[Surgery of esophageal cancer in Liège. II. Analysis of factors influencing long-term survival after esophagectomy for epidermoid cancer or adenocarcinoma].
OBJECTIVE
To determine prognosis factors influencing long-term survival after surgical resection for oesophageal adenocarcinoma or squamous cell carcinoma.


METHODS
Patients operated for oesophageal cancer between 1989 and 1995 were included in this study, excluding perioperative deaths. Were studied as potential prognosis factors: age, sex, operative intent, transfusion, digestive transplant, Barrett metaplasia, stage, tumoral extension (T), nodal involvement (N), distant metastases (M), tumoral differentiation, pre- or post-operative neoadjuvant treatment.


RESULTS
Follow-up was 2 to 100 months. Median survival was 21 months for squamous cell carcinoma, and 12 months for adenocarcinoma. By univariate analysis, factors influencing survival were, for squamous cell carcinoma: nodal involvement (N) (p = 0.0003), stage (p = 0.006), and operative intent (p = 0.04); for adenocarcinoma: tumoral differentiation (p = 0.0015), local extension (T) (p = 0.0022), stage (p = 0.0043), nodal involvement (N) (p = 0.0052), operative intent (p = 0.006), and distant metastases (p = 0.014). By multivariate analysis, independent prognosis factors were, for squamous cell carcinoma, nodal involvement (N) (p = 0.0002), and for adenocarcinoma, operative intent (p = 0.0018) and tumoral differentiation (p = 0.0014).


CONCLUSIONS
Diagnosis of oesophageal cancer at an early stage is the most important prognosis factor. This retrospective study failed to show any significant benefit from neoadjuvant treatment, in term of long-term survival. Patients with poor prognosis factors, such as determined by accurate preoperative staging, could potentially benefit from more aggressive multimodal therapies.
Kolh
P
P
Service de Chirurgie cardio-vasculaire, Université de Liège.
Honoré
P
P
Degauque
C
C
Azzam
C
C
Gielen
J L
JL
Legrand
M
M
Dewé
W
W
Jacquet
N
N
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001471:Barrett Esophagus / Q000150:complications; D001530:Belgium; D001803:Blood Transfusion; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007422:Intestines / Q000637:transplantation; D008137:Longitudinal Studies; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010166:Palliative Care; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate