ADJUVANT CHEMOIMMUNORADIO/CHEMOIMMUNOTHERAPY SIGNIFICANTLY IMPROVED 5-YEAR SURVIVAL OF ESOPHAGEAL/CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY

1. ADJUVANT CHEMOIMMUNORADIO/CHEMOIMMUNOTHERAPY SIGNIFICANTLY IMPROVED 5-YEAR
SURVIVAL OF ESOPHAGEAL/CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY
Oleg Kshivets Surgery Department, Siauliai Public Hospital, Lithuania
OBJECTIVE: This study aimed to determine expediency of adjuvant
chemoimmunoradiotherapy and chemoimmunotherapy for esophageal and
cardioesophageal cancer (ECEC) patients (ECECP) after complete en block
(R0) esophagogastrectomies (EG) through left or right thoracoabdominal
incision.
METHODS: We analyzed data of 407 consecutive ECEC patients
(age=55.6±8.6 years; tumor size=6.7±3.3 cm) radically operated and
monitored in 1975-2010 (m=305, f=102;EG Garlock=271, EG Lewis=136,
combined EG with resection of pancreas, liver, diaphragm, colon
transversum, lung, trachea, pericardium, splenectomy=125;
adenocarcinoma=212, squamous=185, mix=10; T1=62, T2=96, T3=140,
T4=109; N0=167, N1=56, M1A=184, G1=116, G2=96, G3=195; esophageal
cancer=135, cardioesophageal cancer=272): only surgery=324, adjuvant
treatment-AT=83 (chemoimmunoradiotherapy=35: 5-FU+thymalin/taktivin
+radiotherapy 45-50Gy, adjuvant chemoimmunotherapy=48).
Survival curves were estimated by the Kaplan-Meier method.
Differences in curves between groups of ECECP were evaluated using a
log-rank test. Multivariate Cox modeling, multi-factor clustering, structural
equation modeling, Monte Carlo, bootstrap simulation and neural networks
computing were used to determine any significant dependence.
RESULTS: For total of 407 ECECP overall life span (LS) was
1612.6±2070.5 days, (median=783 days) and cumulative 5-year survival
(5YS) reached 40%, 10 years – 32.7%, 20 years – 23.5%. 101 ECECP lived
more than 5 years without ECEC. 215 ECECP died because of ECEC. 5YS of
CECP was superior significantly after AT (60.8%; LS=1589.4±1916 days)
compared with surgery alone (36.4%; LS=1618.5±2111 days) (P=0.00018 by
log-rank test). Cox modeling displayed that 5YS of ECECP after complete
EG significantly depended on: AT, N, age, weight, cell ratio factors
(P=0.000-0.042). Neural networks computing, genetic algorithm selection
and bootstrap simulation revealed relationships between 5YS and AT
(rank=1), N (rank=2), weight (3), healthy cells/cancer cells (CC) (4),
lymphocytes/CC (5), monocytes/CC (6), age (7), leucocytes/CC (8),
erythrocytes/CC (9). Correct prediction of 5YS was 100% by neural
networks computing (error=0.000; urea under ROC curve=1.0).
CONCLUSIONS: adjuvant chemoimmunoradiotherapy and
chemoimmunotherapy significantly improved 5-year survival of esophageal
and cardioesophageal cancer patients after surgery.