Système gastro-intestinal et digestif

Abstrait

Esophageal Cancer: 10 Year Survival after Surgery

Oleg Kshivets

Objective: 10 Year survival (10 YS) after radical surgery for esophageal cancer (EC) patients (ECP) (T1-4N0-2M0) was analyzed.

Methods: We analyzed data of 551 consecutive ECP (age=56.5 ± 8.9 years; tumor size=6 ± 3.5 cm) radically operated (R0) and monitored in 1975-2021 (m=411, f=140; esophagogastrectomies (EG) Garlock=284, EG Lewis=267, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=154; adenocarcinoma=314, squamous=227, mix=10; T1=128, T2=115, T3=181, T4=127; N0=278, N1=70, N2=203; G1=157, G2=141, G3=253; early EC=109, invasive=442; only surgery=423, adjuvant chemoimmunoradiotherapy-AT=128: 5-FU+thymalin/taktivin+radiotherapy 45 Gy-50 Gy. Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.

Results: Overall life span (LS) was 1881.1 ± 2230.6 days and cumulative 5 year survival (5 YS) reached 52.1%, 10 years 45.9%, 20 years 33.7%. 184 ECP lived more than 5 years (LS=4308.7 ± 2413.3 days), 99 ECP more than 10 years (LS=5883 ± 2296.6 days). 226 ECP died because of EC (LS=628.3 ± 319.9 days). AT significantly improved 5 YS (68.8% vs. 48.5%) (P=0.00025 by log rank test). Cox modeling displayed that 10 YS of ECP significantly depended on: phase transition (PT) N0-N12 in terms of synergetics, cell ratio factors (ratio between cancer cells CC and blood cells subpopulations), T, G, histology, age, AT, localization, blood cells, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 10 YS and PT N0-N12 (rank=1), healthy cells/CC (2), PT early invasive EC (3), thrombocytes/CC (4), erythrocytes/CC (5), lymphocytes/CC (6), eosinophils/CC (7), stick neutrophils/CC (8), segmented neutrophils/CC (9), monocytes/CC (10). Leucocytes/CC (11). Correct prediction of 5 YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).

Conclusion: 10 Year survival after radical procedures significantly depended on: (1) PT “early invasive cancer”; (2) PT N0- N12; (3) Cell Ratio Factors; (4) blood cell circuit; (5) biochemical factors; (6) hemostasis system; (7) AT; (8) EC characteristics; (9) tumor localization; (10) anthropometric data; (11) surgery type. Optimal diagnosis and treatment strategies for EC are: (1) screening and early detection of EC; (2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; (3) aggressive en block surgery and adequate lymph node dissection for completeness; (4) precise prediction; (5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.