Prognostic factors in patients with thoracic esophageal carcinoma staged pT(1-4a)N(0)M(0) undergone esophagectomy with three-field lymphadenectomy

Background: To analyze prognostic factors in patients with thoracic esophageal carcinoma staged pT(1-4a)N(0)M(0) and undergone esophagectomy with 3-field lymphadenectomy and to evaluate the effect of postoperative radiotherapy. Methods: From January 1993 to March 2007, 770 patients with stage pT(1-4a)N(0)M(0) underwent 3-field lymphadenectomy at Fujian Province Cancer Hospital, China were enrolled for analysis. The study consisted of 770 patients with stage pT(1-4a)N(0)M(0) who underwent 3-field lymphadenectomy at Fujian Province Cancer Hospital, China. A total of 687 had received surgery only, and 83 patients had undergone surgery followed by postoperative radiotherapy. Radiation dose was 50 Gy in 25 fractions. Results: The overall survival rates at 1, 3, 5, and 10 years were 92.9%, 80.8%, 71.7% and 57.4%, respectively. Univariate analysis showed that age and T staging were two independent factors on prognoses. Five-year survival in cases younger and older than 60 were 76.5% vs. 63.3% (P=0.001), while those of pT1, pT(2), pT(3) and pT(4a) were 83.8%, 78.8%, 67.8% and 54.1%, respectively (P=0.000). Five-year survival in group of simple surgery was 71.3%, compared with 74.5% in group of surgery plus postoperative radiotherapy (P=0.763), while stratified analysis indicated that postoperative radiotherapy was able to boost the survival of patients in pT(4a) which were 72.4% vs. 33.8% (P=0.036) and to lower relapse rate of tumor bed in patients with pT(4a) (P=0.005). Multivariate analysis showed that age and T staging were two independent factors on prognoses. Conclusions: Patients with high T staging and at an age more than 60 turned out bad prognoses, neither could postoperative radiotherapy improve their survival.