Factors associated with early recurrence and death after esophagectomy for cancer

Andrew R. Davies*, Andrew Pillai, Pranab Sinha, Harinderjeet Sandhu, Amina Adeniran, Fredrik Mattsson, Asif Choudhury, Matthew J. Forshaw, James Gossage, Jesper Lagergren, William H. Allum, Robert Mason

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    61 Citations (Scopus)

    Abstract

    Background 
    Accurate selection of patients for radical treatment of esophageal cancer is essential to avoid early recurrence and death (ERD) after surgery. We sought to evaluate a large series of consecutive resections to assess factors that may be associated with this poor outcome. 

    Methods 
    This was a cohort study including 680 patients operated for esophageal cancer between 2000 and 2010. The poor outcome group comprised 100 patients with tumor recurrence and death within 1 year of surgery. The comparison group comprised 267 long-term survivors, defined as those surviving more than 3 years from surgery. Pathological characteristics associated with poor outcome were analyzed using logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). 

    Results 
    On the adjusted model T stage and N stage predicted poor survival, with the greatest risk being patients with locally advanced tumors and three or more involved lymph nodes (OR 10.6, 95% CI 2.8-40.0). Poor differentiation (OR 2.8, 95% CI 1.4-5.5), chemotherapy response (OR 3.6, 95% CI 1.2-10.6), and involved resection margins (OR 2.7, 95% CI 1.2-6.0) were all significant independent prognostic markers in the multivariable model. There was a trend toward worse survival with lymphovascular invasion (OR 2.0, 95% CI 0.9-4.2) and low albumin (OR 1.9, 95% CI 0.8-4.4) but not of statistical significance in the adjusted model. 

    Conclusions 
    Esophageal cancer patients with poorly differentiated tumors and three or more involved lymph nodes have a particularly high risk of ERD after surgery. Accurate risk stratification of patients may identify a group who would be better served by alternative oncological treatment strategies. 

    Original languageEnglish
    Pages (from-to)459-464
    Number of pages6
    JournalJournal of Surgical Oncology
    Volume109
    Issue number5
    DOIs
    Publication statusPublished - Apr 2014

    Keywords

    • surgery
    • recurrence
    • esophageal cancer
    • QUALITY-OF-LIFE
    • CIRCUMFERENTIAL RESECTION MARGIN
    • POSITRON-EMISSION-TOMOGRAPHY
    • ENDOSCOPIC ULTRASOUND
    • ESOPHAGOGASTRIC JUNCTION
    • NEOADJUVANT CHEMOTHERAPY
    • PREOPERATIVE CHEMORADIOTHERAPY
    • GASTROESOPHAGEAL CANCER
    • HIGH-RESOLUTION
    • TUMOR RESPONSE

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