Guillaume Luc1,2, Caroline Gronnier3, Gil Lebreton4, Cecile Brigand5, Jean-Yves Mabrut6, Jean-Pierre Bail7, Bernard Meunier8, Denis Collet9, Christophe Mariette3. 1. Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux, France. guillaume.luc33@yahoo.fr. 2. Inserm, Unit 1026, University of Bordeaux, Bordeaux, France. guillaume.luc33@yahoo.fr. 3. Department of Digestive and Oncological Surgery, Claude Huriez, University Hospital, Lille, France. 4. Department of Digestive Surgery, Côte de Nacre University Hospital, Caen, France. 5. Department of General and Digestive Surgery, Hautepierre University Hospital, Strasbourg, France. 6. Department of General and Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France. 7. Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France. 8. Department of Hepatic and Digestive Surgery, Pontchaillou University Hospital, Rennes, France. 9. Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux, France.
Abstract
BACKGROUND: Minimal data have previously emerged from studies regarding the factors associated with recurrence in patients with ypT0N0M0 status. The purpose of the study was to predict survival and recurrence in patients with pathological complete response (pCR) following chemoradiotherapy (CRT) and surgery for esophageal cancer (EC). METHODS: Among 2944 consecutive patients with EC operations in 30 centers between 2000 and 2010, patients treated with neoadjuvant CRT followed by surgery who achieved pCR (n = 191) were analyzed. The factors associated with survival and recurrence were analyzed using a Cox proportional hazard regression analysis. RESULTS: Among 593 patients who underwent neoadjuvant CRT followed by esophagectomy, pCR was observed in 191 patients (32.2 %). Recurrence occurred in 56 (29.3 %) patients. The median time to recurrence was 12 months. The factors associated with recurrence were postoperative complications grade 3-4 [odds ratio (OR): 2.100; 95 % confidence interval (CI) 1.008-4.366; p = 0.048) and adenocarcinoma histologic subtype (OR 2.008; 95 % CI 0.1.06-0.3.80; p = 0.032). The median overall survival was 63 months (95 % CI 39.3-87.1), and the median disease-free survival was 48 months (95 % CI 18.3-77.4). Age (>65 years) [hazard ratio (HR): 2.166; 95 % CI 1.170-4.010; p = 0.014), postoperative complications grades 3-4 [HR 2.099; 95 % CI 1.137-3.878; p = 0.018], and radiation dose (<40 Gy) (HR 0.361; 95 % CI 0.159-0.820; p = 0.015) were identified as factors associated with survival. CONCLUSIONS: An intensive follow-up may be beneficial for patients with EC who achieve pCR and who develop major postoperative complications or the adenocarcinoma histologic subtype.
BACKGROUND: Minimal data have previously emerged from studies regarding the factors associated with recurrence in patients with ypT0N0M0 status. The purpose of the study was to predict survival and recurrence in patients with pathological complete response (pCR) following chemoradiotherapy (CRT) and surgery for esophageal cancer (EC). METHODS: Among 2944 consecutive patients with EC operations in 30 centers between 2000 and 2010, patients treated with neoadjuvant CRT followed by surgery who achieved pCR (n = 191) were analyzed. The factors associated with survival and recurrence were analyzed using a Cox proportional hazard regression analysis. RESULTS: Among 593 patients who underwent neoadjuvant CRT followed by esophagectomy, pCR was observed in 191 patients (32.2 %). Recurrence occurred in 56 (29.3 %) patients. The median time to recurrence was 12 months. The factors associated with recurrence were postoperative complications grade 3-4 [odds ratio (OR): 2.100; 95 % confidence interval (CI) 1.008-4.366; p = 0.048) and adenocarcinoma histologic subtype (OR 2.008; 95 % CI 0.1.06-0.3.80; p = 0.032). The median overall survival was 63 months (95 % CI 39.3-87.1), and the median disease-free survival was 48 months (95 % CI 18.3-77.4). Age (>65 years) [hazard ratio (HR): 2.166; 95 % CI 1.170-4.010; p = 0.014), postoperative complications grades 3-4 [HR 2.099; 95 % CI 1.137-3.878; p = 0.018], and radiation dose (<40 Gy) (HR 0.361; 95 % CI 0.159-0.820; p = 0.015) were identified as factors associated with survival. CONCLUSIONS: An intensive follow-up may be beneficial for patients with EC who achieve pCR and who develop major postoperative complications or the adenocarcinoma histologic subtype.
Authors: D Schizas; M Frountzas; I Lidoriki; E Spartalis; K Toutouzas; D Dimitroulis; T Liakakos; K S Mylonas Journal: Ann R Coll Surg Engl Date: 2019-09-11 Impact factor: 1.891
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