[en] OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 females; mean age was 59.3 years (range 42-77 years). Preoperative neoadjuvant treatment consisted in chemotherapy alone in three patients and in combined radiochemotherapy in 14. Digestive continuity was restored with a gastric transplant in 26 patients and a colonic graft in 8. Surgery was curative in 28 patients and palliative in 6. There were three stage I, 14 stage II, 13 stage III, and 4 stage IV diseases. In 19 patients the lymph nodes were invaded. The tumour was well differentiated in 17 patients, moderately in 9, and poorly in 8. RESULTS: Follow-up ranged from 2 to 100 months. Overall median postoperative survival was 21 months. By univariate analysis, factors influencing survival were curative surgery (p = 0.04), stage (p = 0.006), and nodal involvement (p = 0.0003). Nodal involvement was an independent prognostic factor by multivariate analysis (p = 0.0002). Patient age and sex, perioperative transfusion, digestive transplant, tumour local extension, grade of differentiation, and distant metastasis did not influence survival. Also, we did not observe any significant benefit of preoperative or postoperative chemotherapy or radiochemotherapy. CONCLUSIONS: Nodal involvement was the most important prognostic factor influencing survival. Therefore, an earlier diagnosis of oesophageal cancer in a less advanced stage is important to improve survival rates. Our study could not confirm the benefit of neoadjuvant therapy in terms of late survival.
Disciplines :
Surgery
Author, co-author :
Kolh, Philippe ; Université de Liège - ULiège > Département des Sciences biomédicales et précliniques > Service de Biochimie et de Physiologie générales, humaines, normales et pathologiques
Honore, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Gielen, J. L.
Degauque, C.
Azzam, C.
Legrand, Marc ; Centre Hospitalier Universitaire de Liège - CHU > Chirurgie abdominale- endocrinienne et de transplantation
Comhair, N.
Language :
English
Title :
Analysis of Factors Influencing Long-Term Survival after Surgical Resection for Oesophageal Squamous Cell Carcinoma
CALAMENT G., CAUVIN J., ROBASZKIEWICZ M. et al. Traitement et survie du cancer épidermoïde de l'oesophage dans le département du Finistère entre 1984 et 1988 (716 cas). Gastroenterol Clin Biol, 1993, 17 : 9-16.
BLOT W., DEVESA S., KNELLER R., FRAUMENI J. J. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA, 1991, 265 : 1287-9.
EARLAM R., CUNHA-MELO J. Oesophageal squamous cell carcinoma. I. A critical review of surgery. Br J Surg, 1980, 67 : 381-90.
MÜLLER J., ERASMI H., STELZNER M., ZIEREN U., PICHMAIER H. Surgical therapy of oesophageal carcinoma. Br J Surg, 1990, 77 : 845-57.
SIEWERT J., FINK U., BECKURTS K., RODER J. Surgery of squamous cell carcinoma of the esophagus. Ann Oncol, 1994, 5 : 1-7.
RODER J., BUSCH R., STEIN H., FINK U., SIEWERT J. Ratio of invaded to removed lymph nodes as a predictor of survival in squamous cell carcinoma of the oesophagus. Br J Surg, 1994, 81 : 410-3.
TAM P., SIU K., CHEUNG H., MA L., WONG J. Local recurrences after subtotal esophagectomy for squamous cell carcinoma. Ann Surg, 1987, 205 : 189-94.
SUGIMACHI K., INOKUCHI K., KUWANO H., KAI H., OKAMURA T., OKUDAIRA Y. Patterns of recurrence after curative resection for carcinoma of the thoracic part of the oesophagus. Surg Gynecol Obstet, 1983, 157 : 537-40.
LAW S., FOK M., WONG J. Pattern of recurrence after oesophageal resection for cancer : clinical implications. Br J Surg, 1996, 83 : 107-11.
HERMANEK P., HENSON D., HUTTIER R. TNM supplement 1993, Berlin, Springer-Verlag, 1993, p. 119.
ROTH J., PUTMAN J. Jr. Surgery for cancer of the esophagus. Semin Oncol, 1994, 21 : 453-61.
ELLIS F. H. Jr. Treatment of carcinoma of the esophagus or cardia. Mayo Clin Proc, 1989, 64 : 945-55.
HENNESSY T. P. Lymph node dissection. World J Surg, 1994, 18 : 367-72.
ORRINGER M., MARSHALL B., STERLING M. Transhiatal esophagectomy for benign and malignant disease. J Thorac Cardiovasc Surg, 1993, 105 : 265-76.
FINLEY R., INCULET R. The results of esophagogastrectomy without thoracotomy for adenocarcinoma of the esophagogastric junction. Ann Surg, 1989, 210 : 535-42.
GOLDMINC M., MADDERN G., LE PRISE E., MEUNIER B., CAMPION J., LAUNOIS B. Oesophagectomy by a transhiatal approach or thoracotomy. Br J Surg, 1993, 80 : 367-70.
HANKINS J., ATTAR S., COUGHLIN T. J. et al. Carcinoma of the oesophagus : a comparison of the results of transhiatal and transthoracic resection. Ann Thorac Surg, 1989, 47 : 700-5.
SHAHIAN D., NEPTUNE W., ELLIS F., WATKINS E. J. Transthoracic versus extrathoracic esophagectomy : Mortality, morbidity, and long-term survival. Ann Thorac Surg, 1986, 41 : 237-46.
KELSEN D., MINSKY B., SMITH M. et al. Preoperative therapy for oesophageal cancer : a randomized comparison of chemotherapy versus radiation therapy. J Clin Oncol, 1990, 8 : 1352-61.
ROTH J., PASS H. I., FLANAGAN F. L., GRAEGER G., ROSENBERG J., STEINBERG S. Randomized clinical trial of preoperative and postoperative adjuvant chemotherapy with cisplatin, vindesine, and bleomycin for carcinoma of the esophagus. J Thorac Cardiovasc Surg, 1988, 96 : 242-8.
AJANI J., ROTH J., RYAN B. et al. Evaluation of pre- and postoperative chemotherapy for resectable adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol, 1990, 8 : 1231-8.
FORASTIERE A. A., HEITMILLER R. F., LEE D. J. et al. Intensive chemoradiation followed by esophagectomy for squamous cell and adenocarcinoma of the esophagus [see comments]. Cancer J Sci Am, 1997, 3 : 144-52.
BOSSET J. F., GIGNOUX M., TRIBOULET J. P. et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med, 1997, 337 : 161-7.
KOLH P., HONORE P., GIELEN J., AZZAM C., LEGRAND M., JACQUET N. A retrospective review of a consecutive series of 90 oesophageal resections for malignant diseases. Br J Surg, 1997, 84 (Suppl. 2) : 119-20.
HIPPELAINEN M., ESKELINEN M., LIPPONEN P., CHANG F., SYRJANEN K. Mitotic activity index, volume corrected mitotic index, and human papilloma-virus suggestive morphology are not prognostic factors in carcinoma of the oesophagus. Anti-cancer Res, 1993, 13 : 677-81.
ROBEY-CAFFERTY S., EL-NAGGAR A., SAHIN A., BRUNER J., RO J., CLEARY K. Prognostic factors in esophageal squamous cell carcinoma. A study of histologic features, blood group expression and DNA ploïdy. Am J Clin Pathol, 1991, 95 : 844-89.
SUGIMACHI K., MATSUURA H., KAI H. Prognostic factors of esophageal carcinoma : Univariate and multivariate analysis. J Surg Oncol, 1986, 31 : 108-12.
EDWARDS M. J., HILLIER V., LAWSON R., MOUSSALLI H., HASLETON P. Squamous carcinoma of the esophagus : Histological criteria and their prognostic significance. Br J Cancer, 1989, 59 : 429-33.
KLIMSTRA D. Pathologic prognostic factors in esophageal cancer. Semin Oncol, 1994, 21 : 425-30.
GERTSCH P., VAUTHEY J., LUSTENBERGER A., FRIEDLANDERKLAR H. Long-term results of transhiatal esophagectomy for esophageal carcinoma : A multivariate analysis of prognostic factors. Cancer, 1993, 72 : 2312-9.
PATIL P. K., REDKAR A., PATEL S. et al. Prognosis of operable squamous cell carcinoma of the esophagus. Relationship with clinico-pathological features and DNA ploidy. Cancer, 1993, 72 : 20-4.
SCHNEEBERGER A., FINLEY R., LOHMANN R., KEENEY M., INCULET R. The prognostic significance of tumor ploidy and pathology in adenocarcinoma of the esophagogastric junction. Cancer, 1990, 65 : 1206-10.
SARBIA M., PORSCHEN R., BORCHARD F. Incidence and prognostic significance of vascular and neural invasion in squamous cell carcinomas of the esophagus. Int J Cancer, 1995, 61 : 333-6.
BOTET J. F., LIGHTDALE C. J., ZAUBER A. G., GERDES H., URMACHER C., BRENNAN M. F. Preoperative staging of esophageal cancer : Comparison of endoscopic US and dynamic CT. Radiology, 1991, 181 : 419-25.
PETERS J. H., HOEFT S. F., HEIMBUCHER J. et al. Selection of patients for curative or palliative resection of esophageal cancer based on preoperative endoscopie ultrasonography. Arch Surg, 1994, 129 : 534-9.
VALK P. E., POUNDS T. R., HOPKINS D. M. et al. Staging non-small cell lung cancer by whole body positron emission tomographic imaging. Ann Thorac Surg, 1995, 60 : 1573-82.
LUKETICH J. D., SCHAUER P. R., MELTZER C. C. et al. Role of positron emission tomography in staging esophageal cancer. Ann Thorac Surg, 1997, 64 : 765-9.
