ⅱ patients who received postoperative adjuvant treatment were significantly lower than those who received surgery alone,but the distant metastasis rates of stage Ⅱ/Ⅲ patients who received postoperative adjuvant therapy were higher than those who received surgery alone.Conclusion There are high thoracic-regional recurrence rate and distant metastasis rate in the patients with stage Ⅱ / Ⅲ esophageal squamous cell carcinoma after radical surgery.Compared with PORT,POCRT can significantly reduce the thoracic-region recurrence rate.It is recommended that POCRT could be applied on stage Ⅱ or N1 esophageal cancer patients.

Objective To analysis the failure mode and the efficacy of salvage therapy for post-operative local recurrence or metastasis in stage pT1-3N0M0 thoracic esophageal squamous cell carcinoma.Methods A retrospective analysis was performed in 265 patients with post-operative local recurrence or metastasis in stage pT1-3N0M0 thoracic esophageal squamous cell cancer who were admitted to the Fourth Hospital of Hebei Medical University from January 2007 to December 2010.SPSS19.0 software was used to analyze the failure mode,the value of salvage therapy and its influencing factors.Results In all patients,the 1-,3-and 5-year overall survival rates were 42.9％,20.0％ and 15.2％,respectively;the median time was 9.8 months(95％CI:7.9-11.7) after failure.Univariate analysis showed that age,degree of differentiation,type of failure,radiotherapy and chemoradiotherapy after failure were associated with OS(x2=5.090,8.319,11.566,17.982,6.878;P＜0.05).Multivariate analysis showed that degree of differentiation,treatment after failure,chemoradiotherapy after failure were the independent factors for OS(P＜0.05).Conclusion The degree of tumor differentiation and thc treatment mode after failure are the independent factors for stage pT1-3N0M0 thoracic esophageal squamous cell carcinoma after radical resection.Salvage radiotherapy and chemoradiotherapy can improve OS after recurrence.

Objective To evaluation and comparison the curative effect of different adjuvant therapy and prognostic factors with thoracic esophageal squamous cell carcinoma (ESCC) after surgery,and to find the best treatment for them.Methods A total of 863 patients with thoracic ESCC underwent surgery in the fourth hospital of Hebei Medical University,From January 2007 to December 2010,To analyze the influence factors of the patient′s independent prognosis and the effect of postoperative adjuvant therapy on the prognosis of patients.The 1:1, after the tendency of a total of 261 cases were used PSM method (87 cases/group).The Kaplan-Meier method was used to calculate OS,DFS and log-rank test and monovariable analysis,Cox model was used to multivariable analysis.Results The sample size in 1,3,5 was 123,589,863 cases.The 1-,3-,and 5-year overall survival (OS) and disease-free survival (DFS) of all patients were 89.7%,62.1%,51.7% and 76.8%,52.1%,44.2%,respectively.The 1,3,5-years of OS and DFS were 956%,73.3%,61.1% and 85.6%,61.1%,54.4%,78.9%,38.9%,31.3% and 67.8%,27.8%,20.0%,92.2%,55.6%,44.4% and 67.8%,44.4%,36.7%(all P=0.000) among postoperation chemoradiotherapy (POCRT),postoperation chemotherapy (POCT) and postoperation radiotherapy (PORT) after pairing with PSM.The result of COX analysis showed that the degree of inflammatory adhesion,pTNM stage and the number of positive lymph nodes were the independent prognostic factors in patients with OS (P=0.002,0.000,0.007).The history of drinking,pTNM stage and treatment model were the independent prognostic factors of DFS (P=0.009,0.000,0.012).Conclusions Patients with thoracic esophageal squamous cell carcinoma after surgery to receive adjuvant therapy has a good effect,compared with PORT and POCT,POCRT can significantly improve the OS and DFS,and POCRT was the independent prognostic factors of DFS.

Objective To investigate the failure model of patients with stage pN0 thoracic esophageal squamous cell carcinoma (TESCC) after surgery alone and to discuss the feasibility of postoperative radiotherapy.Methods A retrospective analysis was performed on 473 patients with TESCC who received surgery alone from January 2007 to December 2010.The feasibility of adjuvant radiotherapy for pN0 TESCC patients was investigated through the failure model of postoperative patients.Results Of all patients,there were 57 cases with chest-regional recurrence (12.1％),most of which occurred in the mediastinal lymph nodes(52 case).There were 42 (8.9％) patients were identified as distant metastasis (DM),of which 13 cases were found to have both local recurrence and DM,and the total failure rate was 20.9％.The chest-regional recurrence rate of upper TESCC was statistically significantly higher than middle and lower (x2 =7.469,P ＜ 0.05),but DM rate had no statistically significant difference (P ＞ 0.05).The chest-regional recurrence rate and DM rate of the advanced T stage were significantly higher than those of the early T stage(x2 =10.247,7.886,P ＜ 0.05).The result of univariate analysis showed that disease site,the degree of adhesion,postoperative stump were significant factors of chestregional recurrence rate (x2 =14.232,9.486,7.546,P ＜ 0.05).Gender,smoking and preoperative weight loss ≥5 kg significantly influenced DM (x2 =10.823,10.275,6.065,P ＜ 0.05).In addition,the T stage was the significant influence factor of chest-regional recurrence and DM(x2 =15.994,12.885,P ＜0.05).The result of multivariate analysis showed that T stage and postoperative stump were independent factors of chest-regional recurrence (P ＜ 0.05).Smoking was an independent factor of DM (P ＜ 0.05).Conclusions There was a high rate of chest-regional recurrence in patients with stage pN0 TESCC who received surgery alone.Postoperative radiotherapy was recommended for patients with upper TESCC,advanced T stage,severe local adhesion,positive margin in and postoperative stump.Male,smoking and preoperative weight loss≥5 kg were associated with higher DM rate.

Objective To evaluate the efficacy and adverse reactions of postoperative chemoradiotherapy (S+CRT) and postoperative radiotherapy (S+RT) for stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma. Methods Clinical data were collected from 215 patients with stage Ⅱ/Ⅲthoracic esophageal squamous cell carcinoma who received radical resection and postoperative adjuvant radiotherapy or chemoradiotherapy from 2007 to 2010. Survival rates were calculated by the Kaplan?Meier method and analyzed by the log?rank test. Univariate and multivariate analyses were made by the log?rank test and Cox proportional model, respectively. Results The data were comparable between the S+CRT group and the S+RT group ( P=0055?0988) . The numbers of patients who received 1?, 3?, and 5?year follow?up were 203, 133, and 108, respectively. In all the patients, the 1?, 3?, and 5?year overall survival ( OS) rates were 940%, 614%, and 493%, respectively, and the 1?, 3?, and 5?year disease?free survival ( DFS) rates were 749%, 535%, 467%, respectively. Preoperative mediastinal lymph node enlargement on computed tomography ( CT ) , the degree of adhesion of esophageal lesions to peripheral tissues during surgery, pathological N staging, vascular tumor thrombus, the number of positive lymph nodes, and treatment strategy were independent prognostic factors for OS (P=0000?0034). Preoperative mediastinal lymph node enlargement revealed on CT, the degree of adhesion of esophageal lesions to peripheral tissues during surgery, incomplete removal of tumor from the esophagus, the number of positive lymph nodes, and treatment strategy were independent prognostic factors for DFS (P=0000?0049). The S+CRT group had significantly improved OS and DFS rates than the S+RT group ( P=0002, 0002) . The result of stratified analysis showed that for the patients with stageⅡdisease and those with stage N1 disease, the S+CRT group had significantly improved OS and DFS rates than the S+RT group ( P=0041, 0001, 0021, 0024) . The S+CRT group had significantly higher incidence rates of grade ≥2 radiation?induced gastritis and marrow suppression than the S+RT group (P=0000, 0015). Conclusions Both S+CRT and S+RT achieve satisfactory treatment outcomes in patients with stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma. Compared with S+RT, S+CRT can significantly improve the OS and DFS in patients with stage Ⅱ or N1 disease;S+CRT causes more severe but tolerable adverse reactions. Prospective randomized phaseⅢclinical studies are still required to confirm the final conclusions.