Factors associated with early recurrence and death after esophagectomy for cancer. Issue 5 (2nd December 2013)

• Record Type: Journal Article
• Authors: Davies, Andrew R.; Pillai, Andrew; Sinha, Pranab; Sandhu, Harinderjeet; Adeniran, Amina; Mattsson, Fredrik; Choudhury, Asif; Forshaw, Matthew J.; Gossage, James A.; Lagergren, Jesper; Allum, William H.; Mason, Robert C.
• Is Part Of: Journal of surgical oncology. Volume 109:Issue 5(2014:Apr. 01)
• Page Start: 459
• Page End: 464
• Publication Date: 2013-12-02
• Subjects: Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.23511
• Languages: English
• ISSNs: 0022-4790

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jso23511-sec-0001" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="jso23511-sec-0002" sec-type="section"> <title>Methods</title> <p>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).</p> </sec> <sec id="jso23511-sec-0003" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="jso23511-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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. <italic>J. Surg. Oncol. 2014 109:459–464</italic>. © 2013 Wiley Periodicals, Inc.</p> </sec> </abstract>