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

doi:10.1002/jso.23511

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

Guy's and St Thomas' NHS Foundation Trust
Karolinska Institute
Royal Marsden NHS Foundation Trust

Research output: Contribution to journal › Article › peer-review

67 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 language	English
Pages (from-to)	459-464
Number of pages	6
Journal	Journal of Surgical Oncology
Volume	109
Issue number	5
DOIs	https://doi.org/10.1002/jso.23511
Publication status	Published - Apr 2014

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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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10.1002/jso.23511

Cite this

@article{36c4590bb9754884b60e8c129f850ba8,

title = "Factors associated with early recurrence and death after esophagectomy for cancer",

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. ",

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",

author = "Davies, \{Andrew R.\} and Andrew Pillai and Pranab Sinha and Harinderjeet Sandhu and Amina Adeniran and Fredrik Mattsson and Asif Choudhury and Forshaw, \{Matthew J.\} and James Gossage and Jesper Lagergren and Allum, \{William H.\} and Robert Mason",

year = "2014",

month = apr,

doi = "10.1002/jso.23511",

language = "English",

volume = "109",

pages = "459--464",

journal = "Journal of Surgical Oncology",

issn = "0022-4790",

publisher = "Wiley-Liss Inc.",

number = "5",

}

TY - JOUR

T1 - Factors associated with early recurrence and death after esophagectomy for cancer

AU - Davies, Andrew R.

AU - Pillai, Andrew

AU - Sinha, Pranab

AU - Sandhu, Harinderjeet

AU - Adeniran, Amina

AU - Mattsson, Fredrik

AU - Choudhury, Asif

AU - Forshaw, Matthew J.

AU - Gossage, James

AU - Lagergren, Jesper

AU - Allum, William H.

AU - Mason, Robert

PY - 2014/4

Y1 - 2014/4

N2 - 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.

AB - 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.

KW - surgery

KW - recurrence

KW - esophageal cancer

KW - QUALITY-OF-LIFE

KW - CIRCUMFERENTIAL RESECTION MARGIN

KW - POSITRON-EMISSION-TOMOGRAPHY

KW - ENDOSCOPIC ULTRASOUND

KW - ESOPHAGOGASTRIC JUNCTION

KW - NEOADJUVANT CHEMOTHERAPY

KW - PREOPERATIVE CHEMORADIOTHERAPY

KW - GASTROESOPHAGEAL CANCER

KW - HIGH-RESOLUTION

KW - TUMOR RESPONSE

U2 - 10.1002/jso.23511

DO - 10.1002/jso.23511

M3 - Article

SN - 0022-4790

VL - 109

SP - 459

EP - 464

JO - Journal of Surgical Oncology

JF - Journal of Surgical Oncology

IS - 5

ER -

Factors associated with early recurrence and death after esophagectomy for cancer

Abstract

UN SDGs

Keywords

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