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Factors associated with early recurrence and death after esophagectomy for cancer
Author(s) -
Davies Andrew R.,
Pillai Andrew,
Sinha Pranab,
Sandhu Harinderjeet,
Adeniran Amina,
Mattsson Fredrik,
Choudhury Asif,
Forshaw Matthew J.,
Gossage James A.,
Lagergren Jesper,
Allum William H.,
Mason Robert C.
Publication year - 2014
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23511
Subject(s) - medicine , esophagectomy , lymphovascular invasion , esophageal cancer , confidence interval , odds ratio , stage (stratigraphy) , cancer , logistic regression , surgery , cohort , oncology , metastasis , paleontology , biology
Background Accurate selection of patients for radical treatment of esophageal cancer is essential to avoid early recurrence and death (ERD) after surgery. We sought to evaluate a large series of consecutive resections to assess factors that may be associated with this poor outcome. Methods This was a cohort study including 680 patients operated for esophageal cancer between 2000 and 2010. The poor outcome group comprised 100 patients with tumor recurrence and death within 1 year of surgery. The comparison group comprised 267 long‐term survivors, defined as those surviving more than 3 years from surgery. Pathological characteristics associated with poor outcome were analyzed using logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). Results On the adjusted model T stage and N stage predicted poor survival, with the greatest risk being patients with locally advanced tumors and three or more involved lymph nodes (OR 10.6, 95% CI 2.8–40.0). Poor differentiation (OR 2.8, 95% CI 1.4–5.5), chemotherapy response (OR 3.6, 95% CI 1.2–10.6), and involved resection margins (OR 2.7, 95% CI 1.2–6.0) were all significant independent prognostic markers in the multivariable model. There was a trend toward worse survival with lymphovascular invasion (OR 2.0, 95% CI 0.9–4.2) and low albumin (OR 1.9, 95% CI 0.8–4.4) but not of statistical significance in the adjusted model. Conclusions Esophageal cancer patients with poorly differentiated tumors and three or more involved lymph nodes have a particularly high risk of ERD after surgery. Accurate risk stratification of patients may identify a group who would be better served by alternative oncological treatment strategies. J. Surg. Oncol. 2014 109:459–464 . © 2013 Wiley Periodicals, Inc.