Postoperative follow-up programs improve survival in curatively resected gastric and junctional cancer patients: a propensity score matched analysis

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association Vol. 21; no. 3; pp. 552 - 568
• Main Authors: Sisic, Leila, Strowitzki, Moritz J., Blank, Susanne, Nienhueser, Henrik, Dorr, Sara, Haag, Georg Martin, Jäger, Dirk, Ott, Katja, Büchler, Markus W., Ulrich, Alexis, Schmidt, Thomas
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.05.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Adenocarcinoma; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - mortality; Adenocarcinoma - surgery; Adult; Aftercare - methods; Aged; Aged, 80 and over; Cancer Research; Cancer surgery; Esophageal cancer; Esophageal Neoplasms - diagnostic imaging; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagogastric Junction - diagnostic imaging; Esophagogastric Junction - pathology; Esophagogastric Junction - surgery; Female; Gastric cancer; Gastroenterology; Humans; Kaplan-Meier Estimate; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - diagnostic imaging; Neoplasm Recurrence, Local - mortality; Oncology; Original Article; Patients; Propensity Score; Proportional Hazards Models; Stomach Neoplasms - diagnostic imaging; Stomach Neoplasms - mortality; Stomach Neoplasms - surgery; Surgery; Surgical Oncology; Surgical outcomes; Survival; Recurrence; Prognosis; Gastric cancer; Esophageal cancer; Follow-up
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-017-0751-4

Background To date there is no evidence that more intensive follow-up after surgery for esophagogastric adenocarcinoma translates into improved survival. This study aimed to evaluate the impact of standardized surveillance by a specialized center after resection on survival. Methods Data of 587 patients were analyzed who underwent curative surgery for esophagogastric adenocarcinoma in our institution. Based on their postoperative surveillance, patients were assigned to either standardized follow-up (SFU) by the National Center for Tumor Diseases (SFU group) or individual follow-up by other physicians (non-SFU group). Propensity score matching (PSM) was performed to compensate for heterogeneity between groups. Groups were compared regarding clinicopathological findings, recurrence, and impact on survival before and after PSM. Results Of 587 patients, 32.7% were in the SFU and 67.3% in the non-SFU group. Recurrence occurred in 39.4% of patients and 92.6% within the first 3 years; 73.6% were treated, and of those 17.1% underwent resection. In recurrent patients overall and post-recurrence survival (OS/PRS) was influenced by diagnostic tools ( p  < 0.05), treatment ( p  ≤ 0.001), and resection of recurrence ( p  ≤ 0.001). Standardized follow-up significantly improved OS (84.9 vs. 38.4 months, p  = 0.040) in matched analysis and was an independent positive predictor of OS before and after PSM ( p  = 0.034/0.013, respectively). Conclusion After PSM, standardized follow-up by a specialized center significantly improved OS. Cross-sectional imaging and treatment of recurrence were associated with better outcome. Regular follow-up by cross-sectional imaging especially during the first 3 years should be recommended by national guidelines, since early detection might help select patients for treatment of recurrence and even resection in few designated cases.