F-094CLINICAL PREDICTORS OF EARLY MORTALITY FOLLOWING NEOADJUVANT THERAPY AND OESOPHAGECTOMY. (June 2014)

• Record Type: Journal Article
• Authors: Stiles, Brendon; Nasar, A.; Salzler, G.; Paul, S.; Lee, P.; Port, J.; Altorki, N.
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 18(2014)Supplement 1
• Page Start: S25
• Page End: S25
• Publication Date: 2014-06
• Subjects: Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivu167.94
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract : Objectives: Although oesophagectomy can be curative for patients with oesophageal cancer, it may be associated with high morbidity and decreased quality of life. Identifying risk factors for early systemic progression or death after oesophagectomy may help to guide treatment choices in at-risk patients. Methods: Patients undergoing oesophagectomy following neoadjuvant therapy for oesophageal cancer (11/87-1/13) were reviewed, excluding incomplete resections and deaths ≤3 months. Univariate predictors of death ≤1 year of operation were explored by logistic regression. Significant predictors ( P ≤ 0.1) were included in a multivariate model. A risk factor index was created based upon number of significant risk factors in individual patients. Results: Of 551 patients, 238 had neoadjuvant chemo or chemoradiotherapy followed by oesophagectomy (median age 64, adenocarcinoma 73%, male 79%). Of these, 14% died ≤1 year following oesophagectomy, 79% with cancer recurrence. Clinical predictors of death ≤1 year by univariate analysis included performance status >0 (OR 2.4; CI 0.97-5.94), poor tumour differentiation (OR 3.44; CI 1.28-9.24), and lack of clinical response (no response/progression versus complete/partial response) to neoadjuvant therapy (OR 3.04; CI 1.24-7.47). For patients with all factors evaluable ( n = 167), variables were summed to derive a cumulative risk factor index, 0-3. An increased risk factor index (≥2) was highly associated with increased risk of death ≤1 year postoperatively (OR 4.84; CI 1.93-12.16), as well as with poor overall survival. On multivariate analysis, poor differentiation (OR 3.18; CI 1.16-8.71, P = 0.025) and lack of clinical response to induction therapy (OR 2.73; CI 1.08-6.92, P = 0.034) were most predictive of early death. Conclusions: Clinically-defined risk factors predicting early mortality following oesophagectomy for oesophageal cancer include performance status, poor tumour differentiation, and advanced clinical stage. In patients with at least two of these risk factors, 29% die within one year of surgery. These patients should be identified and individual consideration given to less morbid surgical strategies or alternative treatments. Disclosure: No significant relationships.