Prognostic factors influencing survival in combined radiotherapy and surgery of squamous cell carcinoma of the esophagus with special reference to a histopathologic grading system

Abstract

Sixty-six patients with squamous cell carcinoma of the esophagus were treated with combined surgery and radiotherapy, mostly in a sandwich fashion. Fourteen patients received misonidazole during preoperative radiotherapy. Prospective cumulative survival at 1, 2, and 5 years was 60%, 35%, and 17%, respectively. Original biopsy specimens and operation specimens were evaluated according to a histopathologic grading system based on an evaluation of the tumor cell population in terms of cell differentiation, structure, nuclear polymorphism, and the frequency of mitotic figures. The tumor-host relationship was also estimated by the mode of invasion, stage of invasion, vascular invasion, and degree of lymphocytic infiltration. A multivariate regres$ion analysis according to Cox and actuarial survival were used to determine the relative contributions of the clinical and histopathologic parameters to patient outcome. The major results were as follows: (1) patients who were old (70 to 80 years) fared as well as younger patients (P = 0.9198); (2) tumor site did not influence therapeutic outcome (P = 0.1100); (3) there was an insignificant difference in survival between patients with MO and MI disease (P = 0.7130); (4) radical surgery gave better survival; (5) misonidazole administered preoperatively was associated with worse survival (P = 0.0147); and (6) the histopathologic malignancy grading score system was very useful for prognostication-the tumor-host score in the operative specimen was the strongest of all analyzed predictive parameters. Since palliation was excellent in all patients treated in the combined fashion, selection criteria should be wide for such a program, not the least since long-term survival is possible also for patients with very advanced tumors.Cancer 62:895-904, 1988.PIDERMOID CARCINOMA O f the esophagus is a E highly aggressive tumor with a poor prognosis. No general agreement has been reached as to optimal treatment for patients with this disease or as to whether the main goal should be cure or palliati~n.'-~ Radical treatment has been attempted with surgery, radiotherapy, combined radiotherapy and surgery, or a trimodal regime incorporating ~h e m o t h e r a p y .~-~ TreatmentFrom the

Histochemical analysis of collagen reorganization at the invasive front of oral squamous cell carcinoma tumors

“…Previous literature has confirmed that invasive front grading, in contrast to Broder and Bryne's grading, is of high prognostic value, because of the following reasons: (a) tumors often are more poorly differentiated in invasive parts compared to superficial parts; (b) blood group H antigen is often lost in invasive tumor margins of OSCC, and this loss is associated with poor prognosis; (c) the increased expression of proliferation‐associated structures in the invading tumor front; (d) melanoma cells from deep tumor parts have a higher DNA content than more superficial cells; (e) the increased expression of Ki‐67, L‐myc, c‐myc, N‐myc, and c‐erbB‐2 oncoproteins in most invasive lung cancers; and (f) the increased labeling of bromodeoxyuridine at the site of invasion …”

Chemoradiotheraphy of Esophageal Cancer

“…Radiotherapy has been of little value in converting unresectable cancers into resectable ones (30). However, it decreases the incidence of locoregional recurrence (31). A recently published article showed a signi cant survival advantage with postoperative chemoradiation therapy for lymph-node-positive esophageal carcinoma (32).…”

Outcome of surgical treatment of adenocarcinoma in Barrett's oesophagus.

“…Patients with well (GI) or moderately (GII) differentiated tumours classified as stage 0, I, IIA and IIB, III respectively did not show a significant better survival than patients with poorly differentiated (GIII) tumours (Fig 4). 20 columnar epithelium occurred in the lower oesore 2: Survival ofresected patients without regional lymph node metastases (n=61) versus phagus, secondary to gastro-oesophageal reflux.3 nts with regional lymph node metastases (n=20).…”