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Survival benefit of surgery to patients with esophageal squamous cell carcinoma

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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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Overall survivals in patients with esophageal SCC in subgroups of clinical stage and treatmentThe survival differences according to curative treatment modality in patients with T3N(+) and T4 (Surgery alone versus Surgery+Neo/adjuvant Tx versus definite CCRT) (a); and patients with stage T4N0-N(+) (Surgery+Neo/adjuvant Tx versus definite CCRT) (b). Additionally, Kaplan-Meier survival curves for patients with stage T2-T4 in the surgery group according to achieving pathologic complete response or not (c), and in the CCRT group according to the dose of radiotherapy (d).
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f3: Overall survivals in patients with esophageal SCC in subgroups of clinical stage and treatmentThe survival differences according to curative treatment modality in patients with T3N(+) and T4 (Surgery alone versus Surgery+Neo/adjuvant Tx versus definite CCRT) (a); and patients with stage T4N0-N(+) (Surgery+Neo/adjuvant Tx versus definite CCRT) (b). Additionally, Kaplan-Meier survival curves for patients with stage T2-T4 in the surgery group according to achieving pathologic complete response or not (c), and in the CCRT group according to the dose of radiotherapy (d).

Mentions: For patients with clinical stage T2-T3 esophageal SCC, as shown in Table 2, clinical T3 stage, clinical LN involvement, older ages, and no surgical resection were significantly associated with shorter survival time in univariate survival analysis. 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-T3 stage, compared to those treated with definite CCRT (Fig. 2a and Table 3). Furthermore, for the subgroup of patients with T3N(+) and T4, surgery combined with (neo-)adjuvant treatment obviously prolonged the survival rate compared to surgery alone or definite CCRT (Fig. 3a) (surgery alone versus definite CCRT, p = 0.179; surgery+ (neo-)adjuvant treatment versus definite CCRT, p < 0.001). For stage T4 esophageal SCC, there were only 90 patents (18%) received curative intent surgery. As shown in Fig. 3b, surgery combined with (neo-) adjuvant treatment provided the better overall survival rate than definite CCRT, with the median survival was 2.05 years (95% CI 1.57-2.90 yrs) and 0.78 years (95% CI 0.68-0.84 yrs), respectively. As shown in Fig. 2a and Table 4, multivariable survival analysis, surgery combined with (neo-)adjuvant treatment decreased 58% death risk compared to those treated with definite CCRT. In surgery group of patient with stage T2-T4, as shown in Fig. 3c, achieving pathologic complete response (pCR) after neoadjuvant treatment is a significant predictor for longer survival. For stage T2-T3, the 3-yr survival rate was 63.6% for patients with pCR, and 41.6% for patients without pCR (p = 0.013), respectively. For T4 esophageal SCC, the median survival is 4.41 years in patients received surgery with pathologic complete response, and 1.58 years in patients without pCR after neoadjuvant treatment. In addition, patients who treated with definite CCRT had significantly improved survival compared to those only received palliative treatment. In the group of definite CCRT, the radiation dose is the significant predictors for better overall survival (Fig. 3d).


Survival benefit of surgery to patients with esophageal squamous cell carcinoma
Overall survivals in patients with esophageal SCC in subgroups of clinical stage and treatmentThe survival differences according to curative treatment modality in patients with T3N(+) and T4 (Surgery alone versus Surgery+Neo/adjuvant Tx versus definite CCRT) (a); and patients with stage T4N0-N(+) (Surgery+Neo/adjuvant Tx versus definite CCRT) (b). Additionally, Kaplan-Meier survival curves for patients with stage T2-T4 in the surgery group according to achieving pathologic complete response or not (c), and in the CCRT group according to the dose of radiotherapy (d).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f3: Overall survivals in patients with esophageal SCC in subgroups of clinical stage and treatmentThe survival differences according to curative treatment modality in patients with T3N(+) and T4 (Surgery alone versus Surgery+Neo/adjuvant Tx versus definite CCRT) (a); and patients with stage T4N0-N(+) (Surgery+Neo/adjuvant Tx versus definite CCRT) (b). Additionally, Kaplan-Meier survival curves for patients with stage T2-T4 in the surgery group according to achieving pathologic complete response or not (c), and in the CCRT group according to the dose of radiotherapy (d).
Mentions: For patients with clinical stage T2-T3 esophageal SCC, as shown in Table 2, clinical T3 stage, clinical LN involvement, older ages, and no surgical resection were significantly associated with shorter survival time in univariate survival analysis. 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-T3 stage, compared to those treated with definite CCRT (Fig. 2a and Table 3). Furthermore, for the subgroup of patients with T3N(+) and T4, surgery combined with (neo-)adjuvant treatment obviously prolonged the survival rate compared to surgery alone or definite CCRT (Fig. 3a) (surgery alone versus definite CCRT, p = 0.179; surgery+ (neo-)adjuvant treatment versus definite CCRT, p < 0.001). For stage T4 esophageal SCC, there were only 90 patents (18%) received curative intent surgery. As shown in Fig. 3b, surgery combined with (neo-) adjuvant treatment provided the better overall survival rate than definite CCRT, with the median survival was 2.05 years (95% CI 1.57-2.90 yrs) and 0.78 years (95% CI 0.68-0.84 yrs), respectively. As shown in Fig. 2a and Table 4, multivariable survival analysis, surgery combined with (neo-)adjuvant treatment decreased 58% death risk compared to those treated with definite CCRT. In surgery group of patient with stage T2-T4, as shown in Fig. 3c, achieving pathologic complete response (pCR) after neoadjuvant treatment is a significant predictor for longer survival. For stage T2-T3, the 3-yr survival rate was 63.6% for patients with pCR, and 41.6% for patients without pCR (p = 0.013), respectively. For T4 esophageal SCC, the median survival is 4.41 years in patients received surgery with pathologic complete response, and 1.58 years in patients without pCR after neoadjuvant treatment. In addition, patients who treated with definite CCRT had significantly improved survival compared to those only received palliative treatment. In the group of definite CCRT, the radiation dose is the significant predictors for better overall survival (Fig. 3d).

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