Number and Location of Positive Nodes, Postoperative Radiotherapy, and Survival After Esophagectomy With Three-Field Lymph Node Dissection for Thoracic Esophageal Squamous Cell Carcinoma

• Published in: International journal of radiation oncology, biology, physics Vol. 82; no. 1; pp. 475 - 482
• Main Authors: Chen, Junqiang, Pan, Jianji, Zheng, Xiongwei, Zhu, Kunshou, Li, Jiancheng, Chen, Mingqiang, Wang, Jiezhong, Liao, Zhongxing
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Elsevier
• Subjects: Adjuvant radiotherapy; Aged; Aged, 80 and over; Analysis of Variance; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; CARCINOMAS; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - surgery; Esophageal squamous cell carcinoma; Esophagectomy - methods; Esophagectomy - mortality; ESOPHAGUS; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hematology, Oncology and Palliative Medicine; Humans; Lymph Node Excision - methods; Lymph Node Excision - mortality; Lymph node metastasis; LYMPH NODES; Lymph Nodes - pathology; Lymph Nodes - radiation effects; Lymph Nodes - surgery; Lymphatic Metastasis; Male; Mediastinum; Medical sciences; METASTASES; Middle Aged; Neck; Nodal basins; PATIENTS; Postoperative Period; RADIATION DOSES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy Dosage; Retrospective Studies; SEX; Stomach, duodenum, intestine, rectum, anus; SURGERY; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Three-field lymphadenectomy; Treatment Failure; Tumors; Lymph node metastasis; Adjuvant radiotherapy; Esophageal squamous cell carcinoma; Nodal basins; Three-field lymphadenectomy; Postoperative; Lymph node; Esophageal disease; Esophagus squamous cell carcinoma; Adjuvant treatment; Esophagectomy; Malignant lymphadenopathy; Malignant hemopathy; Thorax; Malignant tumor; Radiotherapy; Survival; Esophagus cancer; Esophagus; Lymphadenectomy; Cancerology; Surgery; Digestive diseases; Cancer
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2010.08.037

To analyze influences of the number and location of positive lymph nodes and postoperative radiotherapy on survival for patients with thoracic esophageal squamous cell carcinoma (TE-SCC) treated with radical esophagectomy with three-field lymphadenectomy. A total of 945 patients underwent radical esophagectomy plus three-field lymph node dissection for node-positive TE-SCC at Fujian Provincial Tumor Hospital between January 1993 and March 2007. Five hundred ninety patients received surgery only (S group), and 355 patients received surgery, followed 3 to 4 weeks later by postoperative radiotherapy (S+R group) to a median total dose of 50 Gy in 25 fractions. We assessed potential associations among patient-, tumor-, and treatment-related factors and overall survival. Five-year overall survival rates were 32.8% for the entire group, 29.6% for the S group, and 38.0% for the S+R group ( p = 0.001 for S vs. S+R). Treatment with postoperative radiotherapy was particularly beneficial for patients with ≥3 positive nodes and for those with metastasis in the upper (supraclavicular and upper mediastinal) region or both the upper and lower (mediastinal and abdominal) regions ( p < 0.05). Postoperative radiotherapy was also associated with lower recurrence rates in the supraclavicular and upper and middle mediastinal regions ( p < 0.05). Sex, primary tumor length, number of positive nodes, pathological T category, and postoperative radiotherapy were all independent predictors of survival. Postoperative radiotherapy was associated with better survival for patients with node-positive TE-SCC, particularly those with three or more positive nodes and positive nodes in the supraclavicular and superior mediastinal regions.