gms | German Medical Science

Background: AC and SCC of the esophagus differ regarding pathogenesis and tumor biology. Nevertheless both tumor entities are investigated together in several analyses of prognostic factors. The aim of this retrospective study was to compare survival determining factors of curatively resected AC and SCC.

Patients and Methods: 182 patients (pts) (male:female 155:27; 59 years [22-82]) with AC and 130 pts (male:female 100:30; 59 years [34-82]) with SCC of the esophagus underwent curative resection from 1990-2002. Tumors were classified according to UICC (2002). 54 factors were analyzed by log Rank-test and cox regression regarding their relevance for survival. Likelihood of survival was calculated according to Kaplan-Meier. Their was no significant difference in the distribution of tumor stages between the 2 cohorts.

Results: Incidence of complications did not differ significantly (AC/SCC): anastomotic leak 3.3%/5.4%, in hospital mortality 4.4%/6.2%. Median, 2- und 5-year survival were as follows (AC/SCC): 24 months/14 months, 50%/41%, 30%/30% (p>.05). Factors significant for survival of pts with AC identified by univariate analysis were recurrent tumor (p< 10-4), stage (p=10‑4), pN-category (p=.0011), hiatal hernia (p=.002), preoperative dysphagia (p=.0042), extent of barrett mucosa (p=.014) and G-category (p=.03). Factors identified by multivariate analysis were recurrent tumor (p <10-4, hazard ratio (HR) 2.364 [95% confidence interval (CI) 1,754-3,187), pN-category (p= .004; HR 1,881 [95% CI 1.222-2.897]) and preoperative dysphagia (p=.025; HR 0.773 [95% CI 0.617-0.96]). Factors significant for survival of pts with SCC identified by univariate analysis were recurrent tumor (p<10-4), stage (p=10-4), pT- (p<10-4), pN- (p<10-4), G-category (p<10-4), endoscopic stenosis (p=.03), longitudinal extent of tumor (p=.04), Multivariate analysis identified recurrent tumor (p<10-4; HR 5.141 [2.869-9.211]) and stage (p<10-4; HR 1.538 [1.232-1.921]) to be of prognostic significance.

Conclusions: Recurrent tumor and tumor stages are of prognostic significance for AC and SCC alike. However prognosis of AC additionally depends on factors which play a role in AC pathogenesis, while in SCC parameters of endoluminal tumor extent have an influence on survival. As a consequence AC and SCC are not comparable with reference to their prognostic factors and thus should be investigated separately in survival analyses.