Recurrence patterns and associated factors of locoregional failure following neoadjuvant chemoradiation and surgery for esophageal cancer. Issue 2 (22nd August 2017)

• Record Type: Journal Article
• Authors: Blackham, Aaron U.; H. Naqvi, Syeda M.; Schell, Michael J.; Jin, William; Gangi, Alexandra; Almhanna, Khaldoun; Fontaine, Jacques P.; Hoffe, Sarah E.; Frakes, Jessica; Venkat, Puja; Pimiento, Jose M.
• Is Part Of: Journal of surgical oncology. Volume 117:Issue 2(2018)
• Page Start: 150
• Page End: 159
• Publication Date: 2017-08-22
• Subjects: esophagectomy -- outcomes -- prognosis -- risk factors; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.24808
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract : Background: Despite neoadjuvant chemoradiation (nCRT) followed by esophagectomy for locally advanced esophageal cancer, locoregional recurrence (LRR) is common and factors associated with LRR have not been clearly identified. Methods: Patients were identified from a single institution, prospectively maintained database (1996‐2013). Patterns of recurrence were described and associated factors of LRR were analyzed using competing risks regression models. Results: Of the 456 patients treated with nCRT and surgery, 167 patients developed recurrence. Locoregional and distant recurrences were observed in 69 (15.1%) and 140 (30.9%) patients, respectively. Time to recurrence (13.6 vs 10.4 months, P = 0.20) and median overall survival (29.3 vs 19.1 months, P = 0.12) were no different among the 27 patients (6%) who developed a solitary LRR compared to patients who developed distant recurrence. Univariable analysis identified lymphovascular invasion (HR 1.46, P = 0.07), lymph node ratio >0.5 (HR 2.16, P = 0.02), positive margin (HR 1.95, P = 0.05), lack of response to neoadjuvant therapy (HR 1.99, P < 0.01), clinical T stage (HR 2.62, P < 0.01) and final T3/4 stage (HR 2.06, P < 0.01) as factors significantly associated with LRR. Clinical T stage and response to neoadjuvant treatment were independently associated with LRR on multivariable analysis. Conclusions: Although aggressive tumor biology plays a significant role in LRR, optimizing neoadjuvant treatments to obtain a complete pathologic response may lead to improved locoregional control.