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Prognostic Factors After Esophagectomy for Squamous Cell Carcinoma of the Esophagus - Does Tumor Location Matter?
Tsz Ting Law*1, Kwan Kit Chan1, Daniel Tong1, Fion S. Chan1, Wai Ho Wong1, Lai Wan Dora Kwong2, Simon Law1
1Surgery, University of Hong Kong, Hong Kong, Hong Kong; 2Clinical Oncology, University of Hong Kong, Hong Kong, Hong Kong
Objective: To compare the clinicopathological features and prognostic factors of supracarinal esophageal cancer versus infracarinal tumors.
Background:
Supracarinal tumor location is presumed to have worse prognosis because of unfavorable anatomy for surgical resection, and more difficulty in achieving negative lateral as well as proximal margins. With increasing use of neoadjuvant therapies however, the impact of tumor location may be lessened and this has not been adequately studied.
Methods:
From January 1990 to December 2011, 1130 patients with esophageal cancer underwent resection, 668 (59.1%) of whom with intrathoracic squamous cell carcinomas were analyzed. Eighty-five (12.7%) patients had supracarinal tumor (group A). Clinico-pathological features were compared with those located more distally (group B). Multivariate analyses were performed to identify prognostic factors.
Results:
More patients in group A received neoadjuvant chemotherapy or chemoradiotherapy (CRT) (50.6% vs. 36.4%, p=0.012). Operation took longer (300 mins vs. 275 mins, p=0.006), and postoperative vocal cord palsies were more frequent (24.7% vs. 8.4%, p<0.01). Other complications did not differ and in-hospital mortality rates were 3.5% and 3.3% respectively, p=0.896. R0 resection was achieved in 69.4% and 72% respectively, p=0.615. Median survival was 15.6 and 20.5 months respectively, p=0.973. Multivariate analysis showed that R1/2 resection (R1/2 vs. R0, HR= 2.43, 95% CI=1.94-3.04), male gender (male vs. female, HR=1.45, 95% CI=1.14-1.85) and higher (y)pTNM stage (stage III/IV vs. 0/I/II/T0N1, HR=1.61, 95% CI=1.17-2.21) were unfavorable prognostic factors; but not tumor location. When only group A patients were analyzed, R1/2 resection (R1/2 vs. R0, HR =3.73, CI =1.86-7.46) and the absence of neoadjuvant chemotherapy or chemoradiotherapy (no CRT vs. CRT, HR=2.2, CI=1.20-4.05) were poor prognostic factors.
Conclusions:
In the modern era of effective neoadjuvant therapies, survival of patients with supracarinal tumors is not inferior. Surgery however is more complicated and more vocal cord palsies result. The use of neoadjuvant therapies is a favorable prognostic factor for such cancers.
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