Published online Dec 7, 2018. doi: 10.3748/wjg.v24.i45.5154
Peer-review started: September 2, 2018
First decision: October 14, 2018
Revised: October 22, 2018
Accepted: November 13, 2018
Article in press: November 13, 2018
Published online: December 7, 2018
To identify the clinicopathological characteristics of pT1N0 esophageal squamous cell carcinoma (ESCC) that are associated with tumor recurrence.
We reviewed 216 pT1N0 thoracic ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy without preoperative chemoradiotherapy. After excluding those cases with clinical follow-up recorded fewer than 3 mo and those who died within 3 mo of surgery, we included 199 cases in the current analysis. Overall survival and recurrence-free survival were assessed by the Kaplan-Meier method, and clinicopathological characteristics associated with any recurrence or distant recurrence were evaluated using univariate and multivariate Cox proportional hazards models. Early recurrence (≤ 24 mo) and correlated parameters were assessed using univariate and multivariate logistic regression models.
Forty-seven (24%) patients had a recurrence at 3 to 178 (median, 33) mo. The 5-year recurrence-free survival rate was 80.7%. None of 13 asymptomatic cases had a recurrence. Preoperative clinical symptoms, upper thoracic location, ulcerative or intraluminal mass macroscopic tumor type, tumor invasion depth level, basaloid histology, angiolymphatic invasion, tumor thickness, submucosal invasion thickness, diameter of the largest single tongue of invasion, and complete negative aberrant p53 expression were significantly related to tumor recurrence and/or recurrence-free survival. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence (Hazard ratios = 3.26, 3.42, and 2.06, P < 0.001, P < 0.001, and P = 0.002, respectively), and a nomogram for predicting recurrence-free survival with these three predictors was constructed. Upper thoracic tumor location and angiolymphatic invasion were independent predictors of distant recurrence. Upper thoracic tumor location, angiolymphatic invasion, submucosal invasion thickness, and diameter of the largest single tongue of invasion were independent predictors of early recurrence.
These results should be useful for designing optimal individual follow-up and therapy for patients with T1N0 ESCC.
Core tip: Recurrences of pT1N0 esophageal squamous cell carcinoma (ESCC) after esophagectomy are usually metachronous regional lymph node or distant metastases. We analyzed 199 thoracic pT1N0 ESCC cases who underwent esophagectomy and thoracoabdominal two-field lymphadenectomy. Forty-seven (24%) patients had a recurrence during 3 to 178 (median, 33) mo. Upper thoracic tumor location, angiolymphatic invasion, and submucosal invasion thickness were independent predictors of tumor recurrence, and a nomogram for predicting recurrence-free survival with these three predictors was constructed. These results should be useful for designing optimal individual follow-up and therapy for patients with T1N0 ESCC.