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 language | English |
---|---|
Pages (from-to) | 459-464 |
Number of pages | 6 |
Journal | Journal of Surgical Oncology |
Volume | 109 |
Issue number | 5 |
DOIs | |
Publication status | Published - 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