Kshivets O. Esophageal and Cardioesophageal Cancer Surgery

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  • Oleg Kshivets, MD, PhD Siauliai Public Hospital, Siauliai, Lithuania

  • 5-YEAR SURVIVAL OF ESOPHAGEAL/CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY SIGNIFICANTLY DEPENDED ON PHASE TRANSITION EARLY-INVASIVE CANCER, LYMPH NODE METASTASES AND CELL RATIO FACTORSOleg Kshivets Surgery Department, Siauliai Public Hospital, Lithuania OBJECTIVE: We examined factors associated with low/high-risk of generalization of esophageal/cardioesophageal cancer (ECEC) (T1-4N0M1A) after complete (R0) esophagogastrectomies (EG). METHODS: We analyzed data of 407 consecutive ECEC patients (ECECP) (age=55.68.6 years; tumor size=6.73.3 cm) radically operated and monitored in 1975-2010 (m=305, f=102;EG Garlock=271, EG Lewis=136, combined EG with resection of pancreas, liver, diaphragm, colon transversum, lung, trachea, pericardium, splenectomy=125; adenocarcinoma=212, squamous=185, mix=10; T1=62, T2=96, T3=140, T4=109; N0=167, N1=56, M1A=184, G1=116, G2=96, G3=195; early ECEC=43, invasive=364). 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 1612.62070.5 days and cumulative 5-year survival (5YS) reached 40%, 10 years 32.7%, 20 years 23.5%. 101ECECP lived more than 5 years without ECEC. 215ECECP died because of ECEC. Cox modeling displayed (Chi2=46.0, df=5, P=0.000) that 5YS of ECECP significantly depended on: phase transition (PT) early-invasive ECEC in terms of synergetics, PT N0--N1-M1A, cell ratio factors (CRF) (ratio between cancer cells CC and blood cells subpopulations) (P=0.001-0.029). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive ECEC (rank=1), PT N0--N1-M1A (rank=2), healthy cells/CC, monocytes/CC, segmented neutrophils/CC, eosinophils/CC, stab neutrophils/CC, leucocytes/CC, lymphocytes/CC, thrombocytes/CC, erythrocytes/CC. Correct prediction of 5YS was 100% by neural networks computing. CONCLUSIONS:5YS of ECECP after radical procedures significantly depended on: 1) PT early-invasive ECEC; 2) PT N0--N1-M1A; 3) CRF.

  • Males305Females..102Age=55.68.6 yearsTumor Size=6.73.3 cmEsophagogastrectomies Ivor-Lewis......136Esophagogastrectomies Garlock....271Combined procedures with resection of pancreas, liver, diaphragm, VCS, colon transversum, lung, trachea, pericardium, splenectomy ..125

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  • T1..62 N0....167 G1..116T2..96 N1...56 G2....96T3140 M1A.184 G3..195T4109Early Cancer..43Invasive Cancer.............................................364Adenocarcinoma.212Squamous Cell Carcinoma...185Mix Carcinoma.........................10

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  • 5-Year Survivors...101 (24.8%) Losses215 (52.8%)

    General Life Span=1612.62070.5 daysFor 5-Year Survivors=4404.42543.9 daysFor Losses=649.8388.2 days

    Cumulative 5-Year Survival....40.0%Cumulative 10-Year Survival..............32.7%

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  • FactorsWalddfPPhase Transition Early-Invasive LC5.86410.015 Phase Transition N0N1-211.87110.001Leucocytes/Cancer Cells5.84410.016Segmented Neutrophils/Cancer Cells4.79410.029Monocytes/Cancer Cells4.99810.025

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  • Discriminant Function Analysis Summary Wilks' Lambda: 0.703 approx. F (8,307)=16.179 p< 0.0000; Correct Classification Rate=78.5% Wilks'-Lambda P Phase Transition Early-Invasive Lung Cancer0.7140.029 Phase Transition N0N1-20.7440.000Erythrocytes/Cancer Cells0.7180.012Leucocytes/Cancer Cells0.7190.010Segmented Neutrophils/Cancer Cells0.7190.010Lymphocytes/Cancer Cells0.7160.018Monocytes/Cancer Cells0.7140.029Healthy Cells/Cancer Cells0.7200.008

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  • 5-Year Survivors LossesBaseline Errors=0.000 Total215101Area under ROC Curve=1.0 Correct215101Correct Classification Rate=100% Wrong00

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  • FactorRankSensitivityPhase Transition Early-Invasive Cancer149239Phase Transition N0---N12215916Healthy Cells/Cancer Cells36775Monocytes/Cancer Cells45656Segmented Neutrophils/Cancer Cells54612Eosinophils/Cancer Cells64176Stab Neutrophils/Cancer Cells73601Leucocytes/Cancer Cells83469Lymphocyte/Cancer Cells93136Thrombocytes/Cancer Cells102925Erythrocytes/Cancer Cells112885

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  • FactorUseful for 5-Year Survival

    Phase Transition Early-Invasive Cancer Yes

    Phase Transition N0---N1M1AYesLeucocyte/Cancer CellsYesMonocyte/Cancer CellsYesHealthy Cells/Cancer CellsYes

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  • Number of Samples=3333Significant FactorsRankKend.Tau-APHealthy Cells/Cancer Cells10.2300.000Erythrocytes/Cancer Cells20.2260.000Leucocytes/Cancer Cells 30.2150.000Lymphocytes/Cancer Cells40.2050.000Thrombocytes/Cancer Cells50.2020.000Segmented Neutrophils/Cancer Cells60.1900.000Eosinophils/Cancer Cells 70.1750.000Phase Transition N0N1M1A8-0.1720.000Monocytes/Cancer Cells90.1580.000Phase Transition Early-Invasive Cancer10-0.1250.001Stab Neutrophils/Cancer Cells110.0830.048

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  • 5-year survival and life span of esophageal and cardioesophageal cancer patients after complete esophagogastrectomies significantly depended on: 1) phase transition earlyinvasive cancer;2) phase tranzition N0---N1M1A;3) cell ratio factors: ratio of cancer cell population to blood cell subpopulations in integral patient organism.

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