| Affiliation: | 1. Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Key Laboratory of Minimally Invasive Techniques & Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province, Linhai, Zhejiang Province, China;2. Department of Thoracic Surgery, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang Province, China;3. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China;4. Department of Thoracic Surgery, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong Province, China;5. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China;6. Department of Thoracic Surgery, Tianjin Medical University Cancer Hospital, Tianjin, China;7. Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou, Zhejiang Province, China;8. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China;9. Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, Sichuan Province, China;10. Department of Thoracic Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong Province, China;11. Department of Surgery and Cancer, Imperial College London, London, United Kingdom;12. Department of Thoracic Surgery, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang Province, China;1. Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China;2. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China;1. Icahn School of Medicine at Mount Sinai, New York, NY, USA;2. Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA;3. Kaiser Permanente Southern California, Pasadena, CA, USA;1. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY;2. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, Calif;1. Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan;2. Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan;1. Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;2. 3rd Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland;3. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Research Institute of Oncology, Warsaw, Poland;4. Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milan, Italy;5. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan |
| Abstract: | ObjectivesThe prognosis of patients with locally advanced esophageal squamous cell carcinoma with different recurrence backgrounds is highly heterogeneous. This study aims to explore the effects of recurrence patterns on prognosis.MethodsThe phase III, multicenter, prospective NEOCRTEC5010 trial enrolled 451 patients with stage IIB-III esophageal squamous cell carcinoma randomly assigned to neoadjuvant chemoradiotherapy combined with surgery (NCRT group) or surgery alone (S group) and followed them long-term. We investigated the effects of recurrence patterns on survival in patients undergoing radical esophagectomy.ResultsIn total, 353 patients were included in the study. The 5-year overall survival of patients with different recurrence patterns was significantly different: recurrence versus recurrence-free (17.8% vs 89.2%; P < .001), early recurrence versus late recurrence (4.6% vs 51.2%; P < .001), and distant metastasis versus locoregional recurrence (17.0% vs 20.0%; P = .666). Patients with early recurrence had significantly shorter survival after recurrence than those with late recurrence (hazard ratio, 1.541; 95% confidence interval, 1.047-2.268, P = .028). There was no significant difference in postrecurrence survival between patients with distant metastasis and locoregional recurrence (hazard ratio, 1.181; 95% confidence interval, 0.804-1.734; P = .396). Multivariate logistic analysis showed that pN1 stage, lymph node dissection <20, and lack of response to NCRT were independent risk factors for postoperative early recurrence. Multivariate Cox regression suggested that NCRT, age ≥60 years, early recurrence, and the pN1 stage were independent risk factors for shortened survival after recurrence.ConclusionsPrerecurrence primary tumor stage is inaccurate in predicting postrecurrence survival. In contrast, recurrence patterns can guide follow-up while also predicting postrecurrence survival. NCRT prolongs disease-free survival but is associated with a worse prognosis in patients with recurrence, especially early recurrence. |
