Gross tumor volume is an independent prognostic factor in patients with postoperative locoregional recurrence of esophageal squamous cell carcinoma

Shi,Yu; Ge,Xiaolin; Gao,Zhenzhen; Liu,Shenxiang; Sun,Xinchen; Luo,Jinhua

doi:10.3892/ol.2019.10529

Gross tumor volume is an independent prognostic factor in patients with postoperative locoregional recurrence of esophageal squamous cell carcinoma

Authors:
- Yu Shi
- Xiaolin Ge
- Zhenzhen Gao
- Shenxiang Liu
- Xinchen Sun
- Jinhua Luo
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Affiliations: Department of Radiotherapy, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China, Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
Published online on: June 26, 2019 https://doi.org/10.3892/ol.2019.10529
Pages: 2388-2393
Copyright: © Shi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Many cases of esophageal squamous cell carcinoma (ESCC) involve lymph node and distant metastases after esophagectomy, and most patients relapse within 2 years. Intensity‑modulated radiotherapy (IMRT) is an important treatment for these cases of recurrence in ESCC and is widely used in clinical practice. A retrospective study of 137 postoperative patients with locoregional recurrences of ESCC who received IMRT was carried out. Kaplan‑Meier survival curves and log‑rank tests of univariate analysis was performed to assess whether there was a significant association between demographic and clinical features and death after recurrence. For multivariate analysis, the statistically significant results from the Kaplan‑Meier method were subjected to Cox regression analysis. A total of 109 male and 28 female patients were included. There were 21 (15.3%), 58 (42.3%), 36 (26.3%), 3 (2.2%), 17 (12.4%), and 2 (1.5%) recurrences in the anastomotic, supraclavicular, mediastinal, tumor bed, polyregional, and abdominal regions, respectively. Univariate analysis showed that the gross tumor volume (GTV) of radiation (<27 vs. ≥27 cm3) and the number of lymph nodes were significantly associated with survival. The survival rates of patients at 1, 2, 3 and 5 years with GTV<27 cm3 were 72.7, 51.5, 37.1 and 25.9%, respectively, and with GTV≥27 cm3 were 63.7, 26.9, 17.9 and 0%, respectively. The significant independent prognostic factor was GTV [<27 vs. ≥27 cm3; hazard ratio (HR), 1.746; 95% confidence interval (CI), 1.112‑2.741]. In conclusion, GTV of radiation (<27 vs. ≥27 cm3) is an independent factor in predicting locoregional recurrence after ESCC. Patients with GTV<27 cm3 are likely to have a better prognosis.

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1	Siegel RL, Miller KD and Jemal A: Cancer Statistics, 2017. CA Cancer J Clin. 67:7–30. 2017. View Article : Google Scholar : PubMed/NCBI
2	Zeng H, Zheng R, Zhang S, Zuo T, Xia C, Zou X and Chen W: Esophageal cancer statistics in China, 2011: Estimates based on 177 cancer registries. Thorac Cancer. 7:232–237. 2016. View Article : Google Scholar : PubMed/NCBI
3	Yao J, Shen X, Li H, Xu J, Shao S, Huang JX and Lin M: LncRNA- ECM is overexpressed in esophageal squamous cell carcinoma and promotes tumor metastasis. Oncol Lett. 16:3935–3942. 2018.PubMed/NCBI
4	Kayani B, Zacharakis E, Ahmed K and Hanna GB: Lymph node metastases and prognosis in oesophageal carcinoma - a systematic review. Eur J Surg Oncol. 37:747–753. 2011. View Article : Google Scholar : PubMed/NCBI
5	Bai Y, Lin H, Fang Z, Luo Q, Fang Y, Su Y, Hu Q, Duan H, Chen F and Zhang ZY: Plasma microRNA-19a as a potential biomarker for esophageal squamous cell carcinoma diagnosis and prognosis. Biomarkers Med. 11:431–441. 2017. View Article : Google Scholar
6	Wu SG, Zhang WW, He ZY, Sun JY, Chen YX and Guo L: Sites of metastasis and overall survival in esophageal cancer: A population-based study. Cancer Manag Res. 9:781–788. 2017. View Article : Google Scholar : PubMed/NCBI
7	Kato H, Fukuchi M, Miyazaki T, Nakajima M, Kimura H, Faried A, Sohda M, Fukai Y, Masuda N, Manda R, et al: Classification of recurrent esophageal cancer after radical esophagectomy with two- or three-field lymphadenectomy. Anticancer Res. 25:3461–3467. 2005.PubMed/NCBI
8	Doki Y, Ishikawa O, Takachi K, Miyashiro I, Sasaki Y, Ohigashi H, Murata K, Yamada T, Noura S, Eguchi H, et al: Association of the primary tumor location with the site of tumor recurrence after curative resection of thoracic esophageal carcinoma. World J Surg. 29:700–707. 2005. View Article : Google Scholar : PubMed/NCBI
9	Bao Y, Liu S, Zhou Q, Cai P, Anfossi S, Li Q, Hu Y, Liu M, Fu J, Rong T, et al: Three-dimensional conformal radiotherapy with concurrent chemotherapy for postoperative recurrence of esophageal squamous cell carcinoma: Clinical efficacy and failure pattern. Radiat Oncol. 8:2412013. View Article : Google Scholar : PubMed/NCBI
10	Hsu PK, Wang BY, Huang CS, Wu YC and Hsu WH: Prognostic factors for post-recurrence survival in esophageal squamous cell carcinoma patients with recurrence after resection. J Gastrointest Surg. 15:558–565. 2011. View Article : Google Scholar : PubMed/NCBI
11	Ji K, Zhao L, Yang C, Meng M and Wang P: Three-dimensional conformal radiation for esophageal squamous cell carcinoma with involved-field irradiation may deliver considerable doses of incidental nodal irradiation. Radiat Oncol. 7:2002012. View Article : Google Scholar : PubMed/NCBI
12	Gupta T, Agarwal J, Jain S, Phurailatpam R, Kannan S, Ghosh-Laskar S, Murthy V, Budrukkar A, Dinshaw K, Prabhash K, et al: Three-dimensional conformal radiotherapy (3D-CRT) versus intensity modulated radiation therapy (IMRT) in squamous cell carcinoma of the head and neck: A randomized controlled trial. Radiother Oncol. 104:343–348. 2012. View Article : Google Scholar : PubMed/NCBI
13	Zhang W, Liu X, Xiao Z, Wang L, Zhang H, Chen D, Zhou Z, Feng Q, Hui Z, Liang J, et al: Efficacy of intensity-modulated radiotherapy for resected thoracic esophageal squamous cell carcinoma. Thorac Cancer. 6:597–604. 2015. View Article : Google Scholar : PubMed/NCBI
14	Jager KJ, van Dijk PC, Zoccali C and Dekker FW: The analysis of survival data: The Kaplan-Meier method. Kidney Int. 74:560–565. 2008. View Article : Google Scholar : PubMed/NCBI
15	Ni A and Cai J: Tuning parameter selection in Cox proportional hazards model with a diverging number of parameters. Scand Stat Theory Appl. 45:557–570. 2018. View Article : Google Scholar : PubMed/NCBI
16	Dresner SM and Griffin SM: Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy. Br J Surg. 87:1426–1433. 2000. View Article : Google Scholar : PubMed/NCBI
17	Xu Y, Chen Q, Yu X, Zhou X, Zheng X and Mao W: Factors influencing the risk of recurrence in patients with esophageal carcinoma treated with surgery: A single institution analysis consisting of 1002 cases. Oncol Lett. 5:185–190. 2013. View Article : Google Scholar : PubMed/NCBI
18	Nakamura T, Hayashi K, Ota M, Eguchi R, Ide H, Takasaki K and Mitsuhashi N: Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg. 188:261–266. 2004. View Article : Google Scholar : PubMed/NCBI
19	Nemoto K, Ariga H, Kakuto Y, Matsushita H, Takeda K, Takahashi C, Takai Y, Yamada S and Hosoi Y: Radiation therapy for loco-regionally recurrent esophageal cancer after surgery. Radiother Oncol. 61:165–168. 2001. View Article : Google Scholar : PubMed/NCBI
20	Kawamoto T, Nihei K, Sasai K and Karasawa K: Clinical outcomes and prognostic factors of chemoradiotherapy for postoperative lymph node recurrence of esophageal cancer. Jpn J Clin Oncol. 48:259–264. 2018. View Article : Google Scholar : PubMed/NCBI
21	Liu Q, Cai XW, Wu B, Zhu ZF, Chen HQ and Fu XL: Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: Implications for the clinical target volume design of postoperative radiotherapy. PLoS One. 9:e972252014. View Article : Google Scholar : PubMed/NCBI
22	Ma DY, Tan BX, Liu M, Li XF, Zhou YQ and Lu Y: Concurrent three-dimensional conformal radiotherapy and chemotherapy for postoperative recurrence of mediastinal lymph node metastases in patients with esophageal squamous cell carcinoma: A phase 2 single-institution study. Radiat Oncol. 9:282014. View Article : Google Scholar : PubMed/NCBI
23	Jingu K, Matsushita H, Takeda K, Umezawa R, Takahashi C, Sugawara T, Kubozono M, Abe K, Tanabe T, Shirata Y, et al: Long-term results of radiotherapy combined with nedaplatin and 5-fluorouracil for postoperative loco-regional recurrent esophageal cancer: Update on a phase II study. BMC Cancer. 12:5422012. View Article : Google Scholar : PubMed/NCBI
24	Miyata H, Yamasaki M, Kurokawa Y, Takiguchi S, Nakajima K, Fujiwara Y, Konishi K, Mori M and Doki Y: Survival factors in patients with recurrence after curative resection of esophageal squamous cell carcinomas. Ann Surg Oncol. 18:3353–3361. 2011. View Article : Google Scholar : PubMed/NCBI
25	Chen XL, Chen TW, Fang ZJ, Zhang XM, Li ZL, Li H, Tang HJ, Zhou L, Wang D and Zhang Z: Patterns of lymph node recurrence after radical surgery impacting on survival of patients with pT1-3N0M0 thoracic esophageal squamous cell carcinoma. J Korean Med Sci. 29:217–223. 2014. View Article : Google Scholar : PubMed/NCBI
26	Huang Y, Chen S-W, Fan C-C, Ting L-L, Kuo C-C and Chiou J-F: Clinical parameters for predicting radiation-induced liver disease after intrahepatic reirradiation for hepatocellular carcinoma. Radiat Oncol. 11:892016. View Article : Google Scholar : PubMed/NCBI
27	Basaki K, Abe Y, Aoki M, Kondo H, Hatayama Y and Nakaji S: Prognostic factors for survival in stage III non-small-cell lung cancer treated with definitive radiation therapy: Impact of tumor volume. Int J Radiat Oncol Biol Phys. 64:449–454. 2006. View Article : Google Scholar : PubMed/NCBI
28	Zhu D, Ma T, Niu Z, Zheng J, Han A, Zhao S and Yu J: Prognostic significance of metabolic parameters measured by (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with small cell lung cancer. Lung Cancer. 73:332–337. 2011. View Article : Google Scholar : PubMed/NCBI