Prognostic Factors for Post-Recurrence Survival in Patients with Thoracic Esophageal Squamous Cell Carcinoma after Curative Resection

Abstract

Background/Aims: We investigated factors affecting the post-recurrence prognosis in order to develop adequate therapeutic guidelines for determining the indication for treatment of recurrent esophageal squamous cell carcinoma (ESCC). Methods: Ninety-three thoracic ESCC patients who developed postoperative recurrence after undergoing curative esophagectomy with 3-field lymphadenectomy at our institute and who received treatment for recurrence were enrolled in this study. Results: A univariate analysis showed that distant organ recurrence, the number of recurrent tumors, the longest diameter of the largest recurrent tumor, the sum of all of the longest diameters of the recurrent tumors, invasion into adjacent structures and the speed of growth of the representative recurrent tumors were significantly associated with the post-recurrence prognosis. A multivariate analysis showed that distant organ recurrence, the longest diameter of the largest recurrent tumor, invasion into adjacent structures and the speed of growth of the representative recurrent tumors were significantly associated with the prognosis. The patients whose recurrent tumor(s) did not meet all 4 of these factors showed a better prognosis. In contrast, the prognosis of the patients whose recurrent tumor(s) demonstrated all 4 factors was almost the same as that observed in the patients who did not receive any treatment for recurrence. Conclusions: The evaluation of these 4 factors may potentially be used to determine the indication for treatment for recurrence.

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“…The last one is the most critical factor in recurrence and affects survival in the long term after the procedure. Positive vertical margin also was identified in other studies by our department in addition to the longest diameter of the largest recurrent tumor, invasion into adjacent structures and speed of growth of the representative recurrent tumors [16,17]. Survival rate % ▶ Fig.…”

“…That has already been described previously by other authors for curability criteria [9,15]. In our cases, the first line for additional therapy was surgery (3FLD), and chemotherapy for patients who were not eligible for surgical treatment, to avoid recurrence and complications as described in past studies of post-recurrence cases [16]. In our patients with tumor-free margins, we practice periodic observation for at least 5 years to provide early control of recurrence.…”

Mid- and long-term outcomes of endoscopic resection for submucosal esophageal cancer types pT1b-SM1 and pT1b-SM2

“…That has already been described previously by other authors for curability criteria 9 15 . In our cases, the first line for additional therapy was surgery (3FLD), and chemotherapy for patients who were not eligible for surgical treatment, to avoid recurrence and complications as described in past studies of post-recurrence cases 16 . In our patients with tumor-free margins, we practice periodic observation for at least 5 years to provide early control of recurrence.…”

Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer

“…As a result, 3FLD can be appropriate; extended lymphadenectomy may prevent recurrence and prolong survival [5]. Furthermore, in recurrent tumors, the use of 3FLD has been reported to help improve an otherwise poor prognosis [7]. …”