205: ADJUNCTIVE SURVEILLANCE MODALITIES AND ONCOLOGIC OUTCOME: A REPORT FROM THE ENSURE STUDY. (23rd April 2022) - Elliott, J A
Abstract: Background and aim: Established and emerging therapies for recurrent esophageal cancer may impact survival and health-related quality-of-life (HRQL), however surveillance protocols after primary curative treatment are inconsistent. Specifically, whether advantages exist for adjunctive surveillance modalities is unknown and was the focus of this study. Methods: ENSURE was an international multicenter observational study of consecutive patients undergoing curative-intent surgery for esophageal and esophagogastric junction cancers (2009–2015) across 20 European and North American cancer centers (NCT03461341). The initial report from ENSURE assessed the impact of intensive imaging surveillance on the primary outcome measure of overall survival (OS); secondary outcomes included treatment, disease-specific survival, recurrence pattern, and HRQL. In the present study, multivariable linear, logistic and Cox proportional hazards regression analyses were performed to determine the independent impact of adjunctive surveillance modalities on oncologic outcome. Results: Results 4, 682 patients were studied (72.6% adenocarcinoma, 69.1% neoadjuvant therapy). Routine biochemistry, nutritional profiling, tumor markers, surveillance endoscopy and flexible nasolaryngoscopy were routinely assessed in 37, 33, 15, 19 and 7% of Centers, respectively. Routine biochemistry and tumour markers were associated with reduced risk of symptomatic recurrence, however neither modality was associated with survival benefit. Endoscopic surveillance was independently associated with increased probability of isolated local or anastomotic recurrence (OR1.49 [1.05–2.14]), and reduced probability of symptomatic recurrence (OR0.17 [0.12–0.25]), but not with improved OS. On subgroup analysis, endoscopic surveillance was associated with reduced symptomatic recurrence (OR0.19 [0.12–0.29]) and increased probability of tumour-directed therapy among patients with adenocarcinoma (OR1.65 [1.14–2.38]), but not those with SCC. Endoscopic surveillance was associated with improved OS (HR0.73 [0.55–0.98]) among patients with Barrett's oesophagus, while flexible nasolaryngoscopy was associated with improved OS among patients with SCC (HR0.19 [0.05–0.80]). Nutritional surveillance was independently associated with increased tumor-directed therapy, improved HRQL ( P = 0.015) and OS (HR0.89 [0.80–0.99]), while a multimodal surveillance approach was also associated with improved OS (HR0.83 [0.72–0.95]). Conclusion: These data suggest that a multimodal and tailored surveillance approach may improve oncologic outcomes following curative-intent surgery for esophageal and esophagogastric junction cancer. These findings may inform guideline development and shared decision-making with patients.