Pattern of Locoregional Recurrence After Radical Surgery in Patients With Esophageal Squamous Cell Carcinoma and The Design of Target Volume of Postoperative Prophylactic Radiotherapy

Abstract Objective The study was undertaken to evaluate preferred sites for locoregional recurrence after radical surgery for patients with esophageal squamous cell carcinoma (ESCC) and to confirm the target volume of postoperative prophylactic radiotherapy.Methods 139 patients with locoregional recurrent ESCC after radical esophagectomy without postoperative radiotherapy were registered in this study. The sites of locoregional recurrence for these patients were collected and influence factors of locoregional recurrence were analyzed.Results The 1, 2, and 3-year progression-free survival rates were 48.2%, 18.0% and 8.6%, respectively. Mediastinum lymph node (LN) recurrence (74.2%) was the most frequent site of recurrence, following the anastomotic site (28.1%), supraclavicular LN (19.4%) and abdominal LN (15.1%) (P=0.000). The upper mediastinum (72.7%) was one of the most common recurrence occurred in mediastinal LN. Compared with upper and middle segment of ESCC, lower segment had the highest recurrence rate of upper abdominal LN (P=0.001). The predictive factors of anastomotic recurrence were the stage of pT3 or pT4, presence of nerve or vessel invasion, removed LN NO.≤ 17, presence of invasion or adhesion and without postoperative adjuvant chemotherapy. In addition, the risk factors of abdominal LN recurrence in patients with middle segment ESCC included the stage of pT3 or pT4, smoking history and without postoperative adjuvant chemotherapy.Conclusion For thoracic ESCC, supraclavicular, upper mediastinum, subcarinal LNs and anastomosis should be incorporated within target volume of postoperative prophylactic radiotherapy. Regarding to lower segment ESCC, target volume should include upper abdominal LNs. And it need cautious evaluated about upper abdominal LNs when presence of clinicopathologic factor in middle segment ESCC.