The clinical characteristics of the enrolled patients are listed in Table 1. 139 presented with locoregional recurrence at 0.3-95.1 months after radical esophagectomy, with a median of 11.6 months. More than half (72/139, 51.8%) recurrences happened within 1 year after operation and within 2 years in 82% (114/139) patients. The number of patients with upper, middle, and lower segment ESCC was 20, 71, and 48, respectively. The diagnoses of the original esophageal cancer were all identified pathologically after radical esophagectomy; the number of patients with poorly, moderately and well differentiated was 52, 77, and 10, respectively. The median number of removed lymph nodes was 17 (range, 2-52) and the median number of positive nodes were 1(range, 0-16). The median length of original esophageal lesions was 3.6 cm (range 0.6-11.0 cm). 55.4% (77/139) of patients treated postoperative adjuvant chemotherapy (principally paclitaxel combine nadapltin) at least one cycle. 74(53.6%) cases were discovered the esophagus lesion had adhesions with surrounding tissues or organs during surgery, while without adhesions in 65(46.8%) cases. Surgery complications developed in 18% (25/139) of patients after radical esophagectomy, include 13 patients developed a post-operative anastomotic leakage, 5 atelectasis and pneumonia, 4 poor wound healing and 3 chylothorax.
Sites of Locoregional Recurrence
The 1, 2, and 3-year DFS rates were 48.2%, 18.0% and 8.6%, respectively (Figure 1). The positions of locoregional recurrence after esophagectomy are showed in Table 2. Mediastinum lymph node (LN) recurrence (74.2%) was the most frequent site of recurrence, following the anastomotic site (28.1%), supraclavicular LN (19.4%) and abdominal LN (15.1%), which showed statistically difference (P=0.000). The upper mediastinum (72.7%) was one of the most common recurrence occurred in mediastinal LN, followed by the middle (19.4%) and lower mediastinum (4.3%) (P=0.000). The recurrent rates of No. 106pre, 106recR, 106recL and 106tbL in the upper mediastinum were exceptionally higher than the rest stations, which were 43.2%, 30.2%, 24.5%, 19.4% and 15.8%, respectively (P=0.000). LNs recurrence of the middle mediastinum mainly occurred in No. 107 (15.8%) followed by No. 108 (3.6%) (P=0.001). The recurrent LNs in the lower mediastinum discovered rarely and the recurrent rate of No.112 was 4.3%. The recurrence rates between the left and right supraclavicular LNs showed no statistically difference for ESCC (P=0.711).
As demonstrated in Table 3, for different segments of ESCC, the sites of No.106pre, 106recR, 106recL and 106tbL lymph nodes all showed the relatively higher recurrence rates. Compared with lower and middle segments ESCC, upper segment represents the highest recurrent rate in the site of No.106tbR (P=0.029). The recurrent rates of upper abdominal LNs for upper, middle, and lower segments ESCC were 0%, 9.9%, and 29.2%, respectively, with statistically significant differences (P= 0.001). However, the recurrent rates of the supraclavicular LNs, mediastinal LNs and anastomosis site demonstrated no significantly difference in three segments of thoracic ESCC, respectively. (P= 0.964, P= 0.766 and P=0.676).
Relations between clinicopathologic factors and locoregional recurrence
The relations between clinicopathologic factors and anastomotic recurrence were displayed in Table 4. The predictive factors of anastomotic recurrence were patients with the stage of pT3 or pT4 of original neoplams during surgery, presence of nerve or vessel invasion, removed LN NO.≤ 17, presence of invasion or adhesion or without postoperative adjuvant chemotherapy after radical surgery. The collections between clinicopathologic factors and supraclvicular LNs recurrence were showed in Table 5. The results revealed that there was no relationship between esch clinicopathologic factor and supraclvicular LNs recurrence. For patients with middle segment ESCC, the high risk factors of upper abdominal LN recurrence included the stage of pT3 or pT4 of original neoplams during surgery, smoking history and without postoperative adjuvant chemotherapy (Table 6).