kshivets o. esophageal & cardioesophageal surgery

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  • PRECISE PREDICTION OF 5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGOGASTRECTOMIES Oleg Kshivets , MD, PhD

  • Abstract: PRECISE PREDICTION OF 5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER ESOPHAGOGASTRECTOMIES Oleg Kshivets OBJECTIVE: We examined factors in terms of precise prediction of 5-year survival (5YS) of esophageal and cardioesophageal cancer (ECEC) patients (ECECP) (T1-4N0M1A) after complete (R0) esophagogastrectomies (EG). METHODS: We analyzed data of 407 consecutive ECECP (age=55.68.6 years; tumor size=6.73.3 cm) radically operated and monitored in 1975-2011 (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%. 101 ECECP lived more than 5 years without cancer. 215 ECECP died because of ECEC. Cox modeling displayed (Chi2=232, df=26, P=0.000) that 5YS of ECECP significantly depended on: phase transition (PT) N0N1-M1A in terms of synergetics, cell ratio factors (CRF) (ratio between cancer cells and blood cells subpopulations), T, G, tumor growth, tumor size, sex, age, adjuvant chemotherapy, localization, blood cells, prothrombin index, ESS, blood chlorides, residual nitrogen (P=0.000-0.043). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT N0--N1-M1A (rank=1), PT early-invasive ECEC (rank=2), tumor size, prothrombin index, blood cells, ESS, age, CRF, blood chlorides, residual nitrogen, localization, adjuvant chemotherapy. Correct prediction of 5YS was 100% by neural networks computing. CONCLUSIONS: 5YS of ECECP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N1-M1A; 3) CRF; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) anthropometric data; 8) adjuvant chemotherapy; 9) tumor localization.

  • Data:Males.305Females.........102

    Age=55.68.6 yearsTumor Size=6.73.3 cmOnly Surgery....324Adjuvant Chemoimmunoradio/Chemoimmunotherapy (5FU+thymalin/taktivin, 5-6 cycles+RT 45-50Gy)..83

  • Radical Procedures:

    Left Thoracoabdominal Esophagogastrectomies (Garlock)..271Right Thoracoabdominal Esophagogastrectomies (Ivor Lewis).136Combined Esophagogastrectomies with Resection of Diaphragm, Pericardium, Lung, Liver, Pancreas, etc....1252-Field Lymphadenectomy.3013-Field Lymphadenectomy.106

  • Left Thoracoabdominal Esophagogastrectomy (Garlock).271

  • Garlock Procedures..271

  • Right Thoracoabdominal Esophagogastrectomy (Ivor Lewis)......................................................136

  • Ivor Lewis Procedures136

  • One-Stage Esophagogastroplasty Intrapleural Anastomosis.301 Neck Anastomosis.106

  • Staging:T162 N0..167 G1116T296 N156 G2..96T3..140 M1A..184 G3195T4..109 M1B..0Stage I..43 Stage IIA...98Stage IIB..28 Stage III54Stage IVA..184 Stage IVB0 Adenocarcinoma..................................212 Squamos Cell Carcinoma185 Mix Carcinoma...10Early Cancer43 Invasive Cancer.364

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  • Survival Rate:Alive....167 (41%)5-Year Survivors...101 (24.8%) 10-Year Survivors...53 (13%)Losses215 (52.8%)General Life Span=1612.62070.5 daysFor 5-Year Survivors=4404.42543.9 daysFor 10-Year Survivors=6095.92468.3 daysFor Losses=691.1389.5 daysCumulative 5-Year Survival..40%Cumulative 10-Year Survival32.7%

  • General Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (Kaplan-Meier) (n=407)

  • Results of Univariate Analysis of Phase Transition EarlyInvasive Cancer in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407)

  • Results of Univariate Analysis of Phase Transition N0N1M1A in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407)

  • Results of Univariate Analysis of Adjuvant Therapy in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407)

  • Results of Univariate Analysis of Tumor Localization in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival (n=407)

  • Results of Cox Regression Modeling in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=407)

  • Results of Neural Networks Computing in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=316)

  • Results of Bootstrap Simulation in Prediction of Esophageal Cancer Patients Survival after Complete Esophagectomies (n=316)

  • Holling-Tenner Models of Esophageal /Cardioesophageal Cancer Cell Population and Cytotoxic Cell Population Dynamics

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  • Results of Kohonen Self-Organizing Neural Networks Computing in Prediction of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagogastrectomies (n=316)

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  • Esophageal/Cardioesophageal Cancer Dynamics

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  • Prognostic SEPATH-Model of Esophageal/Cardioesophageal Cancer Patients Survival after Complete Esophagectomies, n=316

  • Conclusions:5-Year Survival of Esophageal and Cardioesophageal Cancer Patients after Radical Procedures Significantly Depended on: 1) Phase Transition EarlyInvasive Cancer; 2) Phase Transition N0N1M1A; 3) Cell Ratio Factors (ratio between cancer cells and blood cells subpopulations); 4) Blood Cell Circuit; 5) Biochemical Homeostasis; 6) Hemostasis System; 7) Anthropometry; 8) Adjuvant Treatment; 9) Tumor Localization and Characteristics.

  • Address:Oleg Kshivets M.D., Ph.D.,

    Consultant Thoracic, Abdominal, General Surgeon & Surgical Oncologist

    e-mail: [email protected] skype: okshivets http: //www.ctsnet.org/home/okshivets

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