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. 2021 Jun;14(6):101066.
doi: 10.1016/j.tranon.2021.101066. Epub 2021 Mar 18.

Definition and risk factors of early recurrence based on affecting prognosis of esophageal squamous cell carcinoma patients after radical resection

Yaowen Zhang  1 , Junhui Gao  2 , Anping Zheng  3 , Haijun Yang  1 , Jian Li  1 , Shouxin Wu  4 , Jiangman Zhao  5 , Peng Meng  6 , Fuyou Zhou  7
Affiliations

Definition and risk factors of early recurrence based on affecting prognosis of esophageal squamous cell carcinoma patients after radical resection

Yaowen Zhang et al. Transl Oncol. 2021 Jun.

Abstract

Early recurrence after surgery could affect cancerous patients' prognosis, but the definition of early recurrence and its risk factors for esophageal squamous cell carcinoma (ESCC) patients are still unclear. This study analyzed the clinical data of 468 post-surgery recurrent ESCC patients retrospectively. A minimum p-value approach was used to evaluate the optimal cut-off value of recurrence free survival (RFS) to define early recurrence. Risk factors of early recurrence were developed based on a Cox model. The optimal cut-off value of RFS to distinguish early recurrence was 21 months (p <0.001). Independent risk factors for early recurrence included tumor locations (HR=0.562, p <0.001), pathological T stage (HR=1.829, p <0.001), tumor diameter (HR=1.344, p = 0.039), positive lymph nodes (HR=1.361, p <0.001), and total resected lymph nodes (HR=1.271, p = 044). For the late recurrent patients, there was a much more significant survival advantage for recurrence after concurrent chemoradiotherapy than that after sequential chemoradiotherapy and radiotherapy alone (p = 0.0066). In conclusion, this study defined 21 months of RFS as early recurrence and also identified its risk factors. Concurrent chemoradiotherapy was suggested as preferred post-relapse treatment for late recurrent ESCC patients.

Keywords: Early recurrence; Esophageal squamous cell carcinoma; Esophagectomy; Minimum p-value; Post-relapse treatment.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no competing interests.

Figures

Fig 1
Fig. 1
The probability density distribution and correlations of survivals in all patients. (A) Probability density plot of overall survival (OS) (orange line), recurrence-free survival (RFS) (blue line), and post-recurrence survival (PRS) (green line) distribution in all patients. (B, C) Correlations between RFS and PRS (B) and RFS and OS (C) in all patients.
Fig 2
Fig. 2
Defining early and late recurrence. (A) Different cutoff thresholds (x-axis), with the corresponding p values (y-axis), show that the optimal threshold for defining early and late recurrence based on the difference in overall survival is 21 months. (B, C) Kaplan‐Meier Curves showing the difference of OS (B) and PRS (C) between early and late recurrence.
Fig 3
Fig. 3
Kaplan‐Meier Curves of important perioperative variables. Kaplan‐Meier Curves of important perioperative variables significantly associated with RFS (p <0.05) with a primary endpoint of early recurrence (RFS <21 months), including (A) tumor location, (B) positive lymph node (LN), (C) TLNs, (D) pathological T stage, (E) pathological stage, (F) clinicopathological type, and (G) tumor diameter.
Fig 4
Fig. 4
Forest plot of hazard ratio based on multivariate Cox proportional hazards model.
Fig 5
Fig. 5
Kaplan‐Meier Curves demonstrating prognostic differences of post-relapse therapeutic strategies between early (A) and late recurrence (B). Blue line indicates radiotherapy (RT) alone; orange line indicates concurrent chemoradiotherapy (CCRT); and green line indicates sequential chemoradiotherapy (SCRT).
See this image and copyright information in PMC

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