Locally advanced esophageal cancer: What becomes of 5-year survivors?
- PMID: 26651958
- PMCID: PMC5182511
- DOI: 10.1016/j.jtcvs.2015.10.096
Locally advanced esophageal cancer: What becomes of 5-year survivors?
Abstract
Objective: To determine the long-term outcomes of patients with locally advanced esophageal cancer (LAEC) who underwent esophagectomy and survived at least 5 years, and the predictors of disease-free survival (DFS) beyond 5 years.
Methods: This was a retrospective review of a prospective database to identify patients with clinical stage T2N0M0 or higher LAEC. Medical records were reviewed to obtain demographic, clinical, and pathological characteristics, as well as data on recurrence and survival. Multivariable analysis of predictors of DFS beyond 5 years was performed using a Cox regression model.
Results: Between 1988 and 2009, 355 of 500 patients underwent esophagectomy for cT2N0M0 or higher disease. Of these 355 patients, 126 were alive and disease-free at the 5-year follow-up, for an actuarial 5-year DFS of 33%. Recurrent esophageal cancer developed in 8 patients after 5 years. Among the 126 surviving patients, the actuarial overall survival was 94% at 7 years and 80% at 10 years. On multivariable analysis, the sole significant predictor of DFS after the 5-year time point was non-en bloc resection at the original operation (P = .006). Pulmonary-related deaths accounted for 10 out of 22 noncancer deaths. A second primary cancer developed in 23 of the 126 surviving patients.
Conclusions: Prolonged survival can be obtained in one-third of patients with LAEC. An en bloc resection at the original operation is the most significant predictor of prolonged survival. Survivors experience a high rate of second primary cancer and an apparently high rate of deaths from pulmonary disease. Careful follow-up is necessary for these patients, even after the 5-year mark.
Keywords: disease-free survival; en bloc resection; esophageal cancer; recurrence.
Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Statement Authors have nothing to disclose with regard to commercial support. You can watch a Webcast of this AATS meeting presentation by going to: http://webcast.aats.org/2015/Video/Wednesday/04-29-15_608_0908_Ghaly.mp4.
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Comment in
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Measuring quality of life after esophagectomy: Do we really need to go there?J Thorac Cardiovasc Surg. 2016 Mar;151(3):631-632. doi: 10.1016/j.jtcvs.2015.08.111. Epub 2015 Sep 5. J Thorac Cardiovasc Surg. 2016. PMID: 26412314 No abstract available.
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Discussion.J Thorac Cardiovasc Surg. 2016 Mar;151(3):731-732. doi: 10.1016/j.jtcvs.2015.10.107. Epub 2015 Dec 2. J Thorac Cardiovasc Surg. 2016. PMID: 26651963 No abstract available.
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A dream come true: Long-term survivors of esophageal cancer.J Thorac Cardiovasc Surg. 2016 Mar;151(3):733-734. doi: 10.1016/j.jtcvs.2015.11.015. Epub 2015 Dec 1. J Thorac Cardiovasc Surg. 2016. PMID: 26707727 No abstract available.
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