Local Advanced Esophageal Cancer (T3-4N0-2M0): Optimization of Management.
Dr. Oleg Kshivets1
1Bagrationovsk Hospital, surgery dep., Bagrationovsk, Russian Federation
OBJECTIVE: Survival of patients with local advanced esophageal cancer (EC) takes several months. Radical operations are extremely complex, remain the prerogative of several best thoracoabdominal surgeons of the world. The search of optimal treatment plan for EC patients (ECP) with stage T3-4N0-2M0 was realized. We examined prognostic factors for 5-year survival (5YS) of local advanced ECP after complete esophagogastrectomies (E).
METHODS: We analyzed data of 313 consecutive ECP (age=56.2±9 years) operated, monitored in 1975-2024 (m=233, f=80; Lewis=122, Garlock=191, combined E=170; only surgery-S=217, adjuvant chemoimmunoradiotherapy-AT=96: 5FU+thymalin/taktivin +radiotherapy 50Gy; T3=185, T4=128; N0=96, N1=38, N2=179. Cox, clustering, SEPATH, Monte Carlo, bootstrap, synergetics and neural networks were used to determine dependence.
RESULTS: Overall life span (LS) was 1243.6±1691.4 days and cumulative 5YS reached 29%, 10 years – 19.2%, 20 years – 13.3%. 55 ECP lived more than 5 years (LS=4199.4±2295.3 days), 25 – more than 10 years (LS=6256.3±1884.8 days). 186 ECP died because of EC (LS=605.1±289.9 days). AT improved 5YS (56.8% vs. 22%) (P=0.0000). Cox displayed that 5YS significantly depended on: phase transition N0-N12 in terms of synergetics, G, histology, AT, age, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), ESS, prothrombin index, residual nitrogen (P=0.000-0.033). Neural networks revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC, healthy cells/CC, erythrocytes/CC, segmented neutrophils/CC, eosinophils/CC.
CONCLUSIONS: 5YS of local advanced ECP significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical, hemostasis, anthropometric data, AT. Best management for local advanced ECP are: availability of experienced thoracoabdominal surgeons; aggressive en block surgery; precise prognosis; AT for ECP with unfavorable prognosis.