Esophageal Cancer: System Approach

Oleg Kshivets

Roshal Hospital, Roshal, Russia

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–C

Abstract

   OBJECTIVE: Search of optimal diagnosis and treatment strategies for esophageal cancer (EC) pa­tients (ECP) (T1-4N0-2M0) realized.

   METHODS:  We analyzed data of 515 consecutive ECP (age=56.3±8.9 years; tumor size=6.2±3.4 cm) radically operated (R0) and monitored in 1975-2017 (m=380, f=135; esophagogastrectomies (EG) Garlock=280, EG Lewis=235, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=151; adenocarcinoma=292, squamous=213, mix=10; T1=101, T2=114, T3=175, T4=125; N0=248, N1=69, N2=198; G1=148, G2=125, G3=242; early EC=82, invasive=433; only surgery=394, adjuvant chemoimmunoradiotherapy-AT=121: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap, neural networks computing were used to determine any significant dependence    

   RESULTS: Overall life span (LS) was 1814.5±2225.6 days and cumulative 5-year survival (5YS) reached 48.8%, 10 years – 42.3%, 20 years – 31.7%. 160 ECP lived more than 5 years (LS=4384.1±2474.1 days), 89 ECP – more than 10 years (LS=5913.1±2360.3 days). 224 ECP died because of EC (LS=629.2±320.1 days). AT significantly improved 5YS (67.6% vs. 44.6%) (P=0.00008 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, age, AT, localization, blood cells, prothrombin index, coagulation time, residual nitrogen, blood group, Rh, glucose (P=0.000-0.037). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), erythrocytes/CC, protein, T, segmented neutrophils/CC, eosinophils/CC, stick neutrophils/CC, G, CC, PT early-invasive EC, PT N0—N12, localization, thrombocytes/CC,  lymphocytes/CC, monocytes/CC, prothrombin index. Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).

    CONCLUSIONS:  5YS of ECP after radical procedures significantly depended on: PT “early-invasive cancer”; PT N0-N12; cell ratio factors; blood cell circuit; biochemical factors; hemostasis system; AT; EC characteristics; tumor localization; anthropometric data. Optimal diagnosis and treatment strategies for EC are: screening  and early detection of EC; availability of experienced thoracoabdominal surgeons because of complexity of  procedures; aggressive en block surgery, adequate lymph node dissection for completeness; precise prediction; adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.