1.
Esophageal Cancer: 10-Year Survival
Kshivets Oleg
Surgery Department, Roshal Hospital, Moscow, Russia
P1028

2.
Esophageal Cancer: 10-Year Survival P1028
Kshivets Oleg Surgery Department, Roshal Hospital, Moscow, Russia
OBJECTIVE: 10-Year survival (10YS) after radical surgery for esophageal cancer (EC) patients (ECP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 551 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-
2021 (m=411, f=140; esophagogastrectomies (EG) Garlock=284, EG Lewis=267, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS,
colon transversum, lung, trachea, pericardium, splenectomy=154; adenocarcinoma=314, squamous=227, mix=10; T1=128, T2=115, T3=181, T4=127;
N0=278, N1=70, N2=203; G1=157, G2=141, G3=253; early EC=109, invasive=442; only surgery=423, adjuvant chemoimmunoradiotherapy-AT=128: 5-
FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing
were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1881.1±2230.6 days and cumulative 5-year survival (5YS) reached 52.1%, 10 years – 45.9%, 20 years – 33.7%.
184 ECP lived more than 5 years (LS=4308.7±2413.3 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 226 ECP died because of EC
(LS=628.3±319.9 days). AT significantly improved 5YS (68.8% vs. 48.5%) (P=0.00025 by log-rank test). Cox modeling displayed that 10YS of ECP
significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells
subpopulations), T, G, histology, age, AT, localization, blood cells, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021).
Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 10YS and PT N0—N12 (rank=1), healthy
cells/CC (2), PT early-invasive EC (3), thrombocytes/CC (4), erythrocytes/CC (5), lymphocytes/CC (6), eosinophils/CC (7), stick neutrophils/CC (8),
segmented neutrophils/CC (9), monocytes/CC (10). leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area
under ROC curve=1.0; error=0.0).
CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio
Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric
data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced
thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for
completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Significant Factors
(Number of Samples=3333)
Rank Kendal Tau-A P
Tumor Size 1 -0.316 0.000
Healthy Cells/Cancer Cells 2 0.315 0.000
T1-4 3 -0.307 0.000
Erythrocytes/Cancer Cells 4 0.307 0.000
Leucocytes/Cancer Cells 5 0.298 0.000
Thrombocytes/Cancer Cells 6 0.293 0.000
Lymphocytes/Cancer Cells 7 0.289 0.000
Segmented Neutrophils/Cancer Cells 8 0.280 0.000
Residual Nitrogen 9 -0.277 0.000
Phase Transition N0---N12 10 -0.248 0.000
Monocytes/Cancer Cells 11 0.240 0.000
Hemorrhage Time 12 -0.233 0.000
Phase Transition Early---Invasive Cancer 13 -0.225 0.000
Procedure Type 14 -0.192 0.000
Eosinophils/Cancer Cells 15 0.163 0.000
Chlorides 16 0.163 0.000
G1-3 17 -0.140 0.000
Tumor Growth 18 -0.117 0.001
Stick Neutrophils/Cancer Cells 19 0.105 0.01
Erythrocytes 20 0.103 0.01
Weight 21 0.100 0.01
Combined Procedure 22 0.098 0.01
Localization 23 0.070 0.05
Factors: Correct Classification Rate=100%;
Error=0.0; Area under ROC Curve=1.0
Ran
k
Sensitivity
Phase Transition N0---N12
Healthy Cells/Cancer Cells
Phase Transition Early---Invasive Cancer
Thrombocytes/Cancer Cells
Erythrocytes/Cancer Cells
Lymphocytes/Cancer Cells
Eosinophils/Cancer Cells
Stick Neutrophils/Cancer Cells
Segmented Neutrophils/Cancer Cells
Monocytes/Cancer Cells
Leucocytes/Cancer Cells
1
2
3
4
5
6
7
8
9
10
11
14768
11853
10080
8933
8326
7595
6406
5490
3938
2943
2658
Cox Regression
n=551
Parameter
Estimate
Standard
Error
Chi-square P value
95% Lower
CL
95% Upper
CL
Hazard
Ratio
Hemorrhage Time 0.00140 0.000402 12.18223 0.000482 0.00062 0.002192 1.00140
Residual Nitrogen 0.05156 0.011110 21.54182 0.000003 0.02979 0.073339 1.05292
Protein 0.02145 0.008664 6.12841 0.013303 0.00447 0.038428 1.02168
Prothrombin Index 0.02606 0.006403 16.55867 0.000047 0.01351 0.038605 1.02640
T1-4 0.43221 0.085980 25.26934 0.000000 0.26369 0.600727 1.54066
N0---N12 0.59826 0.161755 13.67911 0.000217 0.28122 0.915290 1.81894
Age 0.02845 0.007746 13.48557 0.000240 0.01326 0.043627 1.02885
Histology -0.28768 0.124960 5.30016 0.021323 -0.53260 -0.042767 0.75000
G1-3 0.42034 0.088794 22.41002 0.000002 0.24631 0.594377 1.52248
Adjuvant Chemoimmunoradiotherapy -0.93274 0.197277 22.35461 0.000002 -1.31939 -0.546082 0.39348
Segmented Neutrophils/Cancer Cells 4.04524 1.582385 6.53527 0.010576 0.94382 7.146654 57.12473
Localization -0.53528 0.190887 7.86335 0.005045 -0.90941 -0.161147 0.58551
Leucocytes/Cancer cells -4.11797 1.590909 6.70002 0.009641 -7.23610 -0.999847 0.01628
Eosinophils/Cancer Cells 4.26504 1.671458 6.51111 0.010720 0.98904 7.541033 71.16750
Stick Neutrophils/Cancer Cells 4.33745 1.642549 6.97321 0.008274 1.11812 7.556790 76.51243
Lymphocytes/Cancer Cells 3.93332 1.604682 6.00815 0.014240 0.78820 7.078439 51.07626
Monocytes/Cancer Cells 4.34006 1.643347 6.97483 0.008266 1.11916 7.560962 76.71226
Survival Function
5-year survivalof ECP=52.1%;10-year-survival of ECP=45.9;
20-year Survival of ECP=33.7%; n=551.
Complete Censored
-5 0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Cumulative Proportion Surviving (Kaplan-Meier)
10-year survival of Early ECP=95.7%; 10-Year Survival of Invasive ECP=32.1%; n=551
(P=0.000 by Log Rank Test).
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Invasive ECP, n=442
Early ECP, n=109
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survial of ECP with N0=68.6%; 10-Year survival of ECP withN1-2=20.8%
(P=0.000 by Log Rank Test).
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
ECP with N1-2, n=273
ECP with N0, n=278
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival ECP after Adjuvant Chemoimmunoradiotherapy=68.8%;
10-Year Survival of ECP after Surgery=48.5%
(P=0.00025 by Log Rank Test).
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Adjuvant Chemoimmunoradiotherapy, n=128
Only Surgery, n=423
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival of Esophageal Cancer Patients=60.6%;
10-Year Survival of Cardioesophageal Cancer Patients=30.2%
(P=0.000 by Log Rank Test).
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Esophageal Cancer Patients, n=262
Cardioesophageal Cancer Patients, n=289
Cumulative Proportion Surviving (Kaplan-Meier)
10-Year Survival of ECP in u/3=61.4%;
10-Year Survival of others ECP=42.4%
(P=0.00339 by Log Rank Test)
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
Cumulative
Proportion
Surviving
Others, n=470
ECP in u/3, n=81