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Kshivets eacts milan2018
1. Survival Outcomes in Patients with
Esophageal Cancer after Complete
Esophagogastrectomies
Kshivets Oleg, MD, PhD
Surgery Department, Roshal Hospital,
Roshal, Moscow, Russia
2. • Survival Outcomes in Patients with Esophageal Cancer after
• Complete Esophagogastrectomies
• Kshivets Oleg Surgery Department, Roshal Hospital
• Roshal, Moscow, Russia
• OBJECTIVE: Survival outcomes of radical surgery in esophageal cancer (EC) patients (ECP)
• (T1-4N0-2M0) were analyzed.
• METHODS: We analyzed data of 543 consecutive ECP (age=56.4±8.8 years; tumor
• size=6±3.5 cm) radically operated (R0) and monitored in 1975-2018 (m=405, f=138;
• esophagogastrectomies (EG) Garlock=280, EG Lewis=263, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS,
colon transversum, lung, trachea, pericardium, splenectomy=151; adenocarcinoma=308, squamous=225, mix=10; T1=126, T2=114,
T3=178, T4=125; N0=275, N1=69, N2=199; G1=157, G2=139, G3=247; early EC=107, invasive=436; only surgery=420, adjuvant
chemoimmunoradiotherapy-AT=123: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH,
Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
• RESULTS: Overall life span (LS) was 1892.4±2241 days and cumulative 5-year survival (5YS) reached 51.9%, 10 years – 45.7%, 20
years – 33.5%. 183 ECP lived more than 5 years (LS=4311±2419.7 days), 98 ECP – more than 10 years (LS=5903.4±2299.4 days). 224
ECP died because of EC (LS=629.2±320.1 days). AT significantly improved 5YS (68.2% vs. 48.5%) (P=0.00033 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, histology, age, AT, localization, blood cells, prothrombin
index, coagulation time, residual nitrogen, blood group, Rh, glucose, protein (P=0.000-0.008). Neural networks, genetic algorithm
selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), PT early-invasive EC (rank=2),
PT N0—N12 (rank=3), erythrocytes/CC (4), thrombocytes/CC (5), stick neutrophils/CC (6), lymphocytes/CC (7), segmented
neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10), monocytes/CC (11). Correct prediction of 5YS was 100% by neural
networks computing (area under ROC curve=1.0; error=0.0).
• CONCLUSIONS: Survival outcomes after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12;
3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor
localization; 10) anthropometric data. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC;
2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block
surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for
ECP with unfavorable prognosis.
6. Survival Rate:
• Alive……………………………………..............................................284 (52.3%)
• 5-Year Survivors………………………………………………............183 (33.7%)
• 10-Year Survivors………………………............................................98 (18%)
• Losses……………………..…………………………………………….224 (41.3%)
• General Life Span=1892.4±2241 days
• For 5-Year Survivors=4311±2419.7 days
• For 10-Year Survivors=5903.4±2299.4 days
• For Losses=629.2±320.1 days
• Cumulative 5-Year Survival……………………………………………...….51.9%
• Cumulative 10-Year Survival………………………………………………..45.7%
• Cumulative 20-Year Survival………………………………………………...33.5%
7. General Esophageal Cancer Patients Survival after Complete
Esophagogastrectomies (Kaplan-Meier) (n=543):
Survival Function
General Esophageal Cancer Patients Survival, n=543
5-Year Survival=51.9%; 10-Year Survival=45.7%; 20-Year Survival=33.5%
Complete Censored
-5 0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
CumulativeProportionSurviving
8. Results of Univariate Analysis of Phase Transition Early—
Invasive Cancer in Prediction of Esophageal Cancer Patients
Survival (n=543):
Cumulative Proportion Surviving (Kaplan-Meier)
5-Year Survival of Early ECP=100; 5-Year Survival of Invasive ECP=38.5%,
P=0.00000 by Log-Rank Test
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
CumulativeProportionSurviving
Invasive ECP, n=436
Early ECP, n=107
9. Results of Univariate Analysis of Phase Transition N0—N1-2
in Prediction of Esophageal Cancer Patients Survival (n=543):
Cumulative Proportion Surviving (Kaplan-Meier)
5-Year Survival of ECP with N0=73.9%; 5-Year Survival of ECP with N1-2=27.5%
P=0.00000 by Log-Rank Test
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
CumulativeProportionSurviving
ECP with N1-2, n=268
ECP with N0, n=275
10. Results of Univariate Analysis of Adjuvant
ChemoimmunoradioTherapy in Prediction of Esophageal
Cancer Patients Survival (n=543):
Cumulative Proportion Surviving (Kaplan-Meier)
5-Year Survival of ECP after Adjuvant Treatment=68.2%;
5-Year Survival of ECP after Surgery alone=48.5%;
P=0.00033 by Log-Rank Test
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
CumulativeProportionSurviving
Adjuvant Chemoimmunoradiotherapy, n=123
Only Surgery, n=420
11. Results of Univariate Analysis of localization (upper/3 vs.
middle/3 & lower/3) in Prediction of Esophageal Cancer
Patients Survival (n=543):
Cumulative Proportion Surviving (Kaplan-Meier)
5-Year Survival of ECP of Upper/3=64.7%; 5-Year Survival of Others ECP=49.2%;
P=0.00323 by Log Rank Test
Complete Censored
0 5 10 15 20 25 30 35 40
Years after Esophagogastrectomies
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1.0
CumulativeProportionSurviving
Uper/3 ECP, n=80
Others ECP, n=463
16. Results of Kohonen Self-Organizing Neural Networks
Computing in Prediction of esophageal Cancer Patients
Survival after Complete esophagogastrectomies (n=407):
18. Prognostic Equation Models of Esophageal Cancer Patients
Survival after Complete Esophagogastrectomies (n=407):
19. Prognostic SEPATH-Model of Esophageal Cancer Patients
Survival after Complete Esophagogastrectomies (n=407):
20. 5-YEAR SURVIVAL OF ESOPHAGEAL CANCER
PATIENTS AFTER RADICAL PROCEDURES
SIGNIFICANTLY DEPENDED ON:
1) PHASE TRANSITION “EARLY-INVASIVE
CANCER”;
2) PHASE TRANSITION N0--N12;
3) CELL RATIO FACTORS;
4) BLOOD CELL CIRCUIT;
5) BIOCHEMICAL FACTORS;
6) HEMOSTASIS SYSTEM;
7) ADJUVANT CHEMOIMMUNORADIOTHERAPY;
8) CANCER CHARACTERISTICS ;
9) TUMOR LOCALIZATION;
10) ANTHROPOMETRIC DATA.
Conclusion:
21. OPTIMAL DIAGNOSIS AND TREATMENT STRATEGIES FOR
ESOPHAGEAL CANCER ARE:
1) SCREENING AND EARLY DETECTION OF ESOPHAGEAL
CANCER;
2) AVAILABILITY OF EXPERIENCED THORACOABDOMINAL
SURGEONS BECAUSE OF COMPLEXITY OF RADICAL
PROCEDURES;
3) AGGRESSIVE EN BLOCK SURGERY AND ADEQUATE
LYMPH NODE DISSECTION FOR COMPLETENESS;
4) PRECISE PREDICTION;
5) ADJUVANT CHEMOIMMUNORADIOTHERAPY FOR
ESOPHAGEAL CANCER PATIENTS WITH UNFAVORABLE
PROGNOSIS.
Conclusion: