Analysis of recurrence pattern of neoadjuvant therapy combined with surgical treatment for esophageal squamous cell carcinoma

Objective: To evaluate the recurrence pattern and identify the risk factors of esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery. Methods: Clinical data of 275 patients with thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were retrospectively analyzed. The follow-up data of the enrolled patients were complete and analyzable. The recurrence pattern, recurrence time, recurrence location and influencing factors after neoadjuvant therapy in combination with surgery were analyzed. The recurrence rate was calculated by Kaplan-Meier method. The multivariate analysis was performed by Cox regression model. Results: The median follow-up time was 32 (3-84) months, and the median time of the first recurrence was 10.6 (2.0-69.1) months. The 1-, 2- and 3- year recurrence rates were 32.0%, 45.1% and 52.3%, respectively. A total of 152 cases (55.3%) had recurrence. Among them, 77 cases (50.6%) had local-regional recurrence (LRR), 34 cases (23.4%) had distant metastasis (DM), 33 cases (21.7%) had LRR + DM and 8 cases (6.0%) had recurrence in unknown site. Among the patients with LRR, lymph node recurrence was the most common (n = 98, 89.1%). For DM patients, lung metastasis (n = 33, 49.3%), liver metastasis (n = 16, 23.9%), bone metastasis (n = 14, 20.9%) and non-regional lymph node metastasis (n = 14, 20.9%) were commonly observed. The multivariate analysis showed that postoperative T stage (P = 0.008), N stage (P < 0.001) and the number of lymph node dissection (P < 0.001) were the independent risk factors for recurrence after treatment. Conclusions: The recurrence rate after neoadjuvant therapy remains relatively high for esophageal squamous cell carcinoma, and the regional lymph node is the most common site of recurrence. Postoperative pathological T staging, N staging and the number of lymph node dissection are the independent risk factors for recurrence after treatment. (authors)