Objective To compare the failure modes of the patients with stage Ⅱ and stage Ⅲ thoracic esophageal squamous cell carcinoma (TESCC) treated with surgery, postoperative radiotherapy (PORT) and postoperative radiotherapy and chemotherapy (POCRT), and to explore the best treatment model for different subgroups.
Methods We retrospectively analyzed 468 patients treated with different treatment with stage Ⅱ and Ⅲ TESCC after radical resection, and analyzed the relation between their clinicopathological characteristics and the failure modes. SPSS19.0 statistical software was used for statistical analysis.
Results The thoracic-regional recurrence rate was 40.8%, and the distant metastasis rate was 27.4% in the whole group. The 1, 3, 5 years-thoracic-regional recurrence rates were significantly different among the three groups. The distant metastasis rates were not significant among the three groups. Compared with surgery and PORT groups, POCRT group had lower intrathoracic recurrence rate; but, the surgery group had lower distant metastasis rate. Compared with stage Ⅱ patients, stage Ⅲ patients had higher distant metastasis rate. Compared with N0 stage patients, the patients with N1 stage had significantly higher supraclavicular and abdominal lymph node recurrence rate and higher distant metastasis rate. The intrathoracic recurrence rate of N0 stage patients who received postoperative adjuvant therapy were significantly lower than that in patients who received surgery alone, and N1 stage patients seemed to be able to benefit from POCRT. The supraclavicular lymph recurrence rate and intrathoracic recurrence rate of stageⅡpatients who received postoperative adjuvant treatment were significantly lower than those who received surgery alone, but the distant metastasis rates of stage Ⅱ/Ⅲ patients who received postoperative adjuvant therapy were higher than those who received surgery alone.
Conclusion There are high thoracic-regional recurrence rate and distant metastasis rate in the patients with stageⅡ/Ⅲesophageal squamous cell carcinoma after radical surgery. Compared with PORT, POCRT can significantly reduce the thoracic-region recurrence rate. It is recommended that POCRT could be applied on stageⅡor N1 esophageal cancer patients.
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