[Factors affecting on long-time survival in patients with stage Ⅲ thoracic esophageal carcinoma after esophagectomy].

OBJECTIVE:To retrospectively analyze the prognosis and its related factor in stage Ⅲ thoracic esophageal carcinoma after surgery. METHODS:504 patients with stage Ⅲ thoracic esophageal cancer after resection were included in this study. There were 388 males and 116 females. The median age was 60 years. 476 cases were treated with two-field and 28 with three-field lymphadenectomy. There were 44 cases of upper-, 334 of middle-, and 126 of lower-thoracic esophageal cancer. There were 292 patients with stage Ⅲa, 128 with stage Ⅲb and 84 with stage Ⅲc esophageal cancer. 137 patients were treated with surgery alone, 264 had postoperative chemotherapy (CT), 64 had radiotherapy (RT) and 39 had CT plus RT. RESULTS:The follow-up was ended on September 31, 2014. The 1-, 3-, and 5-year overall survival (OS) rates and median survival were 73.0%, 34.4%, 26.7% and 22 months, respectively. Univariate analysis showed that mode of surgery, site of lesion, N and TNM stages, and postoperative adjuvant therapy were significantly associated with OS (P<0.05 for all). Multivariate analysis showed that TNM and adjuvant therapy were independent factors for OS (P<0.05 for both). The 1-, 3-, 5-years progression-free survival (PFS) rates of patients undergoing postoperative adjuvant therapy were 57.3%, 32.0% and 27.0%, respectively, higher than those of the patients treated by surgery alone (P<0.05). Further analysis showed that postoperative chemotherapy and/or radiotherapy could mainly improve OS in the patients with cancer in the upper- or middle-thoracic segment and well- or moderately differentiated squamous cell carcimoma (P<0.05). Univariate analysis showed that site of lesion, N and TNM stage, R0/R1 and adjuvant therapy were significantly related to PFS (P<0.05). Multivariate analysis showed that site of lesion, R0/R1 resection, TNM stage and postoperative adjuvant therapy were independent factors for PFS (P<0.05 for all). Patients with severe adhesion at surgery or R1 resection had a lower PFS rate (P<0.05). CONCLUSIONS:The prognosis of stage Ⅲ esophageal carcinoma after two-field surgery is poor. TNM stage and postoperative adjuvant therapy are independent factors for OS and PFS. Postoperative chemotherapy and/or radiotherapy can improve OS and PFS. Site of lesion is also associated with prognosis. The risk of disease progression could be increased in patients with severe adhesion at surgery or R1 resection.