Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1172-1181
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1172
Difference in failure patterns of pT3-4N0-3M0 esophageal cancer treated by surgery vs surgery plus radiotherapy
Ya Zeng, Wen Yu, Qi Liu, Wei-Wei Yu, Zheng-Fei Zhu, Wei-Xin Zhao, Jun Liu, Jia-Ming Wang, Xiao-Long Fu, Yuan Liu, Xu-Wei Cai
Ya Zeng, Wen Yu, Jun Liu, Jia-Ming Wang, Xiao-Long Fu, Xu-Wei Cai, Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Wen Yu, Qi Liu, Wei-Wei Yu, Zheng-Fei Zhu, Wei-Xin Zhao, Xiao-Long Fu, Xu-Wei Cai, Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200030, China
Wei-Wei Yu, Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Shanghai Sixth People’s Hospital, Shanghai 200030, China
Yuan Liu, Department of Statistics, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
Author contributions: All authors participated in this research; Zeng Y and Cai XW contributed to manuscript writing, patient collection, and data analysis; Yu W, Yu WW, Liu Qi, Wang JM, Liu J, Zhu ZF, and Zhao WX contributed to patient collection and follow-up visit; Fu XL and Cai XW contributed to patient collection and research design; and Liu Y reviewed the statistical methods of this study.
Supported by Emerging Advanced Technology Joint Research Project of Shanghai Shenkang Hospital Development Center, No. SHDC12017103; and Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support, No. 20161433.
Institutional review board statement: Approval was achieved from the Institute Research Ethics Committee of Shanghai Chest Hospital and Shanghai Cancer Center before the patients were enrolled in the relevant studies. So, there was no additional approval for this study.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xu-Wei Cai, MD, PhD, Chief Doctor, Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 West Huaihai Road, Shanghai 200030, China. cxw1802@shchest.org
Telephone: +86-18916273163
Received: April 26, 2019
Peer-review started: May 9, 2019
First decision: July 31, 2019
Revised: August 8, 2019
Accepted: September 10, 2019
Article in press: September 10, 2019
Published online: December 15, 2019
Abstract
BACKGROUND

There has been no study comparing the difference in the failure patterns between patients with or without postoperative radiotherapy (PORT) after esophagectomy for pT3-4N0-3M0 esophageal squamous cell carcinoma (ESCC).

AIM

To investigate the difference in the failure patterns of stage pT3-4N0-3M0 ESCC patients with or without PORT.

METHODS

Patients with stage pT3-4N0-3M0 ESCC, who underwent surgery with or without PORT, were enrolled in this study. The primary endpoint was to investigate the difference in the failure patterns between patients with or without PORT after esophagectomy. The secondary endpoint was to estimate whether patients with stage pT3-4 ESCC could achieve a disease-free survival (DFS) advantage after receiving adjuvant PORT. Statistical analyses were performed by the Kaplan-Meier method, Cox regression model, and Chi-squared test or Fisher’s exact test.

RESULTS

In total, 230 patients with stage pT3-4N0-3M0 ESCC were included in this study. Fifty-six patients who received PORT were screened from a prospective cohort (S + R arm). And 174 patients involving surgery alone were retrospectively selected from July 2006 to October 2014 (S arm). There were no significant differences in the clinical or pathological characteristics of patients between the two arms, except for tumor location (P = 0.031). The failure patterns between the two arms were significantly different (P < 0.001). Patients in the S arm had a significantly higher proportion of locoregional recurrence and a lower proportion of distant metastasis than those in the S + R arm (92.0% vs 35.7%, P < 0.001 and 19.0% vs 75.0%, P < 0.001, respectively). The difference in the median DFS between the two arms was statistically significant (12.7 vs 8 mo, P = 0.048). Univariate analysis and multivariate analysis both demonstrated that the number of lymph node metastases ≥ 3 (HR = 0.572, 95%CI: 0.430-0.762, P < 0.001) was an independent poor prognostic factor for DFS in patients with stage pT3-4N0-3M0 ESCC.

CONCLUSION

PORT could improve DFS and local control of patients with stage pT3-4N0-3M0 ESCC. However, further studies need to be conducted to control hematogenous metastasis after PORT.

Keywords: Esophageal squamous cell carcinoma, Postoperative radiotherapy, Failure patterns, Disease-free survival

Core tip: This is the first study to compare the difference in the failure patterns for pT3-4N0-3M0 esophageal squamous cell carcinoma (ESCC) patients with or without postoperative radiotherapy (PORT) after esophagectomy. The result showed that PORT could improve disease-free survival and local control of patients with stage pT3-4N0-3M0 ESCC. However, distant metastasis was the main failure pattern after receiving PORT. Further studies need to be conducted to control hematogenous metastasis in the future.