Factors associated with early recurrence and death after esophagectomy for cancer

Davies, Andrew; Pillai, A; Sinha, Pranab; Sandhu, Harinderjeet; Adeniran, Amina; Mattsson, Fredrik; Choudhury, Asif; Forshaw, Matthew; Gossage, James; Lagergren, Jesper; Allum, William; Mason, Robert C.

doi:10.1002/jso.23511

Cited by 59 publications

(62 citation statements)

References 37 publications

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“…In fact, elevated serum CRP levels have been shown to be associated with disease progression and poor prognosis in patients with esophageal carcinoma and preoperative serum CRP levels have been shown to be an independent prognostic factor in patients with resectable esophageal carcinoma. 23 Thus, HMIE better preserving patients' nutritional status may have a role in a better outcome of these patients. In fact, IL-6-CRP cascade was also used to quantify and compare the invasiveness of orthopedic procedures techniques with encouraging results.…”

Section: Discussionmentioning

confidence: 99%

Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status

et al. 2015

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The purpose of this case-control study was to evaluate the impact of hybrid minimally invasive esophagectomy for cancer on surgical stress response and nutritional status. All 34 consecutive patients undergoing hybrid minimally invasive esophagectomy for cancer at our surgical unit between 2008 and 2013 were retrospectively compared with 34 patients undergoing esophagectomy with open gastric tubulization (open), matched for neoadjuvant therapy, pathological stage, gender and age. Demographic data, tumor features and postoperative course (including quality of life and systemic inflammatory and nutritional status) were compared. Postoperative course was similar in terms of complication rate. Length of stay in intensive care unit was shorter in patients undergoing hybrid minimally invasive esophagectomy (P = 0.002). In the first postoperative day, patients undergoing hybrid minimally invasive esophagectomy had lower C-reactive protein levels (P = 0.001) and white cell blood count (P = 0.05), and higher albumin serum level (P = 0.001). In this group, albumin remained higher also at third (P = 0.06) and seventh (P = 0.008) postoperative day, and C-reactive protein resulted lower at third post day (P = 0.04). Hybrid minimally invasive esophagectomy significantly improved the systemic inflammatory and catabolic response to surgical trauma, contributing to a shorter length of stay in intensive care unit.

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Section: Discussionmentioning

confidence: 99%

Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status

et al. 2015

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“…Patient and tumour characteristics examined were: sex (male or female), age (continuous), preoperative stenting (yes or no), NAC (yes or no), surgery type (TTO versus THO), resection outcome (R0 or R1), lymphovascular invasion (yes or no), pathological stage (pT0 N0, pT1–2 N0, pT1–2 N1, pT1–2 N2–3, pT3–4 N0, pT3–4 N1, pT3–4 N2–3), pathological grade (poorly differentiated, moderately differentiated, well differentiated or complete pathological response), Mandard tumour regression score (1, 2–3, 4–5, or not applicable) and adjuvant treatment (none, chemotherapy or chemoradiotherapy). Time to recurrence was considered to be less relevant, particularly as most recurrences after oesophagectomy occur within 2 years4, 5, 6. It was therefore decided to treat the outcome ‘recurrence’ as a categorical variable using logistic regression.…”

Section: Methodsmentioning

confidence: 99%

“…Once the disease has progressed beyond the mucosa, oesophagectomy is generally an important element in any treatment protocol designed to achieve cure. Unfortunately, a high proportion of patients have evidence of micrometastasis at the time of surgery, and half of all resected patients develop recurrent disease within 2 years of surgery2, 3, 4, 5, 6. Systemic recurrence remains the most common cause of death following oesophageal resection and, as a result, most patients are offered oncological therapies in combination with surgery, in the hope of reducing this risk7.…”

Section: Introductionmentioning

confidence: 99%

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Knight

Zylstra²,

Hemelrijck

et al. 2017

BJS Open

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BackgroundTumour recurrence following oesophagectomy for oesophageal cancer is common despite neoadjuvant treatment. Understanding patterns of recurrence and risk factors associated with locoregional and systemic recurrence might influence future treatment strategies.MethodsThis was a cohort study involving patients undergoing resection for adenocarcinoma or squamous cell carcinoma of the oesophagus between 2000 and 2014. Clinicopathological factors associated with locoregional and systemic recurrence were analysed using multivariable logistic regression to determine odds ratios (ORs) and 95 per cent confidence intervals.ResultsSome 698 patients were identified. Lymphovascular invasion (OR 2·09, 95 per cent c.i. 1·18 to 3·71) and preoperative stenting (OR 3·70, 1·34 to 10·23) were independent risk factors for isolated locoregional recurrence. Pathological nodal disease in patients with pT1–2 (pN1: OR 2·72, 1·35 to 5·48; pN2–3: OR 5·00, 2·35 to 10·66) or pT3–4 (pN1: OR 3·03, 1·51 to 6·07; pN2–3: OR 5·75, 3·15 to 10·49) disease predisposed to systemic recurrence. Poor or no response to chemotherapy was also an independent risk factor for isolated systemic recurrence (OR 1·85, 1·05 to 3·26). A positive resection margin (R1 resection) was not associated with a significantly increased risk of isolated locoregional recurrence (OR 1·37, 0·81 to 2·33).ConclusionThese findings confirm that oesophageal adenocarcinoma is frequently a systemic disease. Understanding the key predictors of local and systemic recurrence may facilitate the tailoring of oncological therapies to the individual patient.

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“…The preoperative model encompassed five factors that would logically imply a threatened margin, namely: depth of tumour invasion (T3–4), aggressive biology (poor differentiation), how well the tumour has responded to treatment (CT estimation of tumour response), tumour size (tumour volume) and evidence of local invasion by involvement of adjacent structures (CT invasion). The fact that these same factors also independently influence overall survival suggests that a positive resection margin is a surrogate for aggressive tumour biology and not simply a measure of inadequate locoregional clearance. This conclusion has also been reached by others.…”

Section: Discussionmentioning

confidence: 99%

Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus

et al. 2019

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BackgroundA positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. The aim of this study was to establish if clinicopathological and radiological variables might predict CRM positivity in patients who received neoadjuvant chemotherapy before surgery for oesophageal adenocarcinoma.MethodsMultivariable analysis of clinicopathological and CT imaging characteristics considered potentially predictive of CRM was performed at initial staging and following neoadjuvant chemotherapy. Prediction models were constructed. The area under the curve (AUC) with 95% confidence intervals (c.i.) from 1000 bootstrapping was assessed.ResultsA total of 223 patients were included in the study. Poor differentiation (odds ratio (OR) 2·84, 95 per cent c.i. 1·39 to 6·01) and advanced clinical tumour status (T3–4) (OR 2·93, 1·03 to 9·48) were independently associated with an increased CRM risk at diagnosis. CT‐assessed lack of response (stable or progressive disease) following chemotherapy independently corresponded with an increased risk of CRM positivity (OR 3·38, 1·43 to 8·50). Additional CT evidence of local invasion and higher CT tumour volume (14 cm3) improved the performance of a prediction model, including all the above parameters, with an AUC (c‐index) of 0·76 (0·67 to 0·83). Variables associated with significantly higher rates of locoregional recurrence were pN status (P = 0·020), lymphovascular invasion (P = 0·007) and poor response to chemotherapy (Mandard score 4–5) (P = 0·006). CRM positivity was associated with a higher locoregional recurrence rate, but this was not statistically significant (P = 0·092).ConclusionThe presence of advanced cT status, poor tumour differentiation, and CT‐assessed lack of response to chemotherapy, higher tumour volume and local invasion can be used to identify patients at risk of a positive CRM following neoadjuvant chemotherapy.

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Factors associated with early recurrence and death after esophagectomy for cancer

Abstract: Esophageal cancer patients with poorly differentiated tumors and three or more involved lymph nodes have a particularly high risk of ERD after surgery. Accurate risk stratification of patients may identify a group who would be better served by alternative oncological treatment strategies.

Cited by 59 publications

References 37 publications

Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status

Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status

Patterns of recurrence in oesophageal cancer following oesophagectomy in the era of neoadjuvant chemotherapy

Prediction of a positive circumferential resection margin at surgery following neoadjuvant chemotherapy for adenocarcinoma of the oesophagus

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