Original article
General thoracic
Prognostic Factors and Family History for Survival of Esophageal Squamous Cell Carcinoma Patients After Surgery

https://doi.org/10.1016/j.athoracsur.2010.05.060Get rights and content

Background

Surgical resection is the most effective treatment for patients with isolated esophageal cancer, but the 5-year survival rate is still very poor in spite of recent advances in early diagnosis and extended lymphadenectomy. To identify the high-risk group and the factors affecting postoperative course, we analyzed the prognostic factors including the family history of esophageal cancer in survival after esophagectomy.

Methods

A total of 1,553 patients with esophageal squamous cell carcinoma after surgery were the subject of the present study. Thirty-one percent of all these patients have family history of esophageal cancer. The prognostic factors analyzed in this study included age, sex, tumor size, tumor location, lymphadenopathy, histologic type, grade of differentiation, stage of cancer, adjuvant treatments, and family history of esophageal cancer.

Results

The overall 3-year and 5-year postoperative survival rates were 43.7% and 26.2%, respectively, for all patients with esophagectomy. The five prognostic factors determined as significant by univariate p value were tumor size, lymphadenopathy, grade of differentiation, stage of cancer, and family history of esophageal cancer. Multivariate analysis showed that the independent prognostic factors were tumor size, grade of differentiation, stage of cancer, and family history of esophageal cancer. Our study also found that patients in groups with mid and upper segment esophageal squamous cell carcinoma, smaller tumor size, earlier stage of cancer, and poor differentiation of tumor cells had a significantly higher rate of positive family history than in the other groups, respectively.

Conclusions

Tumor size, grade of differentiation, lymphadenopathy, stage of cancer, and family history of esophageal cancer were identified as prognostic factors after esophagectomy. Family history of esophageal cancer is an important prognostic factor that surgeons should take into consideration when selecting a treatment method.

Section snippets

Patients

From January 1995 to January 2007, 1,851 patients with carcinoma of the esophagus underwent esophagectomy in our institute. A total of 1,618 of these patients (87.9%) had squamous cell carcinoma and 233 patients (12.7%) had adenocarcinoma. It is recognized that squamous cell carcinoma and adenocarcinoma are two entirely different entities with different prognosis, so patients with adenocarcinoma were not in this study. Of 1,618 patients with ESCC, 26 died of postoperative complications. All

Survival and Univariate Analysis

The overall 3-year and 5-year postoperative survival rates were 43.7% and 26.2%, respectively, for all patients. For overall survival after esophagectomy, five prognostic factors were determined as significant by univariate p value: tumor size, p = 0.0027; lymphadenopathy, p less than 0.0001; grade of differentiation, p = 0.0137; stage of cancer, p less than 0.0001; and family history of esophageal cancer, p = 0.0457 (Table 1).

Results of Multivariate Analyses

Multivariate analyses of survival rates after esophagectomy were

Comment

The overall 3-year and 5-year survival rates were 43.7% and 26.2%, respectively, for patients with esophageal cancer after esophagectomy in this study, which were poorer than the results reported by Lee and colleagues [2]. We considered the reason was that the group of patients in our study had more cases of ESCC with stage III and stage IV. In our study, the overall 3-year and 5-year survival rates after resection were 82.8% and 58.6% for stage I, 51.2% and 34.1% for stage II, 38.1% and 20.7%

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