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Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma

Background: The rates of locoregional and distant recurrence for esophageal squamous cell carcinoma (ESCC) patients underwent radical esophagectomy remain high. The purpose of this study is to explore an optimal postoperative therapeutic modality by investigating the efficacy of various adjuvant the...

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Autores principales: Li, Lili, Zhao, Lihao, Lin, Baochai, Su, Huafang, Su, Meng, Xie, Deyao, Jin, Xiance, Xie, Congying
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ivyspring International Publisher 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559967/
https://www.ncbi.nlm.nih.gov/pubmed/28819406
http://dx.doi.org/10.7150/jca.18981
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author Li, Lili
Zhao, Lihao
Lin, Baochai
Su, Huafang
Su, Meng
Xie, Deyao
Jin, Xiance
Xie, Congying
author_facet Li, Lili
Zhao, Lihao
Lin, Baochai
Su, Huafang
Su, Meng
Xie, Deyao
Jin, Xiance
Xie, Congying
author_sort Li, Lili
collection PubMed
description Background: The rates of locoregional and distant recurrence for esophageal squamous cell carcinoma (ESCC) patients underwent radical esophagectomy remain high. The purpose of this study is to explore an optimal postoperative therapeutic modality by investigating the efficacy of various adjuvant therapies in the treatment of ESCC. Methods: We retrospectively reviewed 408 ESCC patients underwent thoracic esophagectomy and 3-field lymph node dissection from 2010 to 2015. Patients were classified into surgery alone (Group S), adjuvant chemotherapy (Group CT) and postoperative chemotherapy plus radiotherapy (Group CRT), respectively. Univariate and multivariate Cox regression analyses were used to analyze prognostic factors and survival. Results: The overall survival (OS) and disease-free survival (DFS) were similar among groups. Postoperative CT and CRT both were beneficial for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment compared with surgery alone. The 3-year OS and DFS for patients with 3 or more lymph nodes involvement were 30.8%, 53.7%, 50.5% and 19.9%, 41.6%, 34.0% for Group S, CT, and CRT, respectively (p=0.04; p=0.004, respectively). There was no notable difference in OS and DFS between the adjuvant Group CT and CRT (p=0.42; p=0.49, respectively). Postoperative CRT significantly reduced the rates of distant metastasis and overall recurrence for patients with positive lymph nodes (p=0.042; p=0.01, respectively). Number of metastatic lymph nodes, extent of resection, and AJCC stage were independent predictors of survival. Grade 1-2 myelosuppression was experienced significantly more frequently by patients in Group CRT than those in Group CT (P=0.03). Late toxicities were rare and manageable overall. Conclusions: Postoperative CT and CRT both were associated with better survival for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment. Postoperative CRT was significantly more effective at reducing the rates of distant metastasis and overall recurrence for patients with positive lymph nodes.
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spelling pubmed-55599672017-08-17 Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma Li, Lili Zhao, Lihao Lin, Baochai Su, Huafang Su, Meng Xie, Deyao Jin, Xiance Xie, Congying J Cancer Research Paper Background: The rates of locoregional and distant recurrence for esophageal squamous cell carcinoma (ESCC) patients underwent radical esophagectomy remain high. The purpose of this study is to explore an optimal postoperative therapeutic modality by investigating the efficacy of various adjuvant therapies in the treatment of ESCC. Methods: We retrospectively reviewed 408 ESCC patients underwent thoracic esophagectomy and 3-field lymph node dissection from 2010 to 2015. Patients were classified into surgery alone (Group S), adjuvant chemotherapy (Group CT) and postoperative chemotherapy plus radiotherapy (Group CRT), respectively. Univariate and multivariate Cox regression analyses were used to analyze prognostic factors and survival. Results: The overall survival (OS) and disease-free survival (DFS) were similar among groups. Postoperative CT and CRT both were beneficial for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment compared with surgery alone. The 3-year OS and DFS for patients with 3 or more lymph nodes involvement were 30.8%, 53.7%, 50.5% and 19.9%, 41.6%, 34.0% for Group S, CT, and CRT, respectively (p=0.04; p=0.004, respectively). There was no notable difference in OS and DFS between the adjuvant Group CT and CRT (p=0.42; p=0.49, respectively). Postoperative CRT significantly reduced the rates of distant metastasis and overall recurrence for patients with positive lymph nodes (p=0.042; p=0.01, respectively). Number of metastatic lymph nodes, extent of resection, and AJCC stage were independent predictors of survival. Grade 1-2 myelosuppression was experienced significantly more frequently by patients in Group CRT than those in Group CT (P=0.03). Late toxicities were rare and manageable overall. Conclusions: Postoperative CT and CRT both were associated with better survival for patients with positive lymph nodes, particularly for those with 3 or more lymph nodes involvement and metastasis in the middle thoracic segment. Postoperative CRT was significantly more effective at reducing the rates of distant metastasis and overall recurrence for patients with positive lymph nodes. Ivyspring International Publisher 2017-07-05 /pmc/articles/PMC5559967/ /pubmed/28819406 http://dx.doi.org/10.7150/jca.18981 Text en © Ivyspring International Publisher This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license (https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.
spellingShingle Research Paper
Li, Lili
Zhao, Lihao
Lin, Baochai
Su, Huafang
Su, Meng
Xie, Deyao
Jin, Xiance
Xie, Congying
Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma
title Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma
title_full Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma
title_fullStr Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma
title_full_unstemmed Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma
title_short Adjuvant Therapeutic Modalities Following Three-field Lymph Node Dissection for Stage II/III Esophageal Squamous Cell Carcinoma
title_sort adjuvant therapeutic modalities following three-field lymph node dissection for stage ii/iii esophageal squamous cell carcinoma
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559967/
https://www.ncbi.nlm.nih.gov/pubmed/28819406
http://dx.doi.org/10.7150/jca.18981
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