Characteristics Associated with Nodal and Distant Recurrence After Radical Esophagectomy for Squamous Cell Carcinoma of the Thoracic Esophagus

• Published in: Annals of surgical oncology Vol. 27; no. 9; pp. 3195 - 3205
• Main Authors: Kanda, Mitsuro, Koike, Masahiko, Shimizu, Dai, Tanaka, Chie, Hattori, Norifumi, Hayashi, Masamichi, Yamada, Suguru, Omae, Kenji, Kodera, Yasuhiro
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2020; Springer Nature B.V
• Subjects: Esophageal cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophageal Squamous Cell Carcinoma - pathology; Esophageal Squamous Cell Carcinoma - surgery; Esophagectomy; Esophagus; Gastrointestinal surgery; Humans; Lymph Node Excision; Lymph nodes; Lymph Nodes - pathology; Lymphatic Metastasis; Medicine; Medicine & Public Health; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Oncology; Patients; Prognosis; Retrospective Studies; Risk factors; Squamous cell carcinoma; Surgery; Surgical Oncology; Thoracic Oncology; Thorax
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-020-08433-6

Background Recurrence after radical resection of esophageal squamous cell carcinoma (ESCC) is common. Limited evidence is available about the differences in clinical characteristics, risk factors, and prognostic significance between nodal and distant recurrence of thoracic ESCC. Patients and Methods We retrospectively analyzed 341 patients who underwent radical resection of thoracic ESCC and experienced (1) initial recurrence only in lymph nodes ( n  = 39), (2) recurrence only at distant organs ( n  = 57), or (3) no recurrences ( n  = 245) after follow-up ≥ 24 months. Clinicopathological characteristics, survival times, and risk factors were compared between the nodal and distant recurrence groups. Results The median follow-up time was 57.8 months. Metastasectomy as initial treatment for the recurrence was performed for six (15.4%) patients in the nodal recurrence group and one patient in the distant recurrence group. Compared with the nodal recurrence group, patients with distant recurrence had significantly shorter disease-free survival [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.10–2.57, P  = 0.0169], postrecurrence survival (HR 1.77, 95% CI 1.01–3.10, P  = 0.0476), and overall survival (HR 1.98, 95% CI 1.12–3.51, P  = 0.0193). The distant recurrence group had significantly larger macroscopic tumor size and more advanced pathological T stage than the nodal recurrence group, whereas preoperative treatment, tumor location, number of fields dissected, tumor differentiation, lymphatic involvement, and vessel invasion were not significantly different between the two groups. Conclusions Survival times and recurrence risk factors differed between patients with nodal and distant recurrence after radical resection of thoracic ESCC.