Pattern of Recurrence of pT1-3N0M0 Esophageal Squamous Cell Carcinoma After Radical Two-Field Resection

To retrospectively analyze the patterns of postoperative recurrence of stage pT1-3N0M0 esophageal squamous cell carcinoma after radical two-field resection. From Jan 2008 to Dec 2012, a total of 488 patients who underwent two-field R0 esophagectomy, pathologically classified as stage pT1-3N0M0, without adjuvant radiotherapy and/or chemotherapy before or after surgery and postoperative survival time≥ 3 months were enrolled in this study. There were 303 in males and 185 in females; the median age was 62 (range from 34 to 86). There were 115 patients with mediastinal small lymph nodes (SLN, diameter ≤1cm) in CT image before surgery. The site of lesion was located at upper- in 61, middle- in 344 and lower-thoracic in 83 cases. After surgery, there were 102 in stage pT1, 126 in pT2 and 260 cases in pT3, respectively. Multivariate analysis was performed by using Cox model. The date of follow-up ended at the 1, Dec 2019. The rate of follow-up was 92.6%. The rate of total recurrence (TR) was 47.3% (231/488); among them, the rates of locoregional recurrence (LR), distant metastases (DM), LR compared with DM were 27.7% (135/488), 9.0% (44/488), 10.7% (52/488), respectively; so, the total rates of LR and DM was 38.4% and 19.7%. 81% (187/231) of TR patients occurred with LR; and recurrence at supraclavicular, mediastinal and abdominal region accounted for 19.8% (37/187), 83.4% (156/187) and 7.0% (13/187) in LR patients, respectively. The 1-, 3-, 5-years overall survival and disease-free survival was 93.2%, 73.0%, 62.1%, and 85.7%, 68.0%, 59.2%, respectively. The 1-, 2-, 3-, 5-years rates of total TR, LR and DM were 14.3%, 22.6%, 32.0%, 40.8%, 12.5%, 19.7%, 26.7%, 34.4%, 3.7%, 7.2%, 11.3%, 17.2%, respectively. Univariate and multivariate analysis demonstrated that tumor site, pT staging and SLN in CT images before surgery were the independent factors affecting the TR and LR. In patients of stage pT1-3N0M0 esophageal squamous cell carcinoma after two-field R0 esophagectomy alone, LR was the most common pattern of recurrence and most of LR was occurred at mediastinum; tumor site, pT staging and SLN in CT images are the pivotal factors for postoperative total recurrence and LR, which offer a guidance to the selection of indications for postoperative adjuvant radiotherapy.