TY - JOUR
T1 - Recurrent Disease After Esophageal Cancer Surgery
T2 - A Substudy of The Dutch Nationwide Ivory Study
AU - Kalff, Marianne C.
AU - Henckens, Sofie P. G.
AU - Voeten, Daan M.
AU - Heineman, David J.
AU - Hulshof, Maarten C. C. M.
AU - van Laarhoven, Hanneke W. M.
AU - Eshuis, Wietse J.
AU - Baas, Peter C.
AU - Bahadoer, Renu R.
AU - Belt, Eric J. T.
AU - Brattinga, Baukje
AU - Claassen, Linda
AU - Ćosović, Admira
AU - Crull, David
AU - Daams, Freek
AU - van Dalsen, Annette D.
AU - Dekker, Jan Willem T.
AU - van Det, Marc J.
AU - Drost, Manon
AU - van Duijvendijk, Peter
AU - van Esser, Stijn
AU - Gaspersz, Marcia P.
AU - Görgec, Burak
AU - Groenendijk, Richard P. R.
AU - Hartgrink, Henk H.
AU - van der Harst, Erwin
AU - Haveman, Jan W.
AU - Heisterkamp, Joos
AU - van Hillegersberg, Richard
AU - Kelder, Wendy
AU - Kingma, B. Feike
AU - Koemans, Willem J.
AU - Kouwenhoven, Ewout A.
AU - Lagarde, Sjoerd M.
AU - Lecot, Frederik
AU - van der Linden, Philip P.
AU - Luyer, Misha D. P.
AU - Nieuwenhuijzen, Grard A. P.
AU - Olthof, Pim B.
AU - van der Peet, Donald L.
AU - Pierie, Jean-Pierre E. N.
AU - Pierik, E. G. J. M. Robert
AU - Plat, Victor D.
AU - Polat, Fatih
AU - Rosman, Camiel
AU - Ruurda, Jelle P.
AU - van Sandick, Johanna W.
AU - Scheer, Rene
AU - Slootmans, Cettela A. M.
AU - Sosef, Meindert N.
AU - Sosef, Odin V.
AU - de Steur, Wobbe O.
AU - Stockmann, Hein B. A. C.
AU - Stoop, Fanny J.
AU - Vugts, Guusje
AU - Vijgen, Guy H. E. J.
AU - Weeda, V. ola B.
AU - Wiezer, Marinus J.
AU - van Oijen, Martijn G. H.
AU - van Berge Henegouwen, Mark I.
AU - Gisbertz, Suzanne S.
N1 - Publisher Copyright: Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - OBJECTIVE: This study investigated the patterns, predictors, and survival of recurrent disease following esophageal cancer surgery. BACKGROUND: Survival of recurrent esophageal cancer is usually poor, with limited prospects of remission. METHODS: This nationwide cohort study included patients with distal esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma after curatively intended esophagectomy in 2007 to 2016 (follow-up until January 2020). Patients with distant metastases detected during surgery were excluded. Univariable and multivariable logistic regression were used to identify predictors of recurrent disease. Multivariable Cox regression was used to determine the association of recurrence site and treatment intent with postrecurrence survival. RESULTS: Among 4626 patients, 45.1% developed recurrent disease a median of 11 months postoperative, of whom most had solely distant metastases (59.8%). Disease recurrences were most frequently hepatic (26.2%) or pulmonary (25.1%). Factors significantly associated with disease recurrence included young age (≤65 y), male sex, adenocarcinoma, open surgery, transthoracic esophagectomy, nonradical resection, higher T-stage, and tumor positive lymph nodes. Overall, median postrecurrence survival was 4 months [95% confidence interval (95% CI): 3.6-4.4]. After curatively intended recurrence treatment, median survival was 20 months (95% CI: 16.4-23.7). Survival was more favorable after locoregional compared with distant recurrence (hazard ratio: 0.74, 95% CI: 0.65-0.84). CONCLUSIONS: This study provides important prognostic information assisting in the surveillance and counseling of patients after curatively intended esophageal cancer surgery. Nearly half the patients developed recurrent disease, with limited prospects of survival. The risk of recurrence was higher in patients with a higher tumor stage, nonradical resection and positive lymph node harvest.
AB - OBJECTIVE: This study investigated the patterns, predictors, and survival of recurrent disease following esophageal cancer surgery. BACKGROUND: Survival of recurrent esophageal cancer is usually poor, with limited prospects of remission. METHODS: This nationwide cohort study included patients with distal esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma after curatively intended esophagectomy in 2007 to 2016 (follow-up until January 2020). Patients with distant metastases detected during surgery were excluded. Univariable and multivariable logistic regression were used to identify predictors of recurrent disease. Multivariable Cox regression was used to determine the association of recurrence site and treatment intent with postrecurrence survival. RESULTS: Among 4626 patients, 45.1% developed recurrent disease a median of 11 months postoperative, of whom most had solely distant metastases (59.8%). Disease recurrences were most frequently hepatic (26.2%) or pulmonary (25.1%). Factors significantly associated with disease recurrence included young age (≤65 y), male sex, adenocarcinoma, open surgery, transthoracic esophagectomy, nonradical resection, higher T-stage, and tumor positive lymph nodes. Overall, median postrecurrence survival was 4 months [95% confidence interval (95% CI): 3.6-4.4]. After curatively intended recurrence treatment, median survival was 20 months (95% CI: 16.4-23.7). Survival was more favorable after locoregional compared with distant recurrence (hazard ratio: 0.74, 95% CI: 0.65-0.84). CONCLUSIONS: This study provides important prognostic information assisting in the surveillance and counseling of patients after curatively intended esophageal cancer surgery. Nearly half the patients developed recurrent disease, with limited prospects of survival. The risk of recurrence was higher in patients with a higher tumor stage, nonradical resection and positive lymph node harvest.
KW - Esophageal cancer
KW - Esophagectomy
KW - Neoadjuvant treatment
KW - Palliative treatment
KW - Recurrences
UR - http://www.scopus.com/inward/record.url?scp=85139571115&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/SLA.0000000000005638
DO - https://doi.org/10.1097/SLA.0000000000005638
M3 - Article
C2 - 35880759
SN - 0003-4932
VL - 276
SP - 806
EP - 813
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -