Esophageal Cancer Survivors Need Monitoring for 10 Years

Roxanne Nelson, RN

April 30, 2015

Patients with locally advanced esophageal cancer often have poor outcomes despite advances in therapy. But a new study shows that a relatively high proportion of these patients are surviving 5 years, and after reaching that milestone, only a small percentage continue to be at risk for recurrence.

At 5 years post esophagectomy, 140 of 355 patients were still alive, with an absolute 5-year survival rate of 39%. "This promising result likely reflects more accurate preoperative staging, improvements in surgical and perioperative management, and wider application of multimodality treatment strategies," explained Brendon Stiles, MD, associate professor of cardiothoracic surgery, Weill Cornell Medical College, New York City, in a statement.

Dr Stiles presented his data at the 95th annual meeting of the American Association for Thoracic Surgery.

Despite the good survival rate, these patients still face a number of health risks and should be monitored for at least 10 years, if not longer.

These risks include recurrence of the original cancer, appearance of new primary cancers, and/or chronic pulmonary disease.

Long-term Recurrence Occurs

It has been unclear whether patients who reach the 5-year survival milestone are cured of the disease, the authors note, because there is little published information on their outcomes in the longer term. The goal of the current study was to define predictors of 5-year survival as well as to determine outcomes in this population beyond 5 years.

Dr Stiles and colleagues conducted a retrospective analysis of the health records of 356 patients with locally advanced esophageal cancer of stage cT2N0 or higher who underwent esophagectomy between January 1988 and September 2009.

Within this group, more than two thirds (n = 246; 69%) had adenocarcinoma, and 179 (50%) had received neoadjuvant therapy.

Recurrent disease developed in 192 patients, with about half of the cases developing in the first year (n = 101; 53%), 45 (23%) in the second year, 27 (14%) in year 3, seven (4%) in year 4, four (2%) in year 5, and eight (4%) after 5 years.

The 140 patients who survived beyond 5 years were followed for up to 41 months from the 5-year survival point.

For these 140 patients, the overall survival at 7 years was 86%; at 10 years, it was 70%, and at 15 years, 51%.

Cancer-specific survival, which was assessed from the 5-year mark to death from esophageal cancer, was 88% at 7 years and 84% at 10 years.

As of September 2014, the researchers note, 90 patients remained alive and free of disease, including seven patients who had been treated for recurrence during the first 5 years.

Of the 140 patients who survived 5 years, 32 (23%) experienced a disease recurrence. Most occurred within 5 years following surgical resection (24 patients), with the remaining cases occurring after that point.

Predictors of Survival and Mortality

Patients with recurrences received treatment with various modalities, including chemotherapy, surgical resection, or chemoradiation; 11 survived at least 5 years after treatment, and six were disease free at their last follow-up. Overall, almost one third of this subgroup were alive after 10 years; a total of 20 deaths occurred that were attributed to recurrent esophageal cancer.

"The annualized risk of recurrence was 1.4% per year until year 10, when the cancer-specific survival reaches its plateau," said Dr Stiles.

When looking at predictors of mortality and recurrence, tumor factors were still the most significant determinant; despite being at least 5 years from resection, tumor factors were still the most significant predictors of recurrence or death.

On univariate analysis, pT3-4 classification (OR, 3.23) and pN+ (OR, 2.81) predicted poor survival, but on multivariate analysis, only positive pathologic N (OR 2.38) significantly predicted delayed recurrence or death.

Independent predictors by multivariable analysis for long-term survival were good performance status (0 vs ≥1; OR, 1.87), en bloc resection (OR, 2.03), the absence of nodal metastases (OR, 2.86), and R0 resection (OR, 6.59).

These results suggest that continued surveillance may be necessary for as long as 10 years after resection, given the continued risk for disease recurrence. "Importantly, surveillance does not appear to be futile, as 11 patients who were treated for recurrent esophageal cancer survived at least 5 years after treatment of their recurrence," said Dr Stiles.

95th Annual Meeting of the American Association for Thoracic Surgery. Presented April 29, 2015.


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