Kshivets O. Esophageal & Cardioesophageal Surgery

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PRECISE PREDICTION OF 5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGOGASTRECTOMIES

Transcript of Kshivets O. Esophageal & Cardioesophageal Surgery

  • PRECISE PREDICTION OF5-YEAR SURVIVAL OF ESOPHAGEAL ANDCARDIOESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGOGASTRECTOMIES Oleg Kshivets , MD, PhD
  • Abstract: PRECISE PREDICTION OF 5-YEAR SURVIVAL OF ESOPHAGEAL ANDCARDIOESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGOGASTRECTOMIES Oleg Kshivets OBJECTIVE: We examined factors in terms of precise prediction of 5-year survival (5YS) of esophageal andcardioesophageal cancer (ECEC) patients (ECECP) (T1-4N0M1A) after complete (R0) esophagogastrectomies(EG). METHODS: We analyzed data of 407 consecutive ECECP (age=55.68.6 years; tumor size=6.73.3 cm)radically operated and monitored in 1975-2011 (m=305, f=102;EG Garlock=271, EG Lewis=136, combined EGwith resection of pancreas, liver, diaphragm, colon transversum, lung, trachea, pericardium, splenectomy=125;adenocarcinoma=212, squamous=185, mix=10; T1=62, T2=96, T3=140, T4=109; N0=167, N1=56, M1A=184,G1=116, G2=96, G3=195; early ECEC=43, invasive=364). 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 1612.62070.5 days and cumulative 5-year survival (5YS) reached 40%,10 years 32.7%, 20 years 23.5%. 101 ECECP lived more than 5 years without cancer. 215 ECECP diedbecause of ECEC. Cox modeling displayed (Chi2=232, df=26, P=0.000) that 5YS of ECECP significantlydepended on: phase transition (PT) N0N1-M1A in terms of synergetics, cell ratio factors (CRF) (ratio betweencancer cells and blood cells subpopulations), T, G, tumor growth, tumor size, sex, age, adjuvant chemotherapy,localization, blood cells, prothrombin index, ESS, blood chlorides, residual nitrogen (P=0.000-0.043). Neuralnetworks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT N0--N1-M1A (rank=1), PT early-invasive ECEC (rank=2), tumor size, prothrombin index, blood cells, ESS, age,CRF, blood chlorides, residual nitrogen, localization, adjuvant chemotherapy. Correct prediction of 5YS was100% by neural networks computing. CONCLUSIONS: 5YS of ECECP after radical procedures significantly depended on: 1) PT early-invasivecancer; 2) PT N0--N1-M1A; 3) CRF; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7)anthropometric data; 8) adjuvant chemotherapy; 9) tumor localization.
  • Data: Males.305 Females.........102 Age=55.68.6 years Tumor Size=6.73.3 cm Only Surgery....324 Adjuvant Chemoimmunoradio/Chemoimmunotherapy (5FU+thymalin/taktivin, 5-6 cycles+RT 45-50Gy)..83
  • Radical Procedures: Left Thoracoabdominal Esophagogastrectomies (Garlock)..271 Right Thoracoabdominal Esophagogastrectomies (Ivor Lewis).136 Combined Esophagogastrectomies with Resection of Diaphragm, Pericardium, Lung, Liver, Pancreas, etc....125 2-Field Lymphadenectomy.301 3-Field Lymphadenectomy.106
  • Left Thoracoabdominal Esophagogastrectomy(Garlock).271
  • Garlock Procedures..271
  • Right Thoracoabdominal Esophagogastrectomy(Ivor Lewis)......................................................136
  • Ivor Lewis Procedures136
  • One-Stage EsophagogastroplastyIntrapleural Anastomosis.301Neck Anastomosis.106
  • Staging: T162 N0..167 G1116 T296 N156 G2..96 T3..140 M1A..184 G3195 T4..109 M1B..0 Stage I..43 Stage IIA...98 Stage IIB..28 Stage III54 Stage IVA..184 Stage IVB0 Adenocarcinoma..................................212 Squamos Cell Carcinoma185 Mix Carcinoma...10 Early Cancer43 Invasive Cancer.364
  • Survival Rate: Alive....167 (41%) 5-Year Survivors...101 (24.8%) 10-Year Survivors...53 (13%) Losses215 (52.8%) General Life Span=1612.6 2070.5 days For 5-Year Survivors=4404.4 2543.9 days For 10-Year Survivors=6095.9 2468.3 days For Losses=691.1 389.5 days Cumulative 5-Year Survival..40% Cumulative 10-Year Survival32.7%
  • General Esophageal/Cardioesophageal Cancer Patients Survivalafter Complete Esophagogastrectomies (Kaplan-Meier) (n=407) Surv iv al Function Ge ne ral Esophage al and Cardioe sophage al Cance r Patie nts Surv iv al afte r Comple te Esophagogastre ctomie s, n=407 Cumulativ e 5-Ye ar Surv iv al=40%; 10-Ye ar surv iv al=32.7% Complete Censored 1.2Cumulative Proportion Surviving 1.1 1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 -5 0 5 10 15 20 25 30 35 40 Ye ars afte r Esophagogastre ctomie s
  • Results of Univariate Analysis of Phase Transition EarlyInvasive Cancer in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407) Cumulativ e Proportion Surv iv ing (Kaplan-M e ie r) Cumulativ e 5-Ye ar Surv iv al of Early Cance r Patie nts=100% Cumulativ e 5-Ye ar Surv iv al of Inv asiv e Cance r Patie nts=33.2% P=0.000 by Log-Rank Te st Complete Censored 1.0 Cumulative Proportion Surviving 0.8 0.6 Invasive Cancer Patients=364 0.4 Early Cancer Patients=43 0.2 0.0 -0.2 0 5 10 15 20 25 30 35 40 Ye ars afte r Esophagogastre ctomie s
  • Results of Univariate Analysis of Phase Transition N0N1M1A in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407) Cumulativ e Proportion Surv iv ing (Kaplan-M e ie r) Cumulativ e 5-Ye ar Surv iv al of Cance r Patie nts with N0=60.3% Cumulativ e 5-Ye ar Surv iv al of Cance r Patie nts with N1-M 1A=25.1% P=0.000 by Log-Rank Te st Complete Censored 1.0 Cumulative Proportion Surviving 0.9 0.8 Cance r Patie nts with N0=167 Cance r Patie nts with N1-M 1A=240 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0 0 5 10 15 20 25 30 35 40 Ye ars afte r Esophagogastre ctomie s
  • Results of Univariate Analysis of Adjuvant Therapy in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407) Cumulative Proportion Surviving (Kaplan-Meier) Complete Censored 5-Year Survival after Adjuvant Treatment=60.8%; 5-Year Survival after Surgery Along=36.4%; P=0.00018 by Log-Rank Test 1.0 0.9 Cumulative Proportion Surviving 0.8 Adjuvant Treatment, n=83