Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease

Abstract

BACKGROUND Despite increasingly radical surgery for esophageal carcinoma, a large number of patients still experience recurrent disease soon after operation. The current study was undertaken to evaluate the pattern of recurrence after curative esophagectomy for cancer of the thoracic esophagus and to identify factors predictive of recurrent disease. METHODS A total of 439 consecutive patients discharged from the authors' institution following R0 resection between January 1982 and July 2002 were followed for evidence of recurrence over a mean interval of 37.3 (range, 1–207) months. RESULTS Overall 1‐, 3‐ and 5‐years survival rates were 91%, 54%, and 41%, respectively. Some 230 patients (52.4%) developed proven recurrence, of whom 24 were alive and 206 were dead at the time of writing. The median time to recurrence was 12.0 (range, 6–96) months, with a median survival thereafter of 7.0 (range, 0–83) months. The pattern of recurrence was local in 12.1%, regional in 20.5% (cervical 3.6%, mediastinal 14.8%, and abdominal 2.1%), and distant in 19.8%, respectively. The overall pattern of dissemination was significantly different according to the histologic subtype (P = 0.021). One hundred five (45.7%) of all recurrences occurred within 12 months of surgery, with local, regional, and distant recurrence occurring at a median of 14.0 (range, 6–77), 13.5 (range, 6–73), and 11.0 (range, 6–96) months, respectively; A factor predictive of recurrent disease was histologic tumor depth invasion (P = 0.001). CONCLUSIONS Depth of tumor invasion should be used to identify patients who will have recurrence within 12 months of operation, so that these patients may be either entered into trials of multimodality treatment or offered nonsurgical palliation. Cancer 2003;97:1616–23. © 2003 American Cancer Society. DOI 10.1002/cncr.11228

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

“…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.…”

“…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.…”

MicroRNA-141 confers resistance to cisplatin-induced apoptosis by targeting YAP1 in human esophageal squamous cell carcinoma

“…18 In spite of comprehensive available treatment, including chemotherapy, surgery and radiotherapy, the overall 5-year survival rate for patients with esophageal squamous cell carcinoma (ESCC), the most common form of esophageal cancer, remains low, at 10-40%, because of advanced disease, metastasis and resistance of the tumor to chemotherapy and radiotherapy. [19][20][21] Cisplatin is the most frequently used chemotherapeutic agent for ESCC. However, given that resistance to cisplatin limits the success of treatment, elucidation of the mechanisms that regulate cisplatin resistance in ESCC is urgently needed.…”

Esophageal Cancer with Solitary Renal Metastasis Treated with Multidisciplinary Therapy: A Case Report and Mini Review of the Literature

“…3 Although 50% to 70% of patients can be treated surgically with curative intent, half of these patients suffer from local recurrence or distant metastasis after complete resection. 4 The most common sites of metastasis are the liver, lungs, bones, and adrenal glands through the hematogenous route. 4,5 However, the development of a solitary renal metastasis of esophageal cancer has rarely been reported.…”

“…4 The most common sites of metastasis are the liver, lungs, bones, and adrenal glands through the hematogenous route. 4,5 However, the development of a solitary renal metastasis of esophageal cancer has rarely been reported. Herein, we report a case of solitary renal metastasis after esophagectomy of advanced esophageal cancer treated by multimodality.…”