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Recurrence patterns and associated factors of locoregional failure following neoadjuvant chemoradiation and surgery for esophageal cancer
Author(s) -
Blackham Aaron U.,
H. Naqvi Syeda M.,
Schell Michael J.,
Jin William,
Gangi Alexandra,
Almhanna Khaldoun,
Fontaine Jacques P.,
Hoffe Sarah E.,
Frakes Jessica,
Venkat Puja,
Pimiento Jose M.
Publication year - 2018
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.24808
Subject(s) - medicine , esophagectomy , neoadjuvant therapy , lymphovascular invasion , esophageal cancer , stage (stratigraphy) , oncology , lymph node , cancer , proportional hazards model , t stage , gastroenterology , metastasis , breast cancer , paleontology , biology
Background Despite neoadjuvant chemoradiation (nCRT) followed by esophagectomy for locally advanced esophageal cancer, locoregional recurrence (LRR) is common and factors associated with LRR have not been clearly identified. Methods Patients were identified from a single institution, prospectively maintained database (1996‐2013). Patterns of recurrence were described and associated factors of LRR were analyzed using competing risks regression models. Results Of the 456 patients treated with nCRT and surgery, 167 patients developed recurrence. Locoregional and distant recurrences were observed in 69 (15.1%) and 140 (30.9%) patients, respectively. Time to recurrence (13.6 vs 10.4 months, P = 0.20) and median overall survival (29.3 vs 19.1 months, P = 0.12) were no different among the 27 patients (6%) who developed a solitary LRR compared to patients who developed distant recurrence. Univariable analysis identified lymphovascular invasion (HR 1.46, P = 0.07), lymph node ratio >0.5 (HR 2.16, P = 0.02), positive margin (HR 1.95, P = 0.05), lack of response to neoadjuvant therapy (HR 1.99, P < 0.01), clinical T stage (HR 2.62, P < 0.01) and final T3/4 stage (HR 2.06, P < 0.01) as factors significantly associated with LRR. Clinical T stage and response to neoadjuvant treatment were independently associated with LRR on multivariable analysis. Conclusions Although aggressive tumor biology plays a significant role in LRR, optimizing neoadjuvant treatments to obtain a complete pathologic response may lead to improved locoregional control.