Prognostic Factors and Causes of Death in Patients Cured of Esophageal Cancer

• Published in: Annals of surgical oncology Vol. 21; no. 5; pp. 1749 - 1755
• Main Authors: Kakuta, Tomoyuki, Kosugi, Shin-ichi, Kanda, Tatsuo, Ishikawa, Takashi, Hanyu, Takaaki, Suzuki, Tsutomu, Wakai, Toshifumi
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.05.2014; Springer Nature B.V
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Cause of Death; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - mortality; Female; Follow-Up Studies; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Grading; Neoplasm Staging; Oncology; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Thoracic Oncology; Primary Cancer; Pulmonary Complication; Esophageal Cancer; Mediastinal Lymph Node Dissection; Potential Prognostic Factor
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-014-3499-7

Background The number of patients cured of esophageal cancer after esophagectomy is gradually increasing owing to advances in surgical techniques, perioperative management, and adjuvant therapies. This study assessed the clinical course and sought to identify the prognostic factors of these patients. Methods A series of 220 consecutive patients who underwent esophagectomy and survived for more than 5 years with no relapse were enrolled. Survival analysis was performed using 25 variables including patient characteristics and operative and perioperative factors. Potential prognostic factors were identified by univariate and multivariate analyses, and the development of other primary cancers and the causes of death were retrospectively reviewed. Results The overall 10-, 15-, and 20-year survival rates were 71.6, 50.1, and 32.2 %, respectively, with a median survival time of 180 months (range, 61–315 months). The negative independent prognostic factors identified were age at surgery [hazard ratio (HR), 1.05; P  < .01], being male (HR, 2.62; P  = .02), pulmonary comorbidities (HR, 2.03; P  = .02), synchronous presence of other cancers (HR, 2.35; P  < .01), colonic/jejunal interposition (HR, 1.76; P  = .03), perioperative blood transfusion (HR, 1.92; P  = .02), development of pulmonary complications (HR, 1.71; P  = .02), and adjuvant radiotherapy (HR, 2.13; P  = .01). Pulmonary diseases and other primary cancers were found to be the most common causes of death. Conclusions Careful follow-up including the surveillance of other primary cancers is required for long-term survivors of esophageal cancer after esophagectomy.