Predictive Factors in the Recurrence of Esophageal Carcinoma after Curative Esophagectomy

Yutaka shimada, Yuji Kanda, Takashi Wagata, Ichio Shibagaki, Shozo Toda, Yoshihiro Yamazoe, Shunnzou Maetani*, Masayuki Imamura

First Department of Surgery, Faculty of Medicine, Kyoto University
*Research Centre for Biological Engineering, Kyoto University

To establish useful predictors of recurrence in esophageal carcinoma (squamous cell carcinoma) after curative esophagectomy, the clinical, pathological and biological factors relating to 159 patients treated by curative esophagectomy with various supportive therapies, were analyzed using the Akaike information criteria (AIC). Hematogenous, lymph node, pleural and local recurrences were confirmed in 34, 45, 9, and 8 cases, respectively. The survival rates after l, 2, 3, and 5 years were 66.7%, 56.3%, 49.1%, and 43.8%, respectively. Much valuable information regarding recurrence throughout the entire postoperative period was gained by analyzing the number of lymph node metastases, staging, curability, and the degree of lymph node metastasis. The monolayer epithelial growth of cultured cancer cells and abdominal lymph node metastases were shown to be useful in predicting short-term hematogenous recurrence. All categories of mediastinal metastases were related to lymph node recurrence; however, cervical lymph node metastasis was not related to either hematogenous or lymph node recurrence. With regard to supportive therapy, postoperative irradiation was effective in reducing hematogeous and lymph node recurrence, whereas extended lymph node dissection and postoperative chemotherapy were not effective in reduci g either recurrece due to a predominance of advanced cases. Systemic multidiciplinary treatment should be considered for patients exhibiting a high risk of recurrence.

Key words
predictive factor of recurrence, esophageal cancer, akaike's information criteria

Reprint requests
Yutaka Shimada First Department of Surgery, Faculty of Medicine, Kyoto University
54 Kawaracho Shogoin, Sakyo-ku, Kyoto, 606 JAPAN

Accepted
July 6, 1994

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