title: Have surgical outcomes of pathologic T4 esophageal squamous cell carcinoma really improved? Analysis of 268 cases during 45 years of experience.
abstract: BACKGROUND
  Because invasion to an adjacent organ (T4) indicates highly advanced disease, and most surgeons avoid esophagectomy, the prognostic impact of clinicopathologic factors for survival of these patients after esophagectomy has rarely been analyzed.
  
  
  METHODS
  From 1960 to 2005, a total of 268 patients with esophageal squamous cell carcinoma underwent esophagectomy for pathologic T4 disease (pT4). The impact of clinicopathologic factors on survival was evaluated by univariate and multivariate analysis. Changes in surgical outcomes and longterm survival between the earlier period (1960 to 1989) and the later period (1990 to 2005) were analyzed.
  
  
  RESULTS
  Overall survival rates of all patients were 25% at 1 year, 10% at 3 years, and 5% at 5 years. The survival curve of the later group was significantly better than that of the earlier group (p < 0.01). Multivariate analysis indicated that venous invasion (hazards ratio, 1.76; 95% CI, 1.33 to 2.33, p < 0.01) and presence of a postoperative complication (hazards ratio, 2.62; 95% CI, 1.96 to 3.51, p < 0.01) were independent risk factors for poor overall survival. Presence of residual cancer was also an independent risk factor for poor cause-specific survival (hazards ratio, 2.40; 95% CI, 1.23 to 4.69, p=0.01). Venous invasion and intramural metastasis were risk factors for residual cancer. A total of 38 (14%) patients, 15 in the early period and 23 in the later period, underwent complete resection (R0). Although overall survival after R0 resection in the later period improved slightly, cancer-related survival rates were similar in both periods.
  
  
  CONCLUSIONS
  Although overall survival of patients with pT4 improved after 1990, this improvement might be mainly dependent on curability of the resection.
authors.affiliation: Department of Frontier Surgery and the Research Center for Frontier Medical Engineering, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Tooru
authors.initials: T
authors.lastname: Shiratori
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nabeya
authors.forename: Kiyohiko
authors.initials: K
authors.lastname: Shuto
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Akutsu
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Kaichi
authors.initials: K
authors.lastname: Isono
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome