Incidence and management of esophageal cancer recurrence to regional lymph nodes after curative esophagectomy. Issue 10 (5th January 2023)

• Record Type: Journal Article
• Authors: Boerner, Thomas; Carr, Rebecca A.; Hsu, Meier; Michel, Alexa; Tan, Kay See; Vos, Elvira; Sihag, Smita; Bains, Manjit S.; Ku, Geoffrey Y.; Wu, Abraham J.; Jones, David R.; Molena, Daniela
• Is Part Of: International journal of cancer. Volume 152:Issue 10(2023)
• Page Start: 2109
• Page End: 2122
• Publication Date: 2023-01-05
• Subjects: curative esophagectomy -- esophageal cancer -- recurrence; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34417
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Up to 50% of patients treated with curative esophagectomy for esophageal cancer will develop recurrence, contributing to the dismal survival associated with this disease. Regional recurrence may represent disease that is not yet widely metastatic and may therefore be amenable to more‐aggressive treatment. We sought to assess all patients treated with curative esophagectomy for esophageal cancer who developed regional recurrence. We retrospectively identified all patients who underwent esophagectomy for esophageal adenocarcinoma and esophageal squamous cell carcinoma at a single institution from January 2000 to August 2019. In total, 1626 patients were included in the study cohort. As of June 2022, 595 patients had disease recurrence, which was distant or systemic in 435 patients (27%), regional in 125 (7.7%) and local in 35 (2.2%). On multivariable analysis, neoadjuvant chemoradiation with a total radiation dose <45 Gy (hazard ratio [HR], 3.5 [95% CI, 1.7‐7.3]; P = .001), pathologic node‐positive disease (HR, 1.9 [95% CI, 1.3‐3.0]; P = .003) and lymphovascular invasion (HR, 1.6 [95% CI, 1.0‐2.5]; P = .049) were predictors of isolated nodal recurrence, whereas increasing age (HR, 0.97 [95% CI, 0.96‐0.99]; P = .001) and increasing number of excised lymph nodes (HR, 0.98 [95% CI, 0.95‐1.00]; P = .021) were independently associated with decreased risk of regional recurrence. Patients treated with a combination of local and systemic therapies had better survival outcomes than patients treated with systemic therapy alone ( P < .001). In patients with recurrence of esophageal cancer limited to regional lymph nodes, salvage treatment may be possible. Higher radiation doses and more‐extensive lymphadenectomy may reduce the risk of regional recurrence. Abstract : What's new? Currently, a one‐size‐fits‐all, palliative systemic treatment approach is often used for patients with esophageal cancer recurrence. However, regional recurrence may represent disease that is not yet widely metastatic and may therefore be amenable to more‐aggressive treatment. This retrospective single‐center study shows that a significant proportion of esophageal cancer patients with recurrence have disease limited to the regional lymph nodes and suggests that salvage treatment may be possible in these patients. Moreover, the results show that higher radiation doses and more‐extensive lymphadenectomy may reduce the risk of regional recurrence.