La chirurgie du cancer oesophagien à Liège. II. Analyse des facteurs influençant la survie à long terme après oesophagectomie pour cancer epidermoide ou adénocarcinome

OBJECTIVE: To determine prognosis factors influencing long-term survival after surgical resection for oesophageal adenocarcinoma or squamous cell carcinoma. MATERIAL AND METHODS: Patients operated for oesophageal cancer between 1989 and 1995 were included in this study, excluding perioperative deaths. Were studied as potential prognosis factors: age, sex, operative intent, transfusion, digestive transplant, Barrett metaplasia, stage, tumoral extension (T), nodal involvement (N), distant metastases (M), tumoral differentiation, pre- or post-operative neoadjuvant treatment. RESULTS: Follow-up was 2 to 100 months. Median survival was 21 months for squamous cell carcinoma, and 12 months for adenocarcinoma. By univariate analysis, factors influencing survival were, for squamous cell carcinoma: nodal involvement (N) (p = 0.0003), stage (p = 0.006), and operative intent (p = 0.04); for adenocarcinoma: tumoral differentiation (p = 0.0015), local extension (T) (p = 0.0022), stage (p = 0.0043), nodal involvement (N) (p = 0.0052), operative intent (p = 0.006), and distant metastases (p = 0.014). By multivariate analysis, independent prognosis factors were, for squamous cell carcinoma, nodal involvement (N) (p = 0.0002), and for adenocarcinoma, operative intent (p = 0.0018) and tumoral differentiation (p = 0.0014). CONCLUSIONS: Diagnosis of oesophageal cancer at an early stage is the most important prognosis factor. This retrospective study failed to show any significant benefit from neoadjuvant treatment, in term of long-term survival. Patients with poor prognosis factors, such as determined by accurate preoperative staging, could potentially benefit from more aggressive multimodal therapies.