J Cancer 2017; 8(2):249-257. doi:10.7150/jca.16409
Adjuvant Therapy for a Microscopically Incomplete Resection Margin after an Esophagectomy for Esophageal Squamous Cell Carcinoma
1. State Key Laboratory of Oncology in South China,
2. Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, P.R. China,
3. Departments of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China,
4. Departments of Medical Oncology, un Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China,
5. Departments of Medical imaging, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China,
6. Departments of Thoracic Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, P.R. China,
7. Department of Oncology, First People's Hospital of Zhaoqing City, Zhaoqing, Guangdong, P.R. China.
* Dr. Bo Qiu, Dr. JiaXiang Li and Bin Wang contributed equally to this article.
Qiu B, Li J, Wang B, Wang Z, Liang Y, Cai P, Chen Z, Liu M, Fu J, Yang H, Liu H. Adjuvant Therapy for a Microscopically Incomplete Resection Margin after an Esophagectomy for Esophageal Squamous Cell Carcinoma. J Cancer 2017; 8(2):249-257. doi:10.7150/jca.16409. Available from http://www.jcancer.org/v08p0249.htm
Purpose: To investigate the prognosis of esophageal squamous cell carcinoma with a microscopically incomplete (R1) resection margin following an esophagectomy, as well as the impact of adjuvant treatment on survival.
Methods: Data obtained from 124 patients with R1-resected ESCC were reviewed. The impact of clinicopathological factors and adjuvant treatment on the overall survival, locoregional recurrence, and distant recurrence were explored.
Results: For a median follow-up time of 16.8 months, the median overall survival of 124 patients was 25.6 months. The 1, 3, and 5-year overall survival rates were 75.6%±4.0%, 35.9%±5.1%, and 23.2%±5.0%, respectively. Adjuvant therapy was administered in 78 patients. In the univariate analyses, patients with a pN0 stage (log rank, p=0.028) and adjuvant chemotherapy (log rank, p=0.032) exhibited more favorable overall survival. In the multivariate analyses, the pN stage (HR=2.192, p=0.004) and adjuvant chemotherapy (HR=0.032, p=0.004) were independent prognostic factors for overall survival. Locoregional recurrence was the main failure pattern after R1 resection. The pN stage (HR=2.567, p=0.009) and adjuvant radiotherapy (HR=0.278, p=0.000) were independent prognostic factors for locoregional recurrence.
Conclusion: In R1-resected esophageal squamous cell carcinoma, adjuvant radiotherapy reduced locoregional recurrence; however, it did not improve overall survival. Adjuvant chemotherapy demonstrated benefits for overall survival. The pN stage was an independent prognostic factor for locoregional recurrence and overall survival.
Keywords: Esophageal squamous cell carcinoma, R1 resection, adjuvant chemotherapy, adjuvant radiotherapy, prognosis.