What are the independent prognostic factors in patients undergoing esophagectomy for esophageal cancer?

Abstract

Background: This study aims to investigate the prognostic factors affecting survival in patients undergoing surgical treatment for esophageal cancer. Methods: A total of 50 patients (33 males, 17 females; mean age: 57.8±11.8 years; range, 28 to 80 years) who underwent esophagectomy for esophageal cancer in our clinic between January 2008 and March 2018 were retrospectively analyzed. Prognostic factors affecting survival were investigated. Data including age, sex, tumor size, histological and macroscopic type, tumor stage, T and N categories, the total number of resected lymph nodes and metastatic lymph node ratio, differentiation degree, vascular and perineural invasion, proximal surgical margin distance, adjuvant therapy, and the presence of postoperative complications were recorded. Results: The patients after radical surgery with a tumor size of <3 cm, macroscopic type non-ulcerative-infiltrative squamous cell carcinoma pathology, Stage 1 disease, pT1-2, pN0, well-differentiated groups, no perineural invasion, a metastatic lymph node ratio of <0.2, proximal surgery margin length of 5 to 10 cm, and no postoperative complications had higher five-year survival rates. However, when the effects of these factors on overall survival were examined independently, none of them had a statistically significant effect (p>0.05). The main factors affecting the prognosis were Stage ?2 disease, postoperative complications, and proximal surgical margin less than 5 cm. Conclusion: Our study results suggest that Stage 1 disease, a proximal surgical margin length of more than 5 cm, and the absence of complications are associated with longer survival times and these patients are greatly benefited from surgical treatment.

Perineural Invasion Is a Significant Indicator of High Malignant Degree and Poor Prognosis in Esophageal Cancer: A Systematic Review and Meta-Analysis

“…A total of 69 studies were used to analyze the distribution of PNI in different pathological types of EC, including 24 studies on EC (ESCC, EAC, and other types including esophageal small cell undifferentiated carcinoma and esophagus carcinosarcoma) ( 6 – 8 , 10 – 30 ), 32 studies on ESCC ( 9 , 31 – 61 ), and 13 studies on EAC ( 62 – 74 ). The detailed information is shown in Table 1 .…”

“…We also studied the effect of PNI on 5-year OS and 5-year DFS of EC patients. HR and 95% CI of OS and DFS were directly reported in 20 ( 6 – 10 , 18 , 21 , 34 , 43 , 47 , 48 , 50 , 51 , 53 , 62 , 63 , 69 , 72 , 75 , 76 ) and 11 ( 6 – 9 , 18 , 36 , 43 , 47 , 49 , 50 , 53 ) articles, respectively. Since some studies did not provide HR directly, we used fixed-effect models for the prognostic analysis regardless of the heterogeneity.…”

Value of subcarinal lymph node dissection in esophageal cancer surgery: A case-control study

“…Cancer cells first enter the submucosal lymph nodes of the esophagus and pass through the muscle layer into the regional lymph nodes that drain the tumor site; moreover, the affected lymph nodes drain the neck, chest, and abdomen. Furthermore, lymph node metastasis is mostly longitudinal [ 3 ] and directly affects the prognosis of patients with esophageal cancer [ 6 ] ; it is also one of the main causes of death after esophageal cancer surgery. [ 7 ] Subcarinal lymph nodes are important regional lymph nodes in the chest, and their reasonable dissection can help in accurate pathological staging and improve the survival rate of patients postoperatively.…”

“…[ 2 ] Similar to other gastrointestinal malignancies, lymph node metastasis is an important pathway for distant metastasis of esophageal cancer. [ 3 ] Surgical treatment of esophageal cancer requires not only complete resection of the diseased esophagus but also systematic resection. Mediastinal lymph nodes are routinely resected, and the subcarinal lymph nodes represent the extent of mediastinal lymph node resection.…”