Esophageal cancer patients’ survival after surgery significantly depended on cell ratio factors, blood cell circuit, biochemical factors, hemostasis system, adjuvant chemoimmunoradiotherapy, cancer characteristics, localization, anthropometric data

Abstract

Introduction: We examined factors in terms of precise prognosis of 5-year survival (5YS) of esophageal cancer (EC) patients (ECP) (T1-4N0-2M0) after complete (R0) esophagogastrectomies (EG). Method(s): We analyzed data of 499 consecutive ECP (age=56.368.9 years; tumor size=6.363.4 cm) radically operated and monitored in 1975-2017 (m=365, f=134; esophagogastrectomies (EG) Garlock=280, EG Lewis=219, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=147; adenocarcinoma=284, squamous=205, mix=10; T1=92, T2=113, T3=171, T4=123; N0=234, N1=69, N2=196; G1=140, G2=123, G3=236; early EC=73, invasive=426; only surgery=382, adjuvant chemoimmunoradiotherapy-AT=117: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence. Result(s): Overall life span (LS) was 1763.262213.7 days and cumulative 5YS reached 47.3%, 10 years - 40.7%, 20 years - 29.8%. 148 ECP lived more than 5 years (LS=4382.962551 days), 80 ECP - more than 10 years (LS=6027.262445.6 days). 223 ECP died because of EC (LS=630.26320.5 days). AT significantly improved 5YS (67.7% vs. 43.1%) (P=0.00002 by log-rank test). Cox modeling displayed (Chi2=283.82, df=18, P=0.0000) that 5YS of ECP significantly depended on: phase transition (PT) N0-N12 in terms of synergetics, cell ratio factors (ratio between cancer cells and blood cells subpopulations), T, G, age, AT, localization, blood cells, prothrombin index, coagulation time, residual nitrogen (P=0.000-0.047). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT N0-N12 (rank=1), PT early-invasive EC (rank=2), T(3), AT(4), prothrombin index (5), glucose (6), healthy cells/CC(7), thrombocytes/CC (8), erythrocytes/ CC (9), segmented neutrophils/CC (10), lymphocytes/CC (11), monocytes/CC (12) . Correct prediction of 5YS was 100% by neural networks computing. Conclusion(s): 5YS of ECP after radical procedures significantly depended on: 1) PT "early-invasive cancer"; 2) PT N0-N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data.