Pattern of relapse following three-field lymphadenectomy of esophageal carcinoma and related factors predictive of recurrence

Abstract

AbstractBackgroundFor treatment of esophageal carcinoma, the optimal postoperative radiotherapy target volume after three-field lymph node dissection(3-FLD) had not been determined. We analyzed local recurrence pattern of thoracic esophageal carcinoma and risk factors of lymph node recurrence after 3-FLD without prophylactic radiotherapy.MethodsWe reviewed 1282 patients with thoracic esophageal squamous cell carcinoma(ESCC) who were treated with 3-FLD without radiotherapy from 2010 to 2018 and analysed local recurrence patterns and risk factors of lymph node recurrence, in order to provide a reference for determination of the radiotherapy target volume for thoracic ESCC.ResultsThe lymph node recurrence accounted for 91.0% of treatment failures. The mediastinal, cervical and abdominal lymph node recurrence rates were 85.2%, 36.5% and 22.4%, respectively,(x2=264.596, P=0.000). The superior, middle and inferior mediastinal lymph node recurrence rates were 67.54%, 27.87% and 0.98%, respectively(x2=313.600, P=0.000). In a multivariate analysis, Cevical metastases were significantly associated with N stage and Preoperative cevical lymph node status. Abdominal metastases were significantly associated with the number of preoperative abdominal lymph node metastases(LNM), tumor location and N stage.ConclusionsThe main pattern of local-regional recurrence might be lymph node metastasis after radical 3-FLD without radiotherapy in esophageal carcinoma. The dangerous lymph node recurrence regions included neck, superior and middle mediastinum. Radiologist might took the number of pre-operative abdominal lymph nodes and tumor location into consideration while delineating the target area of abdominal region.This study was supported by Health Department Innovation Fundation Project of Fujian Province (No. 2016-CX-10)