Patterns Of Recurrence And Its Value To Target Of Postoperative Radiation Therapy In Patients Of Stage Iii Thoracic Esophageal Carcinoma

To explore the Patterns of recurrence and its value to project the target of postoperative radiation therapy(PORT) in patients of stage III thoracic esophageal carcinoma(EC) after two-field esophagectomy. From Jan 2008 to Dec 2011, 401 patients of stage III thoracic EC were enrolled. Among them, males in 311 and females in 90 cases; the median age was 61 years old (range 37-80 ys). Site of lesion: 31 in upper-, 262 in middle-, and 108 patients in lower-thoracic; the median numbers of dissected lymph node were 10 (range 1-34). Squamous cell carcinoma (SCC) in 348 and no-SCC in 53 patients. 173 patients were treated with surgery alone and 264 patients with postoperative chemotherapy (POCT). During follow-up, there were 275 patients(68.6%) occurred with recurrence; the rates of local regional recurrence(LR), distant metastasis (DM) and complexed recurrence were 46.1%, 16.2% and 6.2%. 183 out of 210 patients with LR could be analysis; the recurrence rates were 29.5% in cervical/supraclavicular, 61.7% in upper-mediastinum, 8.7% in middle or low-mediastinum, and 21.9% in upper abdomen; the recurrence rate were only 10.4% in anastomosis and 1.1% in tumor bed. The recurrence rate in cervical/supraclavicular, upper--mediastinum, middle/low-mediastinum and upper abdomen were 23.1%, 61.5%, 0%, 30.8% in upper-EC; 31.0%, 58.1%, 7.8%, 17.1% in middle-EC; and 24.4%, 56.1%, 9.8%, 31.7% in low-thoracic EC patients, respectively. x2 test showed, the factors that related with postoperative recurrence were level of hemoglobin(HB), the number of dissected lymph nodes, stage N, the percent or area number of metastatic lymph node, degree of resection(R0/R1), and type of pathology(p<0.05). Univariate analysis showed, site of lesion, length of lesion, HB, degree of adhesion during surgery, N and TNM, the percent or area number of metastatic lymph node, and degree of resection (R0/R1) were related with PFS; site of lesion, N and TNM, the percent or area number of metastatic lymph node, type of pathology, and degree of resection (R0/R1) were related with LR; HB, type of pathology, the percent and number of area of metastatic lymph node were related with MD (p<0.05). With multivariate analysis, the independent prognostic factors were site of lesion, HB, the degree of adhesion during surgery and stage N for PFS; site of lesion, degree of resection (R0/R1), type of pathology and stage N for LRR; HB, type of pathology and stage N for DMR. For patient of stage III thoracic EC, the recurrence rates was very high; local regional recurrence was the most common; the most frequent area of recurrence were upper-mediastinum, cervical/supraclavicular and para-aortic lymph node, and this position should be key target for PORT. The middle-thoracic EC, R1, SCC and N1-3 were associated with higher LR; higher level of HB, non-SCC and N1-3 were associated with higher DM.