Researchers call for long-term surveillance of esophageal cancer survivors

SEATTLE — A relatively high percentage of patients with locally advanced esophageal cancer achieve 5-year survival, but a small percentage continue to be at low but constant risk for recurrence after the 5-year mark, according to research presented at the American Association for Thoracic Surgery Annual Meeting.

“This study demonstrates that with good surgical technique and with multidisciplinary treatment, a significant proportion of patients (39%) with locally advanced esophageal cancer reach the 5-year survival mark,” Brendon Stiles, MD, associate professor of cardiothoracic surgery from Weill Cornell Medical College, New York-Presbyterian Hospital, told Healio Gastroenterology. “After 5 years, only a very small proportion of patients will recur (around 7%). Most are in fact, cured of their disease. Nevertheless, these patients are at risk for second primary cancers and for pulmonary disease, presumably secondary to altered gastrointestinal motility.”

Brendon Stiles

Aiming to determine predictors of 5-year survival, as well as outcomes and predictors of death after 5 years, Stiles and colleagues performed a retrospective review of health records of 355 patients with locally advanced esophageal cancer (with cT2N0 disease or higher) who underwent esophagectomy from January 1988 to September 2009. According to a press release, most patients were men with adenocarcinoma, and about half received neoadjuvant therapy.

A total of 140 patients achieved 5-year survival, representing an absolute survival rate of 39%. “This promising result likely reflects more accurate preoperative staging, improvements in surgical and perioperative management, and wider application of multimodality treatment strategies,” Stiles said in the release.

Five-year survivors were then followed up for a median of 41 months. Overall survival was found to be 86% at year 7, 70% at year 10 and 51% at year 15, and cancer-specific survival was found to be 88% at year 7 and 84% at year 10. At the end of the study period, 90 patients were disease-free.

Chemotherapy or radiotherapy before surgery had no effect on overall survival or cancer-specific survival after 5 years, and the strongest predictors of death were tumor recurrence and less aggressive tumor resection.

Among 5-year survivors, 23% had recurrent cancer, most of which occurred within 5 years of surgery. Nearly one-third of these patients achieved 10-year survival. “The annualized risk of recurrence was 1.4% per year until year 10 when the [cancer-specific survival] reaches its plateau,” Stiles said.

About one-fifth of the deaths were attributed to chronic pulmonary disease. “These potentially modifiable adverse events of esophagectomy may be mitigated by proper counseling of patients to avoid meals for 2 to 3 hours before bedtime and sleeping with the head of the bed elevated,” Stiles said. “Post-esophagectomy patients need to be followed by physicians familiar with the long-term sequelae of esophagectomy.”

According to the release, the findings of this study indicate continued surveillance after surgery for up to 10 years may be justified, especially for patients with nodal metastases (the only independent predictor of recurrence).

“Importantly, surveillance does not appear to be futile, as 11 patients who were treated for recurrent esophageal cancer survived at least 5 years after treatment of their recurrence,” Stiles said.

Reference:

Ghaly G, et al. Abstract 111. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: Relevant financial disclosures were not provided.

Editor’s Note: This article was updated on May 5 to reflect additional information.