Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2018; 24(45): 5154-5166
Published online Dec 7, 2018. doi: 10.3748/wjg.v24.i45.5154
Clinicopathological parameters predicting recurrence of pT1N0 esophageal squamous cell carcinoma
Li-Yan Xue, Xiu-Min Qin, Yong Liu, Jun Liang, Hua Lin, Xue-Min Xue, Shuang-Mei Zou, Mo-Yan Zhang, Bai-Hua Zhang, Zhou-Guang Hui, Zi-Tong Zhao, Li-Qun Ren, Yue-Ming Zhang, Xiu-Yun Liu, Yan-Ling Yuan, Jian-Ming Ying, Shu-Geng Gao, Yong-Mei Song, Gui-Qi Wang, Sanford M Dawsey, Ning Lu
Li-Yan Xue, Xue-Min Xue, Shuang-Mei Zou, Li-Qun Ren, Xiu-Yun Liu, Yan-Ling Yuan, Jian-Ming Ying, Ning Lu, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Yan Xue, Center for Cancer Precision Medicine, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xiu-Min Qin, Yong Liu, Yue-Ming Zhang, Gui-Qi Wang, Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Jun Liang, Zhou-Guang Hui, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Hua Lin, Department of Medical Record, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Mo-Yan Zhang, Bai-Hua Zhang, Shu-Geng Gao, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Bai-Hua Zhang, The 2nd Department of Thoracic Surgery, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, CSU, Changsha 410006, Hunan Province, China
Zi-Tong Zhao, Yong-Mei Song, State Key Laboratory of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Li-Qun Ren, Department of Pathology, Chengde Medical College, Chengde 067000, Hebei Province, China
Sanford M Dawsey, Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892, United States
Author contributions: Xue LY and Lu N designed the study and drafted the manuscript; Qin XM, Liu Y, Lin H, and Zhang BH collected the follow-up data; Xue LY and Xue XM performed statistical analyses; Xue LY, Zou SM, and Ren LQ reviewed the pathologic slides; Liu XY and Yuan YL did the immunohistochemistry; Dawsey SM, Liang J, Zhang MY, Hui ZG, Zhao ZT, Zhang YM, Ying JM, Gao SG, Song YM, and Wang GQ made critical revision of the manuscript for important intellectual content.
Supported by the National Natural Science Foundation of China, No. 81402463; CAMS Innovation Fund for Medical Sciences (CIFMS), No. 2016-I2M-1-001 and No. 2016-I2M-3-005; and the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences, No. 2016ZX310178 and No. 2017PT32001.
Correspondence author to: Ning Lu, MD, Chief Doctor, Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China. nlu03@126.com
Telephone: +86-10-87788435 Fax: +86-10-67702630
Received: August 31, 2018
Peer-review started: September 2, 2018
First decision: October 14, 2018
Revised: October 22, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: December 7, 2018
Processing time: 98 Days and 10.6 Hours
Abstract
AIM

To identify the clinicopathological characteristics of pT1N0 esophageal squamous cell carcinoma (ESCC) that are associated with tumor recurrence.

METHODS

We reviewed 216 pT1N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrence-free survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence (≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.

RESULTS

Forty-seven (24%) patients had a recurrence at 3 to 178 (median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence (Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.

CONCLUSION

These results should be useful for designing optimal individual follow-up and therapy for patients with T1N0 ESCC.

Keywords: Esophageal squamous cell carcinoma; Tumor recurrence; Lymph node negative esophageal cancer; Recurrence-free survival; Clinicopathological parameters

Core tip: Recurrences of pT1N0 esophageal squamous cell carcinoma (ESCC) after esophagectomy are usually metachronous regional lymph node or distant metastases. We analyzed 199 thoracic pT1N0 ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy. Forty-seven (24%) patients had a recurrence during 3 to 178 (median, 33) mo. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence, and a nomogram for predicting recurrence-free survival with these three predictors was constructed. These results should be useful for designing optimal individual follow-up and therapy for patients with T1N0 ESCC.