Cause of Death During Long-Term Follow-up for Superficial Esophageal Adenocarcinoma
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The purpose of this study was to evaluate long-term prognosis and cause of death in patients with superficial esophageal adenocarcinoma (SEAC) after surgery.
Patients and Methods
A total of 85 patients without adjuvant or neoadjuvant treatment underwent surgery for SEAC (pT1N0–1, M0) 1984–2011. Medical records and causes of death were reviewed, and 79 specimens (93 %) were reanalyzed for cancer penetration. Survival was calculated according to Kaplan–Meier and comparisons of survival with log-rank test. Multivariate survival was analyzed with Cox proportional hazards model.
Of 85 patients, 36 had transhiatal, 33 transthoracic en bloc, 6 minimally invasive en bloc, 5 vagal sparing esophageal resection and 5 endoscopic mucosal resections; 7 patients (8 %) had lymph node metastasis (LNM). Cancer penetration: 35 pT1a and 44 pT1b. Overall survival was 67 % at 5 years and 50 % at 10 years. Disease-specific survival was 82 % at 5 years and 78 % at 10 years. Recurrence-free survival was 80 % at 5 years. In a Cox multivariate model, poor overall survival was predicted only by LNM. Cumulative mortality during median follow-up of 5 years (0–25 years): 37 of 85 (44 %). Cause of death of these 37: SEAC recurrence for 15 (41 %), postoperative complications for 4 (11 %), another primary malignancy for 5 (14 %), non-cancer-related for 11 (30 %) and for 2 (5 %) cause unknown. Mortality after 5-year follow-up: 11 (30 %); 82 % of these deaths were unrelated to SEAC recurrence.
With SEAC recurrence as the single most common cause of death, disease-specific 5-year survival was good. Overall and late (> 5-year) survival is affected by diseases related to aging.
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- Cause of Death During Long-Term Follow-up for Superficial Esophageal Adenocarcinoma
Annals of Surgical Oncology
Volume 20, Issue 7 , pp 2428-2433
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- 1. Clinic of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital, Heart and Lung Center, Helsinki, Finland
- 2. Department of General and Abdominal Surgery, University Medical Center, Mainz, Germany
- 3. Institute of Pathology, University Medical Center, Mainz, Germany
- 4. Department of Pathology, HUSLAB, Helsinki University Central Hospital and Haartman Institute and Genome-Scale Biology Research Program, University of Helsinki, Helsinki, Finland