Prognosis of Patients with Esophageal Carcinoma following Routine Thoracic Duct Resection: A Propensity-matched Analysis of 12,237 Patients based on the Comprehensive Registry of Esophageal Cancer in Japan

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Oshikiri 18

Figure legends

Fig. 1

Flowchart of patient enrollment for c-Stage I–IV (cT1-3/N0-3/M0-1) patients.

Fig. 2

A) Among c-Stage I–IV patients, the OS rates in the group TD-resected (1,638 patients) at the

1st, 2nd, 3rd, 4th, and 5th year were 84.1%, 70.5%, 63.5%, 60.8%, and 57.5% and 85.3%,

whereas those in TD-preserved group (1,638 patients) were 71.8%, 63.8%, 58.7%, and 55.2%,

respectively (P = 0.367).

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B) Among c-Stage I–IV patients, the CSS rates in the TD-resected group (1,638 patients) at the

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1st, 2nd, 3rd, 4th, and 5th year were 87.3%, 75.5%, 70.0%, 67.7%, and 65.6%, whereas those

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in the TD-preserved group (1,638 patients) were 89.0%, 76.4%, 69.6%, 65.1%, and 63.4%,

13

respectively (P = 0.307).

14

C) Among c-Stage IA patients, the OS rates in TD-resected group (273 patients) for of at the

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1st, 2nd, 3rd, 4th, and 5th year were 94.8%, 90.3%, 85.4%, 84.2%, and 82.0%, whereas those

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in the TD-preserved group (273 patients) were 96.3%, 91.7%, 87.0%, 82.2%, and 80.1%,

17

respectively (P = 0.552).

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D) Among c-Stage IA patients, the CSS rates in in TD-resected group (273 patients) at the 1st,

19

2nd, 3rd, 4th, and 5th year were 99.2%, 96.8%, 94.0%, 93.1%, and 92.1%, whereas those in

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the TD-preserved group (273 patients) were 98.8%, 96.9%, 95.6%, 92.5%, and 91.1%,

21

respectively (P = 0.746).

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E) Among c-Stage II–IV patients, the OS rates in the TD-resected group (914 patients) at the

23

1st, 2nd, 3rd, 4th, and 5th year were 78.5%, 61.0%, 53.4%, 49.9%, and 46.4%, whereas those

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for in the TD-preserved group (914 patients) were 80.2%, 62.3%, 52.0%, 46.9%, and 44.5%,

25

respectively (P = 0.606).

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F) Among of c-Stage II–IV patients, the CSS rates in the TD-resected group (914 patients) at

Oshikiri 19

the 1st, 2nd, 3rd, 4th, and 5th year were 80.5%, 65.1%, 58.9%, 55.7%, and 53.2%, whereas

those in the TD-preserved group (914 patients) were 84.1%, 66.7%, 57.9%, 53.3%, and 51.6%,

respectively (P = 0.793).

c-Stage, clinical stage; OS, overall survival; CSS, cause-specific survival; TD, thoracic duct.

Fig. 3

The forest plot of hazard ratios for overall survival in c-Stage I–IV (cT1-3/N0-3/M0-1)

patients showed no significant difference between both groups in all subgroups.

Table 1. Demographic and clinical characteristics of c-Stage I-IV patients

Patients of c-Stage I-IV (cT1-3/N0-3/M0-1)

Entire cohort

Matched cohort

Patients with

TD resection

(n = 1815)

Patients with

TD preservation

(n = 10422)

Patients with

TD resection

(n = 1638)

Patients with

TD preservation

(n = 1638)

Gender

(male/female)

1552/249

(86%/14%)

8848/1562

(85%/15%)

0.194 a

1409/229

(86%/14%)

1440/198

(88%/12%)

0.108 a

Age (years)

65 (32-79)

66 (27-79)

0.0002 b

65 (32-79)

65 (27-79)

0.942 b

0.981 a

Year

0.0002 a

2007

252 (14%)

1220 (12%)

225 (14%)

236 (14%)

2008

209 (12%)

1206 (12%)

197 (12%)

186 (12%)

2009

318 (18%)

1890 (18%)

301 (18%)

299 (18%)

2010

351 (19%)

1708 (16%)

313 (19%)

307 (19%)

2011

296 (16%)

2060 (20%)

266 (16%)

266 (16%)

2012

389 (21%)

2338 (22%)

336 (21%)

344 (21%)

204/1047/564

(11%/58%/31%)

1381/5676/3365

(13%/55%/32%)

0.015 a

179/933/526

(11%/57%/32%)

163/943/532

(10%/58%/32%)

0.658 a

Histology

(SCC/adeno carcinoma)

1778/37

(98%/2%)

10245/177

(98%/2%)

0.308 a

1605/33

(98%/2%)

1609/29

(98%/2%)

0.608 a

Depth of tumor invasion

(cT1a/1b/2/3)

52/392/347/1024

(3%/22%/19%/56%)

587/3269/2111/4455

(6%/31%/20%/43%)

<.0001 a

50/362/317/909

(3%/22%/19%/56%)

45/363/313/917

(3%/22%/19%/56%)

0.955 a

Lymph node metastasis

(cN 0/1/2/3)

650/732/357/76

(36%/40%/20%/4%)

5365/3184/1579/294

(51%/31%/15%/3%)

<.0001 a

595/652/318

(36%/40%/19%/5%)

579/666/318/75

(35%/41%/19%/5%)

0.858 a

1799/16

(99%/1%)

10367/55

(99%/1%)

0.067 a

1622/16

(99%/1%)

1629/9

(99%/1%)

0.160 a

531/283/871/16

(31%/17%/51%/1%)

4655/1546/3690/55

(47%/16%/37%/1%)

<.0001 a

483/258/776/16

(32%/17%/51%/1%)

487/237/846/9

(31%/15%/54%/1%)

0.157 a

Preoperative chemotherapy

(yes/no)

733/1068

(41%/59%)

3782/6550

(37%/63%)

0.0009 a

653/985

(40%/60%)

667/971

(41%/59%)

0.608 a

Thoracic procedure

(thoracoscopy/open)

435/1325

(25%/75%)

3605/6549

(35%/65%)

<.0001 a

415/1223

(25%/75%)

433/1205

(26%/74%)

0.473 a

Lymph node dissection

(two-field/three-field)

491/1221

(29%/71%)

3982/5078

(44%/56%)

<.0001 a

472/1166

(29%/71%)

484/1154

(29%/71%)

0.645 a

Multiple cancer of other organs

(yes/no)

150/1659

(8%/92%)

944/9448

(9%/91%)

0.277 a

133/1505

(8%/92%)

118/1520

(7%/93%)

0.325 a

Tumor location

(upper/middle/lower)

Distant metastases

(cM 0/1)

UICC c-stage

(I/II/III/IV)

TD; thoracic duct

χ2 test

Student’s t-test

Oshikiri

Table 2. Initial recurrence patterns in patients with thoracic duct resection or preservation of c-Stage I-IV patients

Patients of c-Stage I-IV (cT1-3/N0-3/M0-1)

Entire cohort

Matched cohort

Patients with

TD resection

(n = 1815)

Patients with

TD preservation

(n = 10422)

Patients with

TD resection

(n = 1638)

Patients with

TD preservation

(n = 1638)

Lymph nodes

430

2454

0.893

376

450

0.0029 a

Local

(area near the primary tumor)

65

399

0.611

55

76

0.061 a

Distant

554

2488

< 0.001 a

499

421

0.0024 a

Dissemination

88

334

0.001

79

57

0.054 a

Lung

157

780

0.085

140

139

0.950 a

Liver

134

636

0.038

119

93

0.065 a

Bone

87

413

0.099

81

73

0.509 a

Brain

25

102

0.122

24

19

0.443 a

others

63

223

0.001

56

40

0.097 a

χ2 test , TD; thoracic duct

...