Factors Affecting Survival in Operated Esophageal Squamous Cell Carcinoma

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This study aimed to investigate the factors affecting survival in operated patients with ESCC. Materials and Methods: We included 110 patients (38 [34.5%] male; 72 [65.5%] female) aged ≥18 (median age, 54 [26–77]) years who were operated without any signs of metastases and followed up at Van Yüzüncü Yıl University Dursun Odabaşı Medical Center between 2004 and 2019. Results: Initially, 39 (35.5%) patients were clinical lymph node-positive and 71 (64.5%) patients were negative. Thirty-five (31.8%) patients underwent surgery after neoadjuvant chemoradiotherapy (nCRT) and 75 (%68.2) patients underwent direct surgery without nCRT. Five-year overall survival (OS) was 84.4% and 59.2% in patients who underwent surgery after nCRT and in those who underwent direct surgery, respectively. Median OS was significantly longer in patients who underwent surgery after nCRT (p=0.003). There was a statistically significant difference in OS in patients who underwent surgery after nCRT depending on tumor response (p=0.04). In multivariate analysis, advanced pathologic stage (p=0.002) adversely affected survival, whereas nCRT administration (p=0.031) positively affected OS. Conclusion: We suggest that nCRT should be administrated before surgery, especially in locally advanced ESCCs. In addition, we believe that nCRT response can be used as a good parameter for survival. These results, however, should be supported by prospective studies. Gastroenterology & Hepatology Survival Esophageal cancer Neoadjuvant chemoradiotherapy Esophageal squamous cell carcinoma Figures Figure 1 Figure 2 Introduction Esophageal cancer is an extremely lethal malignancy, which accounts for approximately 17,750 cases of esophageal cancer diagnosed and 16,080 deaths annually in the US alone [1]. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) account for >95 % of esophageal cancers. Furthermore, in the US, while the incidence of ESCC has decreased, the number of EAC cases has considerably increased in the last few years. However, ESCC remains the most prevalent histological subtype worldwide [2-4]. In previous studies, some risk factors associated with ESSC have been identified. It is estimated that 90% of ESCC cases in the US may have resulted from tobacco smoking, excessive alcohol consumption, and low vegetable and fruit intake. The distribution of these risk factors, however, showed significant differences in the rest of the world. For instance, in Asian countries, although the main risk factors remain unclear, several factors including malnutrition, low vegetable and fruit intake, and hot beverage consumption may have played a role in the pathogenesis [5-9]. Regardless of the histological subtype, approximately 50%–80% of ESCC cases are diagnosed at locally advanced or metastatic stages of the disease [6]. In the earliest stages, surgery is the recommended treatment option, whereas neoadjuvant chemoradiotherapy (nCRT), followed by surgery, is the standard of care in locally advanced stages. However, the 5-year overall survival (OS) rate for patients with locally advanced stage rarely exceeds 30% [10, 11]. Previous studies have reported that the stage, Glasgow prognostic score, neutrophil-to-lymphocyte ratio, plasma squamous cell carcinoma antigen, and cytokeratin 19 were significant prognostic markers [12-16]. In this retrospective study, we aimed to analyze the factors affecting survival in operated patients with ESCC. Materials And Methods Study population In this retrospective study, we included patients with ESCC who were treated and followed up at the Department of Medical Oncology, Van Yüzüncü Yıl University between 2004 and 2019. Patients who were operated due to ESCC, non-metastatic patients, aged ≥18 years, with middle and lower localized tumor, and those without missing data were enrolled in the study. The exclusion criteria of the study were: histological subtypes other than ESCC, proximally located tumor, age <18 years, unoperated patients, second primary cancer, and those with missing data. Overall, 110 eligible patients were included in the final analysis. Variables and follow up The baseline characteristics of the patients included gender, age, comorbidities (diabetes mellitus [DM], hypertension [HT], chronic obstructive pulmonary disease [COPD], and chronic ischemic heart disease [CIHD]), initial symptom (obstruction, dysphagia, abdominal pain, and weight loss), Eastern Cooperative Oncology Group (ECOG) Performance Status (PS), primary tumor localization, grade, clinical stage, nCRT (yes vs. no), the regimens used for nCRT (carboplatin + paclitaxel or cisplatin + 5-fluorouracil), response to nCRT, pathological stage, adjuvant treatment (yes vs. no) and the regimens used in the adjuvant setting (5- fluorouracil + calcium folinate, carboplatin-paclitaxel, or cisplatin + 5-fluorouracil), recurrence (yes vs. no), site of recurrence, and last status (dead or alive) were obtained from hospital medical records. The clinical stages before the surgery were performed utilizing the initial whole-body computed tomography or 18 F-fluorodeoxyglucose positron emission tomography. The patients were grouped into 2 according to the ECOG PS as 0–1 (Asymptomatic–Symptomatic but completely ambulatory) or 2–3 (Symptomatic, 50% in bed, but not bedbound). The tumor localization was categorized as middle (1/3) and lower (1/3). Patients who have been operated after nCRT were grouped according to the treatment response: complete response (pCR) fibrosis with no evidence of tumor cells, partial response (PR) fibrosis with rare residual tumor cells, and stable disease (SD) is fibrosis and gross residual tumor. OS was estimated as the time from the date of diagnosis to the date of death or last control. Treatments During nCRT and adjuvant chemotherapy, RT (radiation therapy) was delivered at 1.8 Gy daily fractions to a total dose of 41.4–50.4 Gy. The chemotherapy regimens used with RT were: carboplatin (AUC [area under the curve] 2, IV on day 1, weekly for 5 weeks) + paclitaxel (50 mg/kg, IV on day 1, weekly for 5 weeks) or cisplatin (75–100 mg/kg, IV, on day 1 and 29) + 5-fluorouracil (1000 mg/kg, IV continuous infusion over 24 h on day 1–4 and 29–33). In the adjuvant setting, carboplatin (AUC2, IV on day 1, weekly for 5 weeks) + paclitaxel (50 mg/kg, IV on day 1, weekly for 5 weeks) or cisplatin (75–100 mg/kg, IV, on day 1 and 29) + 5-fluorouracil (1000 mg/kg, IV continuous infusion over 24 h on day 1–4 and 29–33). Statistical analysis Statistical Package for Social Sciences 22.0 for Windows software (Armonk NY, IBM Corp. 2013) was used for the statistical analysis. Descriptive statistics were presented as standard deviation, minimum, maximum, and mean for numerical variables and percentage or number for categorical variables. Numerical variables between two independent groups were analyzed using Student’s t-test when the normal distribution condition was met; otherwise, the Mann–Whitney U test was used. The comparison of rates between groups was analyzed using the chi-square test. Survival analyzes were performed using Kaplan–Meier analysis. The determinant factors were analyzed using Cox regression analysis. The backward stepwise model was used for p-values >0.150 in univariate analysis. The statistical alpha significance level for p-values was accepted as <0.05. Ethical approval This study was performed according to the Declaration of Helsinki. The study was reviewed and approved by the ethical committee of Yüzüncü Yıl University, Faculty of Medicine (Approval number: 2019/18-13). Results Overall, 110 patients (38 [34.5%] male, 72 [65.5%] female) aged ≥18 (median age, 54 [26–77]) years were included. There were 14 (12.7%) patients with HT, 4 (3.6%) patients with DM, 4 (3.6%) patients with CIHD, and 4 patients (3.6%) with COPD. The most common presenting symptoms at the time of diagnosis were: dysphagia (94.5%), weight loss (22.2%), and abdominal pain (13.9%) (Table I). The pathological stage was I in 30 (27.3%) patients, II in 45 (40.9%) patients, and III in 35 (31.8%) patients. Approximately 35 (31.8%) patients received nCRT before surgery. The rates of CR, PR, and SD after nCRT were 15 (42.9%), 13 (37.1%), and 7 (20%), respectively. During the follow-up period, recurrence occurred in 36 (32.7%) patients, 36 (32.7%) of whom died. The sites of recurrence in decreasing order of incidence were: liver (36.1%), distant lymph node (27.8%), locoregional (27.8%), and lung (8.3%) (Table I). According to the pathological stages (I, II, and III) and nCRT status (yes vs. no), the 1- 2-, 3-, 5-, and 10-year OS rates are shown in Table II. The OS rates were significantly different among the pathological stages, with patients in stage III disease having the worst OS (35 months vs. not reached vs. not reached) (Fig. 1). In Kaplan–Meier analysis, the OS of patients who received nCRT was significantly longer than those who did not receive neoadjuvant therapy (Log rank=0.03) (Fig. 2A). Considering survival based on the nCRT response, there were significant differences in OS among the response groups, with the best OS rates observed in patients with CR (Log rank=0.04) (Fig. 2B). Univariate analysis showed that the presence of obstruction, ECOG PS, nCRT, clinical and pathological stage, and adjuvant treatment were the factors affecting OS (p=0.007, p=0.001, p=0.003, p=0.018, p=0.001, and p=0.036, respectively). In the multivariate analysis created with p-value <0.05 parameters with the entered model, nCRT and pathological stage were found to be the factors associated with OS in multivariate analysis (p= 0.031 and p= 0.002, respectively) (Table III). Discussion In this retrospective study, we investigated the factors affecting survival in operated patients with ESCC. We observed better survival in patients treated with nCRT and worse survival duration as the pathological stage increased. In ESCC, esophageal obstruction due to tumor causes progressive dysphagia, often accompanied by weight loss. Dysphagia generally occurs when the esophageal lumen diameter is <13 mm, indicating advanced disease [17]. In this study, dysphagia and obstruction were observed in 95% and 16.4% of the patients, respectively. In ESCC, although the main risk factors remain unclear, malnutrition, low vegetable and fruit intake, and hot beverage consumption are believed may play a role in the pathogenesis [5]. There is no obvious gender difference in regions where ESCC is endemic. However, it is more prevalent in men in low-incidence countries [18]. In this study, the female-to-male ratio was almost two-folds because it was conducted in a high-incidence region for ESCC. Low vegetable and fruit intake and some traditional nutritional habits in our region were quite common, such as salty cheese and hot tea consumption. Furthermore, of the patients included here, 30% were active smokers. A review from our country that included 31 studies between 1988 and 2010 suggested that the frequency of smoking ranged from 27.5% to 63.8% in males and 8.4%–27.8% in females [19]. In this study, the lower rate of smoking resulted from the high female-to-male ratio. A study conducted by Javle et al. that included 172 patients with esophageal cancer, 74 of whom were ESCC, reported that tumor stage and surgery independently affected survival [20]. Suzuki et al. conducted a study on patients with ESCC and reported that stage independently affected survival [21]. Similarly, in this study, a higher stage significantly decreased survival and mortality rate in pathological stage III patients was nearly 5-folds higher than those in stage I. In RTOG 85-01 study, Al Sarraf et al. compared RT to definitive nCRT in 123 locally advanced patients with esophageal cancer. mOS was 14.1 months in nCRT arm vs. 9.3 months in RT arm. Furthermore, another 69 patients were treated with CRT and the OS rate was 17.2 months, similar to the previous outcomes [22]. In another study that randomized 172 locally advanced patients with esophageal cancer to induction chemotherapy, followed by nCRT plus surgery or definitive CRT, no significant survival difference between the groups was observed during the median 6-years follow-up. The 2-year locoregional control rate was found to be better in the surgery arm [23]. In the meta-analyses of studies comparing nCRT vs. surgery alone, nCRT was found to be superior [24-26]. In the meta-analysis that included 14 randomized studies conducted by Jin et al., it was observed that local control rates and survival rates with nCRT were better than surgery alone [24]. Likewise, in the meta-analysis of 9 randomized studies conducted by Urschel et al., it was observed that both 3-year survival and local control rates were better in the nCRT arm than surgery alone [25]. A study conducted by Munch et al. including 95 patients with ESCC compared nCRT with surgery or definitive CRT and found that a higher rate of local tumor control was observed in patients treated with nCRT than in patients treated with definitive CRT. There was at least a trend towards an improved OS and PFS in patients undergoing nCRT [27]. In this study, 75 patients were operated without nCRT, while 35 patients were operated without nCRT. OS was significantly longer in patients operated after nCRT. The 5-year survival rate was 84.4% in those operated after nCRT and 59.5% in patients who underwent direct surgery. In addition, administration of nCRT before surgery decreased the mortality by 68.5%. There are limited studies in the literature that investigated the effect of pathological response after nCRT on survival only in ESCC. The results of the histological subtypes (ESCC and EAC) of esophageal cancer were given together in previous studies. In the study conducted by Takeda et al., pCR after nCRT in esophageal cancer significantly improved survival. Of 134 patients included in the study, only 94 were ESCC [28]. Likewise, in the study conducted by Gua et al. including 122 patients, only 43 patients were ESCC and found that the degree of tumor regression correlated with survival. The authors argued that tumor regression grade can be used to predict the long-term survival of esophageal cancer patients [29]. In this study, however, survival was significantly prolonged as the tumor response improved. At a median follow-up of 35 months, no recurrence or death was observed in any patient with pCR. Unlike other studies, this study only included patients with ESCC and presented real-life data. In addition, only operated patients were included to ensure homogeneity. However, this study was designed retrospectively and as a single center. Furthermore, this study was conducted in a region where esophageal cancer is endemic, thus we were unable to determine how this could affect the results of the study. In conclusion, administration of nCRT and early clinical stage in patients with ESCC were found to be the most important factors affecting survival in this study. It was observed that survival was prolonged as the tumor response improved in those who were operated after nCRT. We suggest that nCRT should be administered before surgery, especially in locally advanced ESCC. In addition, we believe that nCRT response can be used as a good parameter for survival. These results should be supported by prospective clinical studies. Declarations Informed consent statement: Patients were not required to given informed consent for the study, because analyzes were used retrospectively with anonymous clinical data obtained after each patient accepted treatment with written consent. Conflict-of-interest statement: All authors declare no conflicts-of-interest. Funding Source: None Author Contributions: Concept – NA, SS, AS; Design – NA, MNQ, AA; Supervision – MA, UHI, MCK; Resources – NA, SS, AA, UHI; Materials – AS, MNA, MA, MCK; Data Collection and/or Processing – NA, AS, SS; Analysis and/or Interpretation – AS, SS, AA, MNA; Literature Search – MA, UHI, MCK; Writing Manuscript – NA, AS, SS, MCK; Critical Review – AA, MA, UHI; Other – AS, MNA, AA, UHI. References Siegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. 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Patients' Data Characteristics N % Gender Men 38 34.5 Women 72 65.5 Age (year) Median (Min-Max) 54 (26-77) Comorbidities HT 14 12.7 DM 4 3.6 CIHD 4 3.7 COPD 5 4.6 Smoking status No 80 72.7 Yes 30 27.3 Initial symptom Obstruction 18 16.4 Dysphagia 104 95.4 Abdominal pain 15 13.9 Weight loss 24 22.2 ECOG PS 0 53 50.5 1 46 43.8 2 4 3.8 3 2 1.9 Primary tumor localization 2/3 73 66.4 3/3 37 33.6 Grade Good 17 16.7 Moderate 69 67.6 Poor 16 15.7 Clinical stage Lymph node negative 71 64.5 Lymph node positive 39 35.5 nCRT Yes 35 31.8 No 75 68.2 The regimens used for nCRT Carboplatin + Paclitaxel 28 80.0 Cisplatin + 5-Fluorouracil 7 20.0 Response to nCRT CR 15 42.9 PR 13 37.1 SD 7 20.0 Pathological stage I 30 27.3 II 45 40.9 III 35 31.8 Adjuvant treatment No 82 79.6 Yes 21 20.4 Cisplatin + 5-Fluorouracil 15 13.6 Carboplatin + Paclitaxel 6 5.4 Recurrence No 74 67.3 Yes 36 32.7 Site of recurrence Locoregional 10 27.8 Lung 3 8.3 Liver 13 36.1 Distant Lymph Node 10 27.8 Last status Dead 36 32.7 Alive 74 67.3 Abbreviations: CIHD , Chronic İschemic Heart Disease; CR , Complete response; COPD , Chronic Obstructive Pulmonary Disease; DM , Diabetes mellitus; ECOG PS , Eastern Cooperative Oncology Group Performance Status; HT , Hypertension; nCRT, Neoadjuvant chemoradiotherapy; PR , Partial response, SD , Stabil disease. Table II. Survival rates by years. Year All patients nCRT (+) nCRT (-) Stage I Stage II Stage III 1 88.9 96.6 89.3 93.2 91.1 82.9 2 78.2 93.1 72.8 93.2 80.3 68.6 3 68.7 89.1 67.9 81.5 80.3 50.7 5 64.1 84.4 59.2 81.5 77.0 40.0 10 57.6 84.4 45.4 81.5 72.5 32.3 Table III. Univariate analysis and multivariate analysis for OS. Characteristics Univariate analysis for OS Multivariate analysis for OS HR 95.0% CI For HR P HR 95.0% CI For HR P Gender Women vs. Men 0.634 0.179 Age Year 1.013 0.985-1.233 0.370 HT Yes vs. No 0.371 0.089-1.547 0.174 DM Yes vs. No 0.630 0.086-4.600 0.649 CIHD Yes vs. No 0.517 0.071-3.783 0.516 COPD Yes vs. No 1.009 0.242-4.208 0.990 Smoking Yes vs. No 0.761 0.346-1.669 0.495 Dysphagia Yes vs. No 1.228 0.167-9.013 0.840 Abdominal pain Yes vs. No 0.517 0.158-1.690 0.275 Weight loss Yes vs. No 0.890 0.388-2.038 0.782 Obstruction Yes vs. No 2.672 1.307-5.463 0.007 ECOG PS 2-3 Vs 0-1 5.318 1.995-14.177 0.001 Primary tumor localization 2/3 vs 3/3 1.055 0.249-4.461 0.942 Grade Good (Ref.) 1 0.510 Moderate 1.859 0.642-5.381 0.253 Poor 1.875 0.502-7.001 0.350 nCRT Yes vs. No 0.211 0.074-0.596 0.003 0.315 0.110-0.902 0.031 Clinical stage Lymph node positive vs. Lymph node negative 2.207 1.147-4.245 0.018 Pathological stage I (Ref.) 1 0.001 1 0.002 II 1.391 0.435-4.448 0.578 1.554 0.425-5.676 0.505 III 4.348 1.494-12.653 0.007 4.883 1.441-16.540 0.011 Adjuvant treatment Yes vs. No 2.128 1.049-4.315 0.036 Abbreviations: see table 1 . Cite Share Download PDF Status: Published Journal Publication published 31 Mar, 2021 Read the published version in Journal of Gastrointestinal Cancer → Version 1 posted Editorial decision: Accept 15 Mar, 2021 Reviews received at journal 02 Mar, 2021 First submitted to journal 16 Jan, 2021 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Yuzuncu Yil Universitesi","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mehmet","middleName":"Cetin","lastName":"Kotan","suffix":""}],"badges":[],"createdAt":"2021-02-17 07:51:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-250493/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-250493/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s12029-021-00631-z","type":"published","date":"2021-03-31T19:04:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":6279599,"identity":"737e34ac-6869-40d5-a099-431feaf2f8ae","added_by":"auto","created_at":"2021-02-23 21:54:06","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":154681,"visible":true,"origin":"","legend":"Overall survival according to pathologic tumor stage.","description":"","filename":"figure1stage1200.jpg","url":"https://assets-eu.researchsquare.com/files/rs-250493/v1/2d54695fb70cfd7f2cfcf3f6.jpg"},{"id":6279290,"identity":"96e41b7a-3af9-491d-8af9-1febe6ddfdf2","added_by":"auto","created_at":"2021-02-23 21:51:06","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":252235,"visible":true,"origin":"","legend":"Overall survival according to nCRT status (A) and nCRT response (B).","description":"","filename":"figure2nCRT1200.jpg","url":"https://assets-eu.researchsquare.com/files/rs-250493/v1/30498336e3e7aac9118b4aa7.jpg"},{"id":13669540,"identity":"52da3fca-9d33-44fd-a98f-6e2d14aa296d","added_by":"auto","created_at":"2021-09-17 11:01:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":623390,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-250493/v1/38096efc-4939-4a5d-98f0-d50c706f207f.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eFactors Affecting Survival in Operated Esophageal Squamous Cell Carcinoma\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEsophageal cancer is an extremely lethal malignancy, which accounts for approximately 17,750 cases of esophageal cancer diagnosed and 16,080 deaths annually in the US alone [1]. Esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC) account for \u0026gt;95 % of esophageal cancers. Furthermore, in the US, while the incidence of ESCC has decreased, the number of EAC cases has considerably increased in the last few years. However, ESCC remains the most prevalent histological subtype worldwide [2-4].\u003c/p\u003e\n\u003cp\u003eIn previous studies, some risk factors associated with ESSC have been identified. It is estimated that 90% of ESCC cases in the US may have resulted from tobacco smoking, excessive alcohol consumption, and low vegetable and fruit intake. The distribution of these risk factors, however, showed significant differences in the rest of the world. For instance, in Asian countries, although the main risk factors remain unclear, several factors including malnutrition, low vegetable and fruit intake, and hot beverage consumption may have played a role in the pathogenesis [5-9].\u003c/p\u003e\n\u003cp\u003eRegardless of the histological subtype, approximately 50%\u0026ndash;80% of ESCC cases are diagnosed at locally advanced or metastatic stages of the disease [6]. In the earliest stages, surgery is the recommended treatment option, whereas neoadjuvant chemoradiotherapy (nCRT), followed by surgery, is the standard of care in locally advanced stages. However, the 5-year overall survival (OS) rate for patients with locally advanced stage rarely exceeds 30% [10, 11].\u003c/p\u003e\n\u003cp\u003ePrevious studies have reported that the stage, Glasgow prognostic score, neutrophil-to-lymphocyte ratio, plasma squamous cell carcinoma antigen, and cytokeratin 19 were significant prognostic markers [12-16]. In this retrospective study, we aimed to analyze the factors affecting survival in operated patients with ESCC.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e\u003cem\u003eStudy population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn this retrospective study, we included patients with ESCC who were treated and followed up at the Department of Medical Oncology, Van Y\u0026uuml;z\u0026uuml;nc\u0026uuml; Yıl University between 2004 and 2019. Patients who were operated due to ESCC, non-metastatic patients, aged \u0026ge;18 years, with middle and lower localized tumor, and those without missing data were enrolled in the study. The exclusion criteria of the study were: histological subtypes other than ESCC, proximally located tumor, age \u0026lt;18 years, unoperated patients, second primary cancer, and those with missing data. Overall, 110 eligible patients were included in the final analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eVariables and follow up\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe baseline characteristics of the patients included gender, age, comorbidities (diabetes mellitus [DM], hypertension [HT], chronic obstructive pulmonary disease [COPD], and chronic ischemic heart disease [CIHD]), initial symptom (obstruction, dysphagia, abdominal pain, and weight loss), Eastern Cooperative Oncology Group (ECOG) Performance Status (PS), primary tumor localization, grade, clinical stage, nCRT (yes vs. no), the regimens used for nCRT (carboplatin + paclitaxel or cisplatin + 5-fluorouracil), response to nCRT, pathological stage, adjuvant treatment (yes vs. no) and the regimens used in the adjuvant setting (5- fluorouracil + calcium folinate, carboplatin-paclitaxel, or cisplatin + 5-fluorouracil), recurrence (yes vs. no), site of recurrence, and last status (dead or alive) were obtained from hospital medical records. The clinical stages before the surgery were performed utilizing the initial whole-body computed tomography or 18 F-fluorodeoxyglucose positron emission tomography. The patients were grouped into 2 according to the ECOG PS as 0\u0026ndash;1 (Asymptomatic\u0026ndash;Symptomatic but completely ambulatory) or 2\u0026ndash;3 (Symptomatic, \u0026lt;50% in bed during the day\u0026ndash;Symptomatic, \u0026gt;50% in bed, but not bedbound). The tumor localization was categorized as middle (1/3) and lower (1/3). Patients who have been operated after nCRT were grouped according to the treatment response: complete response (pCR) fibrosis with no evidence of tumor cells, partial response (PR) fibrosis with rare residual tumor cells, and stable disease (SD) is fibrosis and gross residual tumor. OS was estimated as the time from the date of diagnosis to the date of death or last control.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTreatments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDuring nCRT and adjuvant chemotherapy, RT (radiation therapy) was delivered at 1.8 Gy daily fractions to a total dose of 41.4\u0026ndash;50.4 Gy. The chemotherapy regimens used with RT were: carboplatin (AUC [area under the curve] 2, IV on day 1, weekly for 5 weeks) + paclitaxel (50 mg/kg, IV on day 1, weekly for 5 weeks) or cisplatin (75\u0026ndash;100 mg/kg, IV, on day 1 and 29) + 5-fluorouracil (1000 mg/kg, IV continuous infusion over 24 h on day 1\u0026ndash;4 and 29\u0026ndash;33). In the adjuvant setting, carboplatin (AUC2, IV on day 1, weekly for 5 weeks) + paclitaxel (50 mg/kg, IV on day 1, weekly for 5 weeks) or cisplatin (75\u0026ndash;100 mg/kg, IV, on day 1 and 29) + 5-fluorouracil (1000 mg/kg, IV continuous infusion over 24 h on day 1\u0026ndash;4 and 29\u0026ndash;33).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStatistical Package for Social Sciences 22.0 for Windows software (Armonk NY, IBM Corp. 2013) was used for the statistical analysis. Descriptive statistics were presented as standard deviation, minimum, maximum, and mean for numerical variables and percentage or number for categorical variables. Numerical variables between two independent groups were analyzed using Student\u0026rsquo;s t-test when the normal distribution condition was met; otherwise, the Mann\u0026ndash;Whitney U test was used. The comparison of rates between groups was analyzed using the chi-square test. Survival analyzes were performed using Kaplan\u0026ndash;Meier analysis. The determinant factors were analyzed using Cox regression analysis. The backward stepwise model was used for p-values \u0026gt;0.150 in univariate analysis. The statistical alpha significance level for p-values was accepted as \u0026lt;0.05.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical approval\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed according to the Declaration of Helsinki. The study was reviewed and approved by the ethical committee of Y\u0026uuml;z\u0026uuml;nc\u0026uuml; Yıl University, Faculty of Medicine (Approval number: 2019/18-13).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOverall, 110 patients (38 [34.5%] male, 72 [65.5%] female) aged \u0026ge;18 (median age, 54 [26\u0026ndash;77]) years were included. There were 14 (12.7%) patients with HT, 4 (3.6%) patients with DM, 4 (3.6%) patients with CIHD, and 4 patients (3.6%) with COPD. The most common presenting symptoms at the time of diagnosis were: dysphagia (94.5%), weight loss (22.2%), and abdominal pain (13.9%) (Table I).\u003c/p\u003e\n\u003cp\u003eThe pathological stage was I in 30 (27.3%) patients, II in 45 (40.9%) patients, and III in 35 (31.8%) patients. Approximately 35 (31.8%) patients received nCRT before surgery. The rates of CR, PR, and SD after nCRT were 15 (42.9%), 13 (37.1%), and 7 (20%), respectively. During the follow-up period, recurrence occurred in 36 (32.7%) patients, 36 (32.7%) of whom died. The sites of recurrence in decreasing order of incidence were: liver (36.1%), distant lymph node (27.8%), locoregional (27.8%), and lung (8.3%) (Table I).\u003c/p\u003e\n\u003cp\u003eAccording to the pathological stages (I, II, and III) and nCRT status (yes vs. no), the 1- 2-, 3-, 5-, and 10-year OS rates are shown in Table II. The OS rates were significantly different among the pathological stages, with patients in stage III disease having the worst OS (35 months vs. not reached vs. not reached) (Fig. 1). In Kaplan\u0026ndash;Meier analysis, the OS of patients who received nCRT was significantly longer than those who did not receive neoadjuvant therapy (Log rank=0.03) (Fig. 2A). Considering survival based on the nCRT response, there were significant differences in OS among the response groups, with the best OS rates observed in patients with CR (Log rank=0.04) (Fig. 2B).\u003c/p\u003e\n\u003cp\u003eUnivariate analysis showed that the presence of obstruction, ECOG PS, nCRT, clinical and pathological stage, and adjuvant treatment were the factors affecting OS (p=0.007, p=0.001, p=0.003, p=0.018, p=0.001, and p=0.036, respectively). In the multivariate analysis created with p-value \u0026lt;0.05 parameters with the entered model, nCRT and pathological stage were found to be the factors associated with OS in multivariate analysis (p= 0.031 and p= 0.002, respectively) (Table III).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this retrospective study, we investigated the factors affecting survival in operated patients with ESCC. We observed better survival in patients treated with nCRT and worse survival duration as the pathological stage increased.\u003c/p\u003e\n\u003cp\u003eIn ESCC, esophageal obstruction due to tumor causes progressive dysphagia, often accompanied by weight loss. Dysphagia generally occurs when the esophageal lumen diameter is \u0026lt;13 mm, indicating advanced disease [17]. In this study, dysphagia and obstruction were observed in 95% and 16.4% of the patients, respectively. In ESCC, although the main risk factors remain unclear, malnutrition, low vegetable and fruit intake, and hot beverage consumption are believed may play a role in the pathogenesis [5].\u003c/p\u003e\n\u003cp\u003eThere is no obvious gender difference in regions where ESCC is endemic. However, it is more prevalent in men in low-incidence countries [18]. In this study, the female-to-male ratio was almost two-folds because it was conducted in a high-incidence region for ESCC. Low vegetable and fruit intake and some traditional nutritional habits in our region were quite common, such as salty cheese and hot tea consumption. Furthermore, of the patients included here, 30% were active smokers. A review from our country that included 31 studies between 1988 and 2010 suggested that the frequency of smoking ranged from 27.5% to 63.8% in males and 8.4%\u0026ndash;27.8% in females [19]. In this study, the lower rate of smoking resulted from the high female-to-male ratio.\u003c/p\u003e\n\u003cp\u003eA study conducted by Javle et al. that included 172 patients with esophageal cancer, 74 of whom were ESCC, reported that tumor stage and surgery independently affected survival [20]. Suzuki et al. conducted a study on patients with ESCC and reported that stage independently affected survival [21]. Similarly, in this study, a higher stage significantly decreased survival and mortality rate in pathological stage III patients was nearly 5-folds higher than those in stage I.\u003c/p\u003e\n\u003cp\u003eIn RTOG 85-01 study, Al Sarraf et al. compared RT to definitive nCRT in 123 locally advanced patients with esophageal cancer. mOS was 14.1 months in nCRT arm vs. 9.3 months in RT arm. Furthermore, another 69 patients were treated with CRT and the OS rate was 17.2 months, similar to the previous outcomes [22]. In another study that randomized 172 locally advanced patients with esophageal cancer to induction chemotherapy, followed by nCRT plus surgery or definitive CRT, no significant survival difference between the groups was observed during the median 6-years follow-up. The 2-year locoregional control rate was found to be better in the surgery arm [23]. In the meta-analyses of studies comparing nCRT vs. surgery alone, nCRT was found to be superior [24-26].\u003c/p\u003e\n\u003cp\u003eIn the meta-analysis that included 14 randomized studies conducted by Jin et al., it was observed that local control rates and survival rates with nCRT were better than surgery alone [24]. Likewise, in the meta-analysis of 9 randomized studies conducted by Urschel et al., it was observed that both 3-year survival and local control rates were better in the nCRT arm than surgery alone [25]. A study conducted by Munch et al. including 95 patients with ESCC compared nCRT with surgery or definitive CRT and found that a higher rate of local tumor control was observed in patients treated with nCRT than in patients treated with definitive CRT. There was at least a trend towards an improved OS and PFS in patients undergoing nCRT [27]. In this study, 75 patients were operated without nCRT, while 35 patients were operated without nCRT. OS was significantly longer in patients operated after nCRT. The 5-year survival rate was 84.4% in those operated after nCRT and 59.5% in patients who underwent direct surgery. In addition, administration of nCRT before surgery decreased the mortality by 68.5%.\u003c/p\u003e\n\u003cp\u003eThere are limited studies in the literature that investigated the effect of pathological response after nCRT on survival only in ESCC. The results of the histological subtypes (ESCC and EAC) of esophageal cancer were given together in previous studies. In the study conducted by Takeda et al., pCR after nCRT in esophageal cancer significantly improved survival. Of 134 patients included in the study, only 94 were ESCC [28]. Likewise, in the study conducted by Gua et al. including 122 patients, only 43 patients were ESCC and found that the degree of tumor regression correlated with survival. The authors argued that tumor regression grade can be used to predict the long-term survival of esophageal cancer patients [29]. In this study, however, survival was significantly prolonged as the tumor response improved. At a median follow-up of 35 months, no recurrence or death was observed in any patient with pCR.\u003c/p\u003e\n\u003cp\u003eUnlike other studies, this study only included patients with ESCC and presented real-life data. In addition, only operated patients were included to ensure homogeneity. However, this study was designed retrospectively and as a single center. Furthermore, this study was conducted in a region where esophageal cancer is endemic, thus we were unable to determine how this could affect the results of the study.\u003c/p\u003e\n\u003cp\u003eIn conclusion, administration of nCRT and early clinical stage in patients with ESCC were found to be the most important factors affecting survival in this study. It was observed that survival was prolonged as the tumor response improved in those who were operated after nCRT. We suggest that nCRT should be administered before surgery, especially in locally advanced ESCC. In addition, we believe that nCRT response can be used as a good parameter for survival. These results should be supported by prospective clinical studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eInformed consent statement:\u003c/strong\u003e Patients were not required to given informed consent for the study, because analyzes were used retrospectively with anonymous clinical data obtained after each patient accepted treatment with written consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict-of-interest statement: \u003c/strong\u003eAll authors declare no conflicts-of-interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Source: \u003c/strong\u003eNone\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e Concept \u0026ndash; NA, SS, AS; Design \u0026ndash; NA, MNQ, AA; Supervision \u0026ndash; MA, UHI, MCK; Resources \u0026ndash; NA, SS, AA, UHI; Materials \u0026ndash; AS, MNA, MA, MCK; Data Collection and/or Processing \u0026ndash; NA, AS, SS; Analysis and/or Interpretation \u0026ndash; AS, SS, AA, MNA; Literature Search \u0026ndash; MA, UHI, MCK; Writing Manuscript \u0026ndash; NA, AS, SS, MCK; Critical Review \u0026ndash; AA, MA, UHI; Other \u0026ndash; AS, MNA, AA, UHI.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSiegel RL, Miller KD, Jemal A (2019) Cancer statistics, 2019. 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J Clin Oncol 15:277-284\u003c/li\u003e\n\u003cli\u003eStahl M, Stuschke M, Lehmann N, et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310-2317\u003c/li\u003e\n\u003cli\u003eLv J, Cao XF, Zhu B, et al (2009) Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma. World J Gastroenterol 15:4962-4968\u003c/li\u003e\n\u003cli\u003eUrschel JD, Vasan H, Blewett CJ (2002) A meta-analysis of randomized controlled trials that compared neoadjuvant chemotherapy and surgery to surgery alone for resectable esophageal cancer. Am J Surg 183:274-279\u003c/li\u003e\n\u003cli\u003eGebski V, Burmeister B, Smithers BM, et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226-234\u003c/li\u003e\n\u003cli\u003eMunch S, Pigorsch SU, Devecka M, et al (2019) Neoadjuvant versus definitive chemoradiation in patients with squamous cell carcinoma of the esophagus. Radiat Oncol 14:66\u003c/li\u003e\n\u003cli\u003eTakeda FR, Tustumi F, de Almeida Obregon C, et al (2019) Prognostic Value of Tumor Regression Grade Based on Ryan Score in Squamous Cell Carcinoma and Adenocarcinoma of Esophagus. Ann Surg Oncol\u003c/li\u003e\n\u003cli\u003eGuo K, Cai L, Zhang Y, et al (2012) The predictive value of histological tumor regression grading (TRG) for therapeutic evaluation in locally advanced esophageal carcinoma treated with neoadjuvant chemotherapy. Chin J Cancer 31:399-408\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable I.\u003c/strong\u003e Patients' Data\u003c/p\u003e\n\u003ctable border=\"1\" width=\"90%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" width=\"65%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e34.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e65.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge (year)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMedian (Min-Max)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"34%\"\u003e\n\u003cp\u003e54 (26-77)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eHT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e12.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDM\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e3.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCIHD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e3.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCOPD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e4.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmoking status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e80\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e72.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e27.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eInitial symptom\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eObstruction\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e16.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDysphagia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e104\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e95.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAbdominal pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e13.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e22.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eECOG PS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e50.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e43.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e3.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e1.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary tumor localization\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2/3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e66.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003e3/3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e33.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGrade\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGood\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e16.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e67.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePoor\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e15.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eClinical stage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLymph node negative\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e64.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLymph node positive\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e35.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003enCRT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e31.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e68.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eThe regimens used for \u003c/strong\u003e\u003cstrong\u003enCRT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCarboplatin + Paclitaxel\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e80.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCisplatin + 5-Fluorouracil\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e20.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eResponse to \u003c/strong\u003e\u003cstrong\u003enCRT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e42.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e37.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e20.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePathological stage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e27.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e40.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e31.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdjuvant treatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e82\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e79.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e21\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e20.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCisplatin + 5-Fluorouracil\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e13.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCarboplatin + Paclitaxel\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e5.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eRecurrence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e67.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e32.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSite of recurrence\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLocoregional\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e27.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLung\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e8.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLiver\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e36.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDistant Lymph Node\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e27.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"31%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLast status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDead\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e32.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"34%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAlive\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"16%\"\u003e\n\u003cp\u003e74\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e67.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e \u003cstrong\u003eCIHD\u003c/strong\u003e, Chronic İschemic Heart Disease;\u003cstrong\u003e CR\u003c/strong\u003e, Complete response; \u003cstrong\u003eCOPD\u003c/strong\u003e, Chronic Obstructive Pulmonary Disease; \u003cstrong\u003eDM\u003c/strong\u003e, Diabetes mellitus; \u003cstrong\u003eECOG\u003c/strong\u003e \u003cstrong\u003ePS\u003c/strong\u003e, Eastern Cooperative Oncology Group Performance Status; \u003cstrong\u003eHT\u003c/strong\u003e, Hypertension; \u003cstrong\u003enCRT, \u003c/strong\u003eNeoadjuvant chemoradiotherapy; \u003cstrong\u003ePR\u003c/strong\u003e, Partial response, \u003cstrong\u003eSD\u003c/strong\u003e, Stabil disease.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable II.\u003c/strong\u003e Survival rates by years.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"90%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAll patients\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e\u003cstrong\u003enCRT (+)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003enCRT (-)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003eStage I\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e\u003cstrong\u003eStage II\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e\u003cstrong\u003eStage III\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e88.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e96.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e89.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e93.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e91.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e82.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e78.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e93.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e72.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e93.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e80.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e68.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e68.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e89.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e67.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e81.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e80.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e50.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e64.1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e84.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e59.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e81.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e77.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e40.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"13%\"\u003e\n\u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"20%\"\u003e\n\u003cp\u003e57.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"18%\"\u003e\n\u003cp\u003e84.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e45.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e81.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"12%\"\u003e\n\u003cp\u003e72.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"10%\"\u003e\n\u003cp\u003e32.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable III.\u003c/strong\u003e Univariate analysis and multivariate analysis for OS.\u003c/p\u003e\n\u003ctable border=\"1\" width=\"90%\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" width=\"35%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"29%\"\u003e\n\u003cp\u003e\u003cstrong\u003eUnivariate analysis for OS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" width=\"29%\"\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate analysis for OS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"0%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e\u003cstrong\u003eHR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e95.0% CI For HR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u003cstrong\u003eHR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e95.0% CI For HR\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eWomen vs. Men\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.634\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.179\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.985-1.233\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.370\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eHT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.371\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.089-1.547\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.174\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDM\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.630\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.086-4.600\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.649\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCIHD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.517\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.071-3.783\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.516\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eCOPD\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.009\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.242-4.208\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.990\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.761\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.346-1.669\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.495\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eDysphagia\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.228\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.167-9.013\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.840\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAbdominal pain\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.517\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.158-1.690\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.275\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eWeight loss\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.890\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.388-2.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.782\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eObstruction\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e2.672\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e1.307-5.463\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.007\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eECOG PS\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2-3 Vs 0-1\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e5.318\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e1.995-14.177\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary tumor localization\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003e2/3 vs 3/3\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.055\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.249-4.461\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.942\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGrade\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eGood (Ref.)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.510\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eModerate\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.859\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.642-5.381\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.253\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePoor\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.875\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.502-7.001\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e0.350\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003enCRT\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e0.211\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.074-0.596\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e0.315\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.110-0.902\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.031\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eClinical stage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eLymph node positive vs.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLymph node negative\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e2.207\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e1.147-4.245\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.018\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003ePathological stage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eI (Ref.)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.002\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e1.391\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.435-4.448\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.578\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e1.554\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e0.425-5.676\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.505\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eIII\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e4.348\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e1.494-12.653\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.007\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e4.883\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e1.441-16.540\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e0.011\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eAdjuvant treatment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"17%\"\u003e\n\u003cp\u003e\u003cstrong\u003eYes vs. No\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"8%\"\u003e\n\u003cp\u003e2.128\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e1.049-4.315\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"5%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e0.036\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"4%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"7%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"15%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"6%\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"125\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"127\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"58\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"42\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"35\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"54\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"109\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"47\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd width=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations: \u003c/strong\u003esee \u003cem\u003etable 1\u003c/em\u003e.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Survival, Esophageal cancer, Neoadjuvant chemoradiotherapy, Esophageal squamous cell carcinoma","lastPublishedDoi":"10.21203/rs.3.rs-250493/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-250493/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e Esophageal squamous cell carcinoma (ESCC) is an extremely fatal and relatively rare gastrointestinal system malignancy. This study aimed to investigate the factors affecting survival in operated patients with ESCC.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e We included 110 patients (38 [34.5%] male; 72 [65.5%] female) aged ≥18 (median age, 54 [26–77]) years who were operated without any signs of metastases and followed up at Van Yüzüncü Yıl University Dursun Odabaşı Medical Center between 2004 and 2019.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Initially, 39 (35.5%) patients were clinical lymph node-positive and 71 (64.5%) patients were negative. Thirty-five (31.8%) patients underwent surgery after neoadjuvant chemoradiotherapy (nCRT) and 75 (%68.2) patients underwent direct surgery without nCRT. Five-year overall survival (OS) was 84.4% and 59.2% in patients who underwent surgery after nCRT and in those who underwent direct surgery, respectively. Median OS was significantly longer in patients who underwent surgery after nCRT (p=0.003). There was a statistically significant difference in OS in patients who underwent surgery after nCRT depending on tumor response (p=0.04). In multivariate analysis, advanced pathologic stage (p=0.002) adversely affected survival, whereas nCRT administration (p=0.031) positively affected OS.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e We suggest that nCRT should be administrated before surgery, especially in locally advanced ESCCs. In addition, we believe that nCRT response can be used as a good parameter for survival. These results, however, should be supported by prospective studies.\u003c/p\u003e","manuscriptTitle":"Factors Affecting Survival in Operated Esophageal Squamous Cell Carcinoma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-02-23 21:51:04","doi":"10.21203/rs.3.rs-250493/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept","date":"2021-03-15T08:31:25+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2021-03-03T00:00:00+00:00","index":0,"fulltext":""},{"type":"submitted","content":"Journal of Gastrointestinal Cancer","date":"2021-01-16T11:05:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-gastrointestinal-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijgc","sideBox":"Learn more about [Journal of Gastrointestinal Cancer](https://www.springer.com/journal/12029)","snPcode":"12029","submissionUrl":"https://submission.nature.com/new-submission/12029/3","title":"Journal of Gastrointestinal Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"ac3c79d9-b8de-402a-8c87-b66901cf69be","owner":[],"postedDate":"February 23rd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":2533009,"name":"Gastroenterology \u0026 Hepatology"}],"tags":[],"updatedAt":"2021-08-18T19:32:29+00:00","versionOfRecord":{"articleIdentity":"rs-250493","link":"https://doi.org/10.1007/s12029-021-00631-z","journal":{"identity":"journal-of-gastrointestinal-cancer","isVorOnly":false,"title":"Journal of Gastrointestinal Cancer"},"publishedOn":"2021-03-31 19:04:57","publishedOnDateReadable":"March 31st, 2021"},"versionCreatedAt":"2021-02-23 21:51:04","video":"","vorDoi":"10.1007/s12029-021-00631-z","vorDoiUrl":"https://doi.org/10.1007/s12029-021-00631-z","workflowStages":[]},"version":"v1","identity":"rs-250493","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-250493","identity":"rs-250493","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}