Esophageal Cancer: Optimization of Management

ABSTRACT

We examined factors associated with generalization of esophageal cancer (EC) after complete esophagectomies (E).

We analyzed data of 126 consecutive EC patients (ECP) (age = 56.8±7.9 years) operated and monitored in 1975-2007 (males = 98, females = 28; E Ivor-Lewis = 89, E Garlock = 37; adenocarcinoma = 93, squamos = 31, mix = 2; T1 = 25, T2 = 38, T3 = 29, T4 = 34; N0 = 55, N1 = 23, M1a = 48; only surgery-S = 97, adjuvant chemoimmunoradiotherapy- AT = 29: 5-FU+ thymalin/taktivin+radiotherapy 45-50Gy). Cox regression, clustering, structural equation modeling, Monte Carlo, bootstrap, neural networks computing were used to determine any significant dependence.

General cumulative 5-year survival (5YS) was 50.5%, 10-year survival - 38.3%. 39 ECP (31%) lived more than 5 years, 17 ECP - 10 years. 55 ECP (43.7%) died because of EC. AT significantly improved ECP 5YS (P = 0.023). Cox modeling displayed that 5YS significantly depended on: T, N, histology, stage, combined procedures, AT, age, blood cell subpopulations (P = 0.000-0.039). Neural networks, genetic algorithm and bootstrap simulation revealed relationships between 5YS of ECP and N (rank = 1), sex, EC growth, T, histology, combined procedures, G, blood residual nitrogen, hemorrhage time, blood chlorides, AT, neutrophils, tumor size, thrombocytes, monocytes. Correct prediction of 5YS was 100% by neural networks computing.

Optimal treatment strategies are: screening/early detection; availability of experienced surgeons; aggressive surgery; precise prediction; AT for ECP with unfavorable prognosis.