Recurrent Disease After Esophageal Cancer Surgery

Kalff, Marianne C.; Henckens, Sofie; Voeten, Daan M.; Heineman, David J.; Hulshof, Maarten C.C.M.; Laarhoven, H.W.M. van; Eshuis, Wietse J.; Baas, Peter C.; Bahadoer, Renu R.; Belt, Eric; Brattinga, Baukje; Claassen, Linda; Ćosović, Admira; Crull, David; Daams, Freek; Dalsen, Annette D van; Dekker, Jan Willem T.; Det, Marc J. van; Drost, Manon; Duijvendijk, Peter van; Esser, Stijn van; Gaspersz, M.; Görgec, Burak; Groenendijk, R.P.R.; Hartgrink, Henk H.; Harst, Erwin van der; Haveman, Jan Willem; Heisterkamp, Joos; Hillegersberg, Richard van; Kelder, Wendy; Kingma, B. Feike; Koemans, Willem J.; Kouwenhoven, Ewout A.; Lagarde, Sjoerd M.; Lecot, Frederik; Linden, Philip P van der; Luyer, Misha; Nieuwenhuijzen, G.A.P.; Olthof, Pim B.; Peet, Donald L. van der; Pierie, Jean-Pierre E. N.; Pierik, E.G.J.M.; Plat, Victor D.; Polat, Fatih; Rosman, Camiel; Ruurda, Jelle P.; Sandick, Johanna W. van; Scheer, Rene; Slootmans, Cettela A.M.; Sosef, Meindert N.; Sosef, Odin; Steur, Wobbe O. de; Stockmann, H. B. A. C.; Stoop, Fanny; Vugts, Guusje; Vijgen, Guy H. E. J.; Weeda, Víola B; Wiezer, Marinus J.; Oijen, Martijn G.H. van; Henegouwen, Mark I. van Berge; Gisbertz, Suzanne S.

doi:10.1097/sla.0000000000005638

Cited by 10 publications

(11 citation statements)

References 41 publications

(107 reference statements)

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“…The present study demonstrates the aggressive nature of EC with high recurrence rates after curative treatments [3]. In our series, approximately 30% of patients developed recurrent disease after curative treatments, 80% of all recurrences were detected within 2 years, and median post-recurrence survival was 12.9 months, observations which are in line with previous studies [4,5,8].…”

Section: Discussionsupporting

confidence: 92%

“…Second, our cohort was comprised of patients receiving various treatment modalities. Recurrence patterns and timing differ according to the initial treatments [3,4,29], which might have affected the results. Third, it is not possible to discern whether the observed isolated solid organ disease represents true OM or the rst clinically apparent presentation of widespread metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

“…Disease recurrences were classi ed as solely locoregional, solely distant, or combined [3]. Locoregional recurrences (LRRs) were located at the site of the primary tumor or in the locoregional lymph nodes, while distant recurrences were systemic or in nonregional lymph nodes, and combined recurrences were de ned as the coexistence of locoregional and distant recurrences, regardless of the order of occurrence.…”

Section: De Nitions Of Recurrence and Oligo Metastasismentioning

confidence: 99%

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Survival outcomes of esophageal cancer patients with recurrence after curative treatments

Sugawara

Oka

Yoshii

et al. 2023

Preprint

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Background: Little is known about predictive factors for survival outcomes of esophageal carcinoma (EC) patients who developed recurrence after undergoing multimodal therapies. We aimed to investigate long-term outcomes and identify prognostic factors in patients with relapsed EC, focusing especially on those with oligometastasis (OM).Methods: EC patients who developed recurrence after curative treatments (radical esophagectomy or definitive chemoradiotherapy (dCRT)) between 2010 and 2017 were reviewed. Multivariate Cox hazards models were applied to determine independent predictors of poor post-recurrence survival (PRS).Results: In total, 178 patients were included. The median PRS was 12.9 months. Of the 178 patients, 98 had OM and 80 non-OM (NOM) disease. The survival outcomes of patients with OM were significantly better than those of patients with NOM (P < 0.01). Surgical treatments provided significantly better survival outcomes than CRT or chemo-/radiotherapy alone (3-year overall survival (OS); 78.1% vs. 42.5% vs. 28.9%, P < 0.01), mainly due to prolonging survival after the recurrence (3-year PRS 62.9% vs. 16.7% vs. 16.2%, P < 0.01). Multivariable analysis focusing on patients with OM revealed cStage III-IV disease (P < 0.01), high GPS at the time of recurrence (P = 0.02) and non-curative treatments (P < 0.01), to be independently associated with poor PRS. In contrast, in patients with NOM, no independent predictors for poor PRS were identified.Conclusions: The survival outcomes of patients with relapsed EC remain poor. Surgical treatments provided significantly better survival outcomes than other treatment modalities, especially in patients with OM, mainly due to prolonging survival after the recurrence.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: De Nitions Of Recurrence and Oligo Metastasismentioning

confidence: 99%

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Survival outcomes of esophageal cancer patients with recurrence after curative treatments

Sugawara

Oka

Yoshii

et al. 2023

Preprint

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“…After neoadjuvant chemoradiotherapy and surgery, the 5-year survival rate is around 50% 5–7 . This modest survival can be explained by therapeutic resistance, early dissemination, and disease recurrence 8 , 9 . The system used most widely to evaluate response to neoadjuvant therapy is the Mandard tumour regression grade (TRG), which describes the proportion of primary tumour mass in the resection specimen replaced by fibrosis following neoadjuvant systemic and/or local treatment 10 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma

Henckens,

Liu,

Gisbertz

et al. 2024

British Journal of Surgery

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Background This study evaluated the association of pathological tumour response (tumour regression grade, TRG) and a novel scoring system, combining both TRG and nodal status (TRG-ypN score; TRG1-ypN0, TRG>1-ypN0, TRG1-ypN+ and TRG>1-ypN+), with recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma. Methods This Dutch nationwide cohort study included patients treated with neoadjuvant chemoradiotherapy followed by oesophagectomy for distal oesophageal or gastro-oesophageal junctional adenocarcinoma between 2007 and 2016. The primary endpoint was the association of Mandard score and TRG-ypN score with recurrence patterns (rate, location, and time to recurrence). The secondary endpoint was overall survival. Results Among 2746 inclusions, recurrence rates increased with higher Mandard scores (TRG1 30.6%, TRG2 44.9%, TRG3 52.9%, TRG4 61.4%, TRG5 58.2%; P < 0.001). Among patients with recurrent disease, the distribution (locoregional versus distant) was the same for the different TRG groups. Patients with TRG1 developed more brain recurrences (17.7 versus 9.8%; P = 0.001) and had a longer mean overall survival (44 versus 35 months; P < 0.001) than those with TRG>1. The TRG>1-ypN+ group had the highest recurrence rate (64.9%) and worst overall survival (mean 27 months). Compared with the TRG>1-ypN0 group, patients with TRG1-ypN+ had a higher risk of recurrence (51.9 versus 39.6%; P < 0.001) and worse mean overall survival (33 versus 41 months; P < 0.001). Conclusion Improved tumour response to neoadjuvant therapy was associated with lower recurrence rates and higher overall survival rates. Among patients with recurrent disease, TRG1 was associated with a higher incidence of brain recurrence than TRG>1. Residual nodal disease influenced prognosis more negatively than residual disease at the primary tumour site.

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“…More than 50% of all esophageal cancer patients are ineligible for treatment with curative intent [1,2]. The main reason for this incurability is the presence of distant metastases upon diagnosis, which are usually detected by fluorodeoxyglucose-positron emission tomography/ computed tomography ( 18 FDG-PET/CT) or other imaging modalities during diagnostic workup [3].…”

Section: Introductionmentioning

confidence: 99%

Thyroid Incidentalomas: Incidence and Oncological Implication in Patients with Esophageal Cancer

van Doesburg,

Kalff,

Voeten

et al. 2023

Dig Surg

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Thyroid incidentalomas are often encountered during imaging performed for the workup of esophageal cancer. Their oncological significance is unknown. This study aimed to establish incidence and etiology of thyroid incidentalomas found during the diagnostic workup of esophageal cancer. All esophageal cancer patients referred to or diagnosed in the Amsterdam UMC between January 2012 and December 2016 were included. Radiology and multidisciplinary team meeting reports were reviewed for presence of thyroid incidentalomas. When present, the 18FDG-PET/CT or CT was reassessed by a radiologist. Primary outcome was the incidence and etiology of thyroid incidentalomas. In total, 1,110 esophageal cancer patients were included. Median age was 66 years, most were male (77.2%) and had an adenocarcinoma (69.4%). For 115 patients (10.4%) a thyroid incidentaloma was reported. Two thyroidal lesions proved malignant. One esophageal cancer metastasis (0.9%) and one was a primary thyroid carcinoma (0.9%). Only the primary thyroid carcinoma resulted in treatment alteration. The other malignant thyroid incidentaloma was in the context of disseminated esophageal disease and ineligible for curative treatment. In this study, thyroid incidentalomas were only very rarely oncologically significant. Further etiological examination should only be considered in accordance with the according to the TI-RADS classification system and when clinical consequences are to be expected.

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Recurrent Disease After Esophageal Cancer Surgery

Cited by 10 publications

References 41 publications

Survival outcomes of esophageal cancer patients with recurrence after curative treatments

Survival outcomes of esophageal cancer patients with recurrence after curative treatments

Prognostic value of Mandard score and nodal status for recurrence patterns and survival after multimodal treatment of oesophageal adenocarcinoma

Thyroid Incidentalomas: Incidence and Oncological Implication in Patients with Esophageal Cancer

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