Long-term survival and risk factors in esophageal squamous cell carcinoma: A Kaplan-Meier and cox regression study

Abstract

BACKGROUND

The global incidence of esophageal cancer (EC) remains high. Despite advancements in medical technology and deeper research into the causes and treatment methods of EC, the effectiveness of treatment for EC is still unsatisfactory. Therefore, it is crucial to address the urgent problem of improving the long-term survival rate of EC patients and providing personalized treatment.

AIM

To analyze the survival prognosis and influencing factors of esophageal squamous cell carcinoma (ESCC).

METHODS

A retrospective analysis was conducted on the clinical data of 115 patients with pT3N0M0 ESCC who underwent radical surgery alone from January 1, 2013, to December 31, 2019. The Kaplan–Meier method was used to evaluate the 1-year, 3-year, and 5-year survival rates and median survival time of the patients. The Cox proportional hazards regression model was used to assess the hazard ratios (HRs) and 95% confidence intervals (95%CIs) of risk factors.

RESULTS

The 1-year, 3-year, and 5-year overall survival (OS) rates for the 115 EC patients analyzed were 85.22%, 50.43%, and 37.48%, respectively. The median OS was 37.00 (95%CI: 24.93-49.07) months, and the median disease-free survival was 21.00 (95%CI: 14.71-27.29) months. Both univariate and multivariate Cox regression analyses revealed that high body mass index (BMI; HR = 1.137, 95%CI: 1.054-1.226), positive perineural invasion (PNI; HR = 13.381, 95%CI: 4.899-36.547), and smoking (HR = 2.415, 95%CI: 1.388-4.203) were independent risk factors for a poor prognosis. In contrast, compared to the upper thoracic location of the tumor, middle thoracic (HR = 0.441, 95%CI: 0.240-0.810) and lower thoracic (HR = 0.328, 95%CI: 0.144-0.750) locations were protective factors.

CONCLUSION

BMI, tumor location, PNI, and smoking are associated with the prognosis of ESCC patients. This study highlights the prognostic risk factors for T3N0M0 ESCC patients and offers personalized insights for clinical treatment.

Keywords: Esophageal squamous cell carcinoma; Risk factors; Survival analysis; Overall survival; Disease free survival

Core Tip: Esophageal squamous cell carcinoma (ESCC) has a relatively high incidence globally, imposing a significant societal burden. This study conducted a survival analysis on 115 patients with T3N0M0 stage ESCC and found that high body mass index, tumor location, positive perineural invasion and smoking were associated with the prognosis of ESCC patients. In the future, prospective multi-center hospital studies need to be carried out to confirm the risk factors affecting prognosis, with a view to providing individualized and standardized treatment measures after surgery.