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Survival benefit of surgery to patients with esophageal squamous cell carcinoma

View Article: PubMed Central - PubMed

ABSTRACT

To assess if surgery provided survival benefit to patients with esophageal squamous cell carcinoma (SCC), we performed a retrospective review of 1230 patients who were newly diagnosed with stage T2-T4 esophageal SCC from 2007 to 2014 in our hospital. There were greater than 70% of patients with age under 65 years, and more than 85% were stage T3-T4 at the time of diagnosis. The median survival time was 1.06 year (95% CI 0.99–1.1 yrs). Survival analyses showed that survival time was significantly associated with age, T stage, clinical lymph node involvement and treatment modality (surgery versus definite chemoradiotherapy). Surgery still possessed a powerful impact on overall survival by multivariable analysis. Death risk of patients treated with curative surgery was significantly lower than those with definite chemoradiotherapy. Furthermore, for patients of stage T3N(+) and T4, surgery combined with (neo-)adjuvant treatment were significantly associated with higher survival rate than surgery alone or definite chemoradiotherapy. In conclusion, the patients who undergo surgery were significantly associated longer survival, therefore, curative resection should be considered for esophageal cancer patients who are medically fit for surgery. Moreover, combined with (neo-)adjuvant treatment is recommended for surgically resectable stage T3-T4 esophageal SCC.

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Treatment modality associated with prognosis of patients in multivariate model for patients with T2-T4 esophageal SCC Multivariable Cox regression analysis of based on different co-variables in patients with T2-T4 (a) Surgery+/−Neo/adjuvant Tx versus definite CCRT; and (b) definite CCRT versus palliative treatment. (c) The details of treatment modality and treatment-related modality for each stage. (*Hazard ratios estimated in the main model were adjusted for age, gender and clinical stage; **Hazard ratios were estimated by fitting the main model within the stratified subgroup).
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f2: Treatment modality associated with prognosis of patients in multivariate model for patients with T2-T4 esophageal SCC Multivariable Cox regression analysis of based on different co-variables in patients with T2-T4 (a) Surgery+/−Neo/adjuvant Tx versus definite CCRT; and (b) definite CCRT versus palliative treatment. (c) The details of treatment modality and treatment-related modality for each stage. (*Hazard ratios estimated in the main model were adjusted for age, gender and clinical stage; **Hazard ratios were estimated by fitting the main model within the stratified subgroup).

Mentions: We further analyzed survival rate by treatment modality for patients with T2-T4 esophageal SCC. The overall 1- and 3-year survival rates after diagnosis were 52, and 22%, respectively. As shown in Fig. 1d, patients received surgery with or without (neo-) adjuvant treatment had significantly longer survival than patients treated with definite radiotherapy and chemotherapy. The median survival time was 2.46 years (95% CI 1.98-2.96 yrs) in patients treated with surgery, 0.85 years (95% CI 0.82-0.95 yrs) in those with definite CCRT, and 0.61 years (95% CI 0.54-0.76 yrs) in those with supportive or palliative treatment. Further multivariable Cox regression analysis of based on different co-variables showed that surgery with or without (neo-) adjuvant treatment could reduce more than 50% risk of death in T2-T4 stage, compared to those treated with definite CCRT (P < 0.001) (Fig. 2a). Figure 2b demonstrated that definite CCRT significantly improved survival compared to those only received palliative treatment. In addition, the details of treatment modality and treatment-related modality for each stage were shown in Fig. 2c. The data revealed that the treatment-related mortality (death occurred during or within 30 days after the completion treatment) rates in patients treated with curative intent surgery or CCRT. By the data, we found that surgery with or without (neo-)adjuvant treatment had no significant impact on treatment-mortality rate compared with that in CCRT group.


Survival benefit of surgery to patients with esophageal squamous cell carcinoma
Treatment modality associated with prognosis of patients in multivariate model for patients with T2-T4 esophageal SCC Multivariable Cox regression analysis of based on different co-variables in patients with T2-T4 (a) Surgery+/−Neo/adjuvant Tx versus definite CCRT; and (b) definite CCRT versus palliative treatment. (c) The details of treatment modality and treatment-related modality for each stage. (*Hazard ratios estimated in the main model were adjusted for age, gender and clinical stage; **Hazard ratios were estimated by fitting the main model within the stratified subgroup).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5382669&req=5

f2: Treatment modality associated with prognosis of patients in multivariate model for patients with T2-T4 esophageal SCC Multivariable Cox regression analysis of based on different co-variables in patients with T2-T4 (a) Surgery+/−Neo/adjuvant Tx versus definite CCRT; and (b) definite CCRT versus palliative treatment. (c) The details of treatment modality and treatment-related modality for each stage. (*Hazard ratios estimated in the main model were adjusted for age, gender and clinical stage; **Hazard ratios were estimated by fitting the main model within the stratified subgroup).
Mentions: We further analyzed survival rate by treatment modality for patients with T2-T4 esophageal SCC. The overall 1- and 3-year survival rates after diagnosis were 52, and 22%, respectively. As shown in Fig. 1d, patients received surgery with or without (neo-) adjuvant treatment had significantly longer survival than patients treated with definite radiotherapy and chemotherapy. The median survival time was 2.46 years (95% CI 1.98-2.96 yrs) in patients treated with surgery, 0.85 years (95% CI 0.82-0.95 yrs) in those with definite CCRT, and 0.61 years (95% CI 0.54-0.76 yrs) in those with supportive or palliative treatment. Further multivariable Cox regression analysis of based on different co-variables showed that surgery with or without (neo-) adjuvant treatment could reduce more than 50% risk of death in T2-T4 stage, compared to those treated with definite CCRT (P < 0.001) (Fig. 2a). Figure 2b demonstrated that definite CCRT significantly improved survival compared to those only received palliative treatment. In addition, the details of treatment modality and treatment-related modality for each stage were shown in Fig. 2c. The data revealed that the treatment-related mortality (death occurred during or within 30 days after the completion treatment) rates in patients treated with curative intent surgery or CCRT. By the data, we found that surgery with or without (neo-)adjuvant treatment had no significant impact on treatment-mortality rate compared with that in CCRT group.

View Article: PubMed Central - PubMed

ABSTRACT

To assess if surgery provided survival benefit to patients with esophageal squamous cell carcinoma (SCC), we performed a retrospective review of 1230 patients who were newly diagnosed with stage T2-T4 esophageal SCC from 2007 to 2014 in our hospital. There were greater than 70% of patients with age under 65 years, and more than 85% were stage T3-T4 at the time of diagnosis. The median survival time was 1.06 year (95% CI 0.99&ndash;1.1 yrs). Survival analyses showed that survival time was significantly associated with age, T stage, clinical lymph node involvement and treatment modality (surgery versus definite chemoradiotherapy). Surgery still possessed a powerful impact on overall survival by multivariable analysis. Death risk of patients treated with curative surgery was significantly lower than those with definite chemoradiotherapy. Furthermore, for patients of stage T3N(+) and T4, surgery combined with (neo-)adjuvant treatment were significantly associated with higher survival rate than surgery alone or definite chemoradiotherapy. In conclusion, the patients who undergo surgery were significantly associated longer survival, therefore, curative resection should be considered for esophageal cancer patients who are medically fit for surgery. Moreover, combined with (neo-)adjuvant treatment is recommended for surgically resectable stage T3-T4 esophageal SCC.

No MeSH data available.


Related in: MedlinePlus