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| Predictors of Recurrence, Time to Progression and Disease-Free Survival in Patients with Completely Resected Esophageal Carcinoma | ||||||||||||||||
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Paul C. Lee1, Jeffrey L. Port1, Subroto Paul1, Brendon M. Stiles1, James Saunders1, Paul Christos2, Nasser K. Altorki1; 1Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY; 2Division of Biostatistics and Epidemiology, Department of Public Health, Weill Medical College of Cornell University, New York, NY Objective: The goal of this study was to determine the clinical and pathological predictors of recurrence, time to progression and long-term disease-free survival in patients with completely resected esophageal carcinoma. Methods: We conducted a retrospective review of a prospective database to identify patients with surgically resected esophageal carcinoma. Medical records were reviewed, and disease-free survival (DFS) was analyzed. Multivariate analysis was performed to determine independent predictors of recurrence, time to progression and DFS. Results: A total of 483 patients had esophagectomy for cancer (median age of 64, 79% male, 29% squamous). Of those, 169 patients received induction therapy. Hospital mortality was 2.5%. Median length of follow-up was 44 months. Ninety-two percent of patients had a R0 resection. The median number of lymph nodes resected was 25. Five and 10-year DFS for the entire cohort were 41% and 34%. Local recurrence rate was stage dependent and occurred in 11.2% of patients. Median time to disease progression was 10 months. Multivariate analysis demonstrated that good performance status, induction chemotherapy and enbloc surgical resection were significant independent factors predicting improved DFS (See Table). Multivariate analysis also showed that poor performance status and non-enbloc resection were significant predictors for increased local recurrence (p=0.016 and p=0.001, respectively). Local recurrence occurred in 9.7% of patients after enbloc resection and 14.3% after non-enbloc resection (p = 0.08). Time to progression was significantly prolonged in the enbloc group compared to the non-enbloc group, median of 11.3 months vs. 7.2 months (p < 0.004). Five and 10-year DFS were significantly improved in the enbloc group compared to non-enbloc group (44% and 37% vs. 29% and 8% respectively, p = 0.001). Conclusion: For patients with completely resected esophageal cancer, good performance status, induction chemotherapy and enbloc resection were significant independent predictors of improved disease-free survival. Local recurrence rate was reduced and time to progression was significantly prolonged after enbloc resection.
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