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Prognostic Factors for Locoregional Recurrence in Patients with Thoracic Esophageal Squamous Cell Carcinoma Treated with Radical Two-Field Lymph Node Dissection: Results from Long-Term Follow-Up

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

To aim of this study was to determine the clinical and biological prognostic factors for locoregional recurrence (LRR) in patients with thoracic esophageal squamous cell carcinoma (ESCC) undergoing radical two-field lymph node dissection (2FLD).

Methods

A total of 462 patients diagnosed with thoracic ESCC underwent radical esophagectomy between March 2001 and May 2010 at Sun Yat-Sen University Cancer Center. Clinical characteristics, CD44 expression, and tumor-infiltrating lymphocyte (TIL) levels were evaluated in 198 patients who underwent R0 dissection with long-term follow-up. Partial Cox regression analysis with leave-one-out cross-validation was performed to validate the selected risk factors.

Results

With a median follow-up of 54 months, the 5-year local failure-free survival (LFFS) rate of 198 patients was 62.5%. Multivariate analysis revealed that T stage (p = 0.043), pathological positive tumor above the carina (p = 0.000), CD44 expression level (p = 0.045) and TIL level (p = 0.007) were prognostic factors for LFFS, while the Cox model with risk scores had an area under the curve value of 83.6% for the prediction of 5-year LFFS. The best cut-off value (sum score = 11.19) was used to determine the high- and low-risk groups, with patients at high risk having a significantly shorter 5-year LFFS than patients at low risk (p = 0.000). The LRR pattern revealed significantly high incidences of recurrent disease at the supraclavicular and cervical sites, mediastinum (above the carina), and anastomosis.

Conclusions

Our predictive model was able to distinguish between patients at high risk for LRR and patients at low risk for LRR. LRR primarily involved the upper thorax and this area must be considered in future study designs for radical trimodality treatment.

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Acknowledgement

The authors would like to thank Dr. SongRan Liu and Dr. Li Ma, Sun Yat-Sen University Cancer Center for data collection, Dr. ZhongXin Liao, MD Anderson Cancer Center for coordination of the international study, and Ms. YiXin Xiong for managing the samples.

Funding

This research was supported by (i) Funds from the University Cancer Foundation via the Sister Institution Network Fund at the University of Texas MD Anderson Cancer Center and, in part, by the National Institutes of Health through University of Texas MD Anderson Cancer Center Support Grant CA016672, as a portion of these studies were performed at the North Campus Flow Cytometry and Cellular Imaging Core (Principal Investigator: Ronald A. DePinho), and (ii) Funds from the Scientific Research Foundation for Returned Overseas Chinese Scholars, State Education Ministry.

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    Authors and Affiliations

    1. Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

      ShiLiang Liu MD, PhD, Bo Qiu MD, PhD, ZhaoLin Chen MD, MengZhong Liu MD, PhD & Hui Liu MD, PhD

    2. Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

      Hong Yang MD, PhD & JianHua Fu MD, PhD

    3. Department of Pathology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

      MuYan Cai MD & Jia Fu MD

    4. Department of Clinical Statistics, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China

      Qing Liu MD

    5. State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, People’s Republic of China

      ShiLiang Liu MD, PhD, Bo Qiu MD, PhD, MuYan Cai MD, Jia Fu MD, Hong Yang MD, PhD, Qing Liu MD, ZhaoLin Chen MD, JianHua Fu MD, PhD, MengZhong Liu MD, PhD & Hui Liu MD, PhD

    6. Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, People’s Republic of China

      ShiLiang Liu MD, PhD, Bo Qiu MD, PhD, MuYan Cai MD, Jia Fu MD, Hong Yang MD, PhD, Qing Liu MD, ZhaoLin Chen MD, JianHua Fu MD, PhD, MengZhong Liu MD, PhD & Hui Liu MD, PhD

    7. Guangdong Esophageal Cancer Research Institute, Guangzhou, Guangdong, People’s Republic of China

      ShiLiang Liu MD, PhD, Bo Qiu MD, PhD, MuYan Cai MD, Jia Fu MD, Hong Yang MD, PhD, Qing Liu MD, ZhaoLin Chen MD, JianHua Fu MD, PhD, MengZhong Liu MD, PhD & Hui Liu MD, PhD

    8. Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

      Simone Anfossi MD, PhD & James Reuben MD, PhD

    9. Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

      Jared K. Burks MD, PhD

    10. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

      Steven H. Lin MD, PhD

    11. Department of Thoracic Surgery, Fujian Provincial Tumor Hospital, Fuzhou, People’s Republic of China

      YuZhen Zheng MD, PhD

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    1. ShiLiang Liu MD, PhD
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    Correspondence to Hui Liu MD, PhD.

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    ShiLiang Liu, Simone Anfossi and Bo Qiu contributed equally to this article.

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    Liu, S., Anfossi, S., Qiu, B. et al. Prognostic Factors for Locoregional Recurrence in Patients with Thoracic Esophageal Squamous Cell Carcinoma Treated with Radical Two-Field Lymph Node Dissection: Results from Long-Term Follow-Up. Ann Surg Oncol 24, 966–973 (2017). https://doi.org/10.1245/s10434-016-5652-y

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