Patients and Methods
Patients
Methods
Staging
Treatment
Pathology
Follow-up Evaluation
Statistical Analysis
Results
Patients’ Characteristics
Group 1 (n = 89)
n (%) | Group 2 (n = 72)
n (%) |
P value | |
---|---|---|---|
Male | 71 (79.8) | 57 (79.2) | 0.924a
|
Age (years), median (IQR) | 63 (58–67) | 64 (57–69) | 0.299b
|
WHO/ECOG performance status | 0.843a
| ||
0–1 | 85 (95.5) | 64 (88.9) | |
2 | 0 (0.0) | 0 (0.0) | |
Missing | 4 (4.5) | 8 (11.1) | |
Comorbidities total | 44 (49.4) | 38 (52.8) | 0.673a
|
Cardiovascular | 34 (38.2) | 28 (38.9) | 0.798a
|
Pulmonary | 3 (3.4) | 1 (1.4) | |
Cardiovascular and pulmonary | 5 (5.6) | 6 (8.3) | |
Other | 2 (2.2) | 3 (4.2) | |
No comorbidities | 45 (50.6) | 34 (47.2) | |
Histology | 0.095a
| ||
Adenocarcinoma | 79 (88.8) | 57 (79.2) | |
Squamous cell carcinoma | 10 (11.2) | 15 (20.8) | |
Tumor location | |||
Middle esophagus | 7 (7.9) | 5 (6.9) | 0.005a
|
Distal esophagus | 76 (85.4) | 49 (68.1) | |
GEJ | 6 (6.7) | 18 (25.0) | |
Tumor length (cm), median (IQR) | 5.0 (3.0–6.0) | 6.5 (5.0–9.0) | 0.000b
|
cT stage | 0.000a
| ||
T1 | 0 (0.0) | 2 (2.8) | |
T2 | 25 (28.1) | 5 (6.9) | |
T3 | 63 (70.8) | 56 (77.8) | |
T4a | 1 (1.1) | 9 (12.5) | |
cN stage | 0.024a
| ||
N0 | 22 (24.7) | 7 (9.7) | |
N1 | 38 (42.7) | 30 (41.7) | |
N2 | 27 (30.3) | 29 (40.3) | |
N3 | 2 (2.2) | 6 (8.3) | |
ypT stage | 0.525a
| ||
CR | 15 (16.9) | 13 (18.1) | |
T0 | 4 (4.5) | 2 (2.8) | |
T1 | 17 (19.1) | 8 (11.1) | |
T2 | 11 (12.4) | 9 (12.5) | |
T3 | 42 (47.2) | 40 (55.6) | |
ypN stage | 0.706a
| ||
N0 | 57 (64.0) | 44 (61.1) | |
N1 | 18 (20.2) | 16 (22.2) | |
N2 | 11 (12.4) | 7 (9.7) | |
N3 | 3 (3.4) | 5 (6.9) | |
Perineural growth | 15 (16.9) | 18 (25.0) | 0.204a
|
Lymphangio-invasion | 14 (15.7) | 19 (26.4) | 0.097a
|
LN ratio (>0.2 LN+) | 12 (13.5) | 11 (15.3) | 0.747a
|
Follow-up (months), median (IQR) | 23.2 (11.8–52.9) | 16.2 (9.2–40.3) | 0.037b
|
Group 1 (n = 89)
n (%) | Group 2 (n = 72)
n (%) |
P value | |
---|---|---|---|
Completed nCRT | 71 (79.8) | 58 (80.6) | 0.902a
|
Hematologic toxicity | 0.068a
| ||
Thrombocytopenia–overall | |||
Not applicable | 26 (29.2) | 28 (38.9) | |
Grade 1 | 54 (60.7) | 43 (59.7) | |
Grade 2 | 8 (9.0) | 1 (1.4) | |
Grade 3 | 1 (1.1) | 0 (0.0) | |
Leukopenia–overall | 0.338a
| ||
Not applicable | 15 (16.9) | 20 (27.8) | |
Grade 1 | 34 (38.2) | 21 (29.2) | |
Grade 2 | 26 (29.2) | 19 (26.4) | |
Grade 3 | 13 (14.6) | 12 (16.7) | |
Grade 4 | 1 (1.1) | 0 (0.0) | |
Blood transfusion | 0.417a
| ||
0 | 87 (97.8) | 67 (93.1) | |
1 | 0 (0.0) | 1 (1.4) | |
2 | 1 (1.1) | 1 (1.4) | |
3 | 1 (1.1) | 2 (2.8) | |
4 | 0 (0.0) | 1 (1.4) | |
Other nCRT complications (grade ≥ 3) | |||
Anemia | 0 (0.0) | 0 (0.0) | NAa
|
Bleeding | 0 (0.0) | 1 (1.4) | 0.203a
|
Nausea | 3 (3.4) | 4 (5.6) | 0.501a
|
Fatigue | 1 (1.1) | 1 (1.4) | 0.880a
|
Neurotoxic | 0 (0.0) | 2 (2.8) | 0.071a
|
Diarrhea | 0 (0.0) | 1 (1.4) | 0.203a
|
Esophagitis | 2 (2.2) | 5 (6.9) | 0.144a
|
Grade ≥ 3 or blood transfusion | 22 (24.7) | 26 (36.1) | 0.117a
|
Postoperative complications | |||
Pulmonary (all grades)b
| 49 (55.1) | 38 (52.8) | 0.773a
|
Pneumonia | 41 (46.1) | 28 (38.9) | 0.360a
|
Respiratory insufficiency | 19 (21.3) | 13 (18.1) | 0.602a
|
Pulmonary embolism | 2 (2.2) | 0 (0.0) | 0.122a
|
Cardiac (all grades)c
| 26 (29.2) | 22 (30.6) | 0.835a
|
Arrhythmia | 25 (28.1) | 22 (30.6) | 0.732a
|
Myocardial infarction | 1 (1.4) | 0 (0.0) | 0.273a
|
Sepsis | 8 (9.0) | 6 (8.3) | 0.883a
|
Postoperative bleeding | 2 (2.2) | 1 (1.4) | 0.678a
|
Chylothorax | 11 (12.4) | 3 (4.2) | 0.057a
|
Cardiac arrest | 2 (2.2) | 3 (4.2) | 0.486a
|
Esophageal anastomotic leak | 8 (9.0) | 12 (16.7) | 0.143a
|
Renal failure | 2 (2.2) | 4 (5.6) | 0.276a
|
IIeus | 6 (6.7) | 2 (2.8) | 0.237a
|
All patients with complications (all grades) | 60 (67.4) | 50 (69.4) | 0.783a
|
Postoperative mortality | |||
30-day mortality | 2 (2.2) | 3 (4.2) | 0.486a
|
90-day mortality | 6 (6.7) | 7 (9.7) | 0.492a
|
Toxicity and Postoperative Survival
Overall Survival
HR (95% CI) |
P value | |
---|---|---|
Univariate analysis | ||
Group 2 | 1.802 (1.200–2.707) | 0.005 |
Celiac lymph node metastasis | 3.969 (2.188–7.198) | 0.000 |
Cardia growth 2–4 cm | 1.329 (0.721–2.452) | 0.362 |
Length >8 cm | 1.217 (0.699–2.118) | 0.488 |
Weight loss >10% | 1.407 (0.892–2.217) | 0.142 |
Squamous cell carcinoma | 0.543 (0.295–1.000) | 0.050 |
ypT0 | 1.000 | 0.008 |
ypT1 | 0.589 (0.254–1.367) | |
ypT2 | 1.945 (0.974–3.884) | |
ypT3 | 1.778 (1.019–3.100) | |
ypN0 | 1.000 | 0.000 |
ypN1 | 1.518 (0.914–2.522) | |
ypN2 | 2.144 (1.158–3.968) | |
ypN3 | 5.024 (2.215–11.398) | |
R1 resection | 3.266 (1.543–6.912) | 0.002 |
LN ratio (>0.2 LN +) | 2.29 (1.437–4.105) | 0.001 |
Perineural growth | 2.076 (1.314–3.279) | 0.002 |
Lymphangio-invasion | 1.829 (1.125–2.874) | 0.015 |
Multivariate analysisa
| ||
ypT0 | 1.000 | 0.043 |
ypT1 | 0.540 (0.224–1.301) | |
ypT2 | 1.798 (0.854–3.789) | |
ypT3 | 1.294 (0.704–2.378) | |
Group 2 | 1.762 (1.157–2.685) | 0.008 |
ypN0 | 1.000 | 0.023 |
ypN1 | 1.349 (0.805–2.263) | |
ypN2 | 1.896 (0.989–3.635) | |
ypN3 | 3.415 (1.446–8.064) |
Disease-Free Survival
HR (95% CI) |
P value | |
---|---|---|
Univariate analysis | ||
Group 2 | 1.509 (0.959–2.375) | 0.075 |
Celiac lymph node metastasis | 3.898 (1.923–7.904) | 0.000 |
Cardia growth 2–4 cm | 1.454 (0.742–2.849) | 0.275 |
Length >8 cm | 1.103 (0.580–2.097) | 0.764 |
Weight loss >10% | 1.229 (0.720–2.096) | 0.450 |
Female | 0.484 (0.255–0.920) | 0.027 |
Squamous cell carcinoma | 0.366 (0.167–0.802) | 0.012 |
cT1 and T2 | 1.000 | 0.084 |
cT3 | 1.961 (1.003–3.833) | |
cT4a | 2.894 (0.984–8.510) | |
ypT0 | 1.000 | 0.023 |
ypT1 | 1.535 (0.636–3.706) | |
ypT2 | 3.056 (1.298–7.194) | |
ypT3 | 2.632 (1.275–5.435) | |
ypN0 | 1.000 | 0.001 |
ypN1 | 1.470 (0.812–2.659) | |
ypN2 | 3.060 (1.618–5.785) | |
ypN3 | 4.374 (1.682–11.375) | |
R1 resection | 4.389 (2.043–9.431) | 0.000 |
LN ratio (>0.2 LN +) | 3.106 (1.758–5.489) | 0.000 |
Perineural growth | 1.694 (0.993–2.890) | 0.053 |
Lymphangio-invasion | 1.940 (1.131–3.327) | 0.016 |
Multivariate analysisa
| ||
Female | 0.474 (0.248–0.907) | 0.024 |
Squamous cell carcinoma | 0.413 (0.185–0.923) | 0.031 |
Group 2 | 1.685 (1.061–2.676) | 0.027 |
LN ratio (>0.2 LN +) | 2.712 (1.524–4.826) | 0.001 |