ABSTRACT
Objective To investigate the predictive value of preoperative albumin-to-fibrinogen ratio (A/F) for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 559 patients with esophageal squainous cell carcinoma who underwent radical resection in the Sun Yat-sen University Cancer Center from January 2009 and January 2012 were collected.There were 443 males and 116 females,aged from 53 to 66 years,with an average age of 59 years.Of 559 patients,394 with A/F ＞ 11.14 were in high A/F group,and 165 with A/F ≤ 11.14 were in low A/F group.Levels of plasma albumin and fibrinogen were measured at two weeks before surgery,and patients underwent radical esophagectomy.Observation indicators:(1) clinicopathological characteristics of patients;(2) survival of patients;(3) risk factors analysis of prognosis of patients.Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to November 2018.The overall survival time was from surgery date to date of endpoint events including death or the last follow-up,and the overall disease-free survival time was from surgery date to date of endpoint events including tumor recurrence,tumor-falted death,or the last follow-up.Measurement data with skewed distribution were expressed by M (range).Count data were described as percentage,and comparison between groups was analyzed using chi-square test or Fisher exact probability.Comparison of ordinal data was analyzed by Mann-Whitney U nonparametric test.The survival rate and curve were calculated and drawn by Kaplan-Meier method and the Log-rank test was used for survival analysis.The univariate and multivariate analyses were done using COX proportional hazard model.Results (1) Clinicopathological characteristics of patients:of 559 patients,cases with age ≤ 60 years and ＞ 60 years,cases in T1 stage,T2 stage,T3 stage(depth of tumor invasion)were 246,148,60,79,255 in the high A/F group,and 79,86,5,32,128 in the low A/F group,there were statistically significant differences in the age and depth of tumor invasion between the two groups (x2 =10.127,Z=-3.468,P＜0.05).(2) Survival of patients:559 patients were followed up for 97 months (range,91-103 months).The 5-year overall survival rate and 5-year disease-free survival rate were 55.8％ and 48.7％ in the high A/F group,and 38.8％ and 35.8％ in the low A/F group,respectively,with statistically significant differences between the two groups (x2 =16.501,11.679,P＜0.05).(3) Risk factors analysis of prognosis of patients:results of univariate analysis showed that sex,age,preoperative fibrinogen level,preoperative A/F level,surgical method,depth of tumor invasion,tumor pathological N staging,and postoperative adjuvant therapy were associated with 5-year overall survival rate of esophageal squamous cell carcinoma after radical esophagectomy [hazard ratio (HR) =1.362,1.358,1.421,0.617,0.772,1.490,1.732,1.436,95％ confidence interval (CI):1.010-1.835,1.084-1.700,1.114-1.814,0.487-0.781,0.612-0.973,1.239-1.792,1.552-1.934,1.128-1.829,P＜ 0.05];age,preoperative fibrinogen level,preoperative A/F level,surgical method,depth of tumor invasion,tumor pathological N staging,postoperative adjuvant therapy were associated with 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy (HR=1.248,1.371,0.675,0.740,1.427,1.665,1.606,95％CI:1.006-1.547,1.086-1.732,0.538-0.847,0.592-0.924,1.202-1.695,1.498-1.851,1.275-2.022,P＜ 0.05).Results of multivariate analysis showed that age,preoperative A/F level,surgical method,depth of tumor invasion,and tumor pathological N staging were independent factors for 5-year overall survival rate and 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy (HR=1.491,0.699,0.741,1.353,1.761,95％CI:1.184-1.877,0.550-0.888,0.587-0.935,1.120-1.634,1.573-1.971,P＜0.05;HR=1.372,0.760,0.703,1.281,1.692,95％CI:1.100-1.711,0.603-0.957,0.562-0.880,1.074-1.527,1.518-1.887,P＜0.05).Conclusion Preoperative A/F level has a good predictive value for survival of esophageal squamous cell carcinoma after radical esophagectomy,and preoperative A/F level ≤ 11.14 is a independent risk factor for 5-year overall survival rate and 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy.
ABSTRACT
Objective: To explore the status of lymph node metastasis of middle third thoracic esophageal squamous cell carcinoma and its influence on the prognosis and to seek the reasonable range of lymphade-nectomy. Methods: A total of 129 patients who underwent curative esophagectomy with modern two-field lymphadenectomy of middle third thoracic esophageal squamous cell carcinoma were reviewed. Results: The lymph node metastasis rate was 56.6% and the upper mediastinal lymph node metastasis rate was 43.4%. The lymph node metastasis ratio (positive nodes/total dissected nodes, LMR) was 11.3%. Paraesophageal lymph nodes, lymph nodes near the right recurrent nerve, the left gastric and infracadnal lymph nodes were most commonly involved when the tumor was located in the middle thoracic esophagus. Tumor differentiation, the depth of tumor invasion and the length of tumor were influencing factors for lymph node metastasis. The 5-year survival of N_0, N_1 (LMR≤20%) and N_1 (LMR>20%) patients were 50.4%, 31.0% and 6.8%, respective-ly, with a significant difference among the three groups (P=0.000). Conclusion: LMR was one of the key fac-tors affecting the prognosis, of esophageal cancer. Patients with middle third thoracic esophageal carcinoma should be treated with radical surgery with modern two-field lymphadenectomy.
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<p><b>BACKGROUND</b>Most stage IIIB (T4/N3) non-small cell lung cancer (NSCLC) can not be cured via operation, but how is the outcome for those with T4 or occasionally N3 which can be completely resected? This paper retrospectively analyses the effects of the tumor characteristics and postoperative treatments on the survival of 51 patients with stage IIIB NSCLC completely resected in this hospital from January 1, 1997 to April 30, 2001.</p><p><b>METHODS</b>The effects of clinical pathophysiological characteristics such as gender, histological type, differentiation, T-stage and lymph node status and the postoperative chemotherapy or radiotherapy on the prognosis of 51 patients with completely resected stage IIIB NSCLC were retrospectively analysed.</p><p><b>RESULTS</b>There were no statistic survival differences in the disease characteristics such as the different gender (Log rank=0.992, P=0.319), histological types (Log rank=1.263, P=0.260), differentiation (Log rank=1.104, P=0.577), T-stage (Log rank=0.106, P=0.588) and lymph node status (Log rank=1.297, P=0.731), also no difference between groups whether or not there was postoperative mediastinal radiotherapy (Log rank=0.482, P=0.488) or postoperative chemotherapy (Log rank=0.051, P=0.759).</p><p><b>CONCLUSIONS</b>Neither the tumor characteristics such as gender, histological type, differentiation, T-stage and N-stage, nor the postoperative mediastinal radiotherapy or chemotherapy affect the survival of stage IIIB NSCLC with complete resection.</p>