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Clinical predictors of early postoperative recurrence after radical esophagectomy for thoracic esophageal cancer

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Abstract

Purpose

Esophagectomy for esophageal cancer has a high incidence rate of early postoperative recurrence and death. This study aimed to identify the clinical and pathological features in early recurrence cases and to confirm the usefulness of prediction using these factors for effective adjuvant therapy and postoperative surveillance.

Methods

One hundred and twenty five patients who developed postoperative recurrence after undergoing radical esophagectomy for thoracic esophageal cancer were classified into two groups as follows: those with early recurrence at ≤ 6 months and those with nonearly recurrence at > 6 months after surgery. After identifying related factors of early recurrence, usefulness of these factors for prediction were examined in all patients with and without recurrence.

Results

The analysis cohort consisted of 43 and 82 patients in the early and nonearly recurrence groups, respectively. In multivariate analysis, factors associated with early recurrence were higher initial levels of tumor markers (squamous cell carcinoma [SCC] ≥ 1.5 ng/ml in tumors, except for adenocarcinoma, and carcinoembryonic antigen [CEA] ≥ 5.0 ng/ml in adenocarcinoma) and higher venous invasion (v), i.e., ≥ 2 (p = 0.040 and p = 0.004, respectively). The usefulness of these two factors for recurrence prediction was confirmed in 378 patients, including 253 patients without recurrence. Patients with at least one of the two factors had significantly higher early recurrence rates than those without any factors in pStages II and III (odds ratio [OR], 6.333; p = 0016 and OR, 4.346; p = 0.008, respectively).

Conclusions

Early recurrence of thoracic esophageal cancer (i.e., during ≤ 6 months after esophagectomy) was associated with higher initial tumor marker levels and pathological findings of v ≥ 2. The combination of these two factors is useful as a simple and critical predictor of early postoperative recurrence.

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Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

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Acknowledgements

The authors thank Kumiko Motooka, a staff member at the Department of Surgery in Keio University School of Medicine, for help in the preparation of the manuscript.

Funding

Funding was provided by Taiho Pharmaceutical, Chugai Pharmaceutical, Yakult Honsha, Daiichi-Sankyo, Merck Serono Co., Ltd., Asahi Kasei Co., Ltd., EA Pharma Co., Ltd., Otsuka Pharmaceutical, Takeda Pharmaceutical Company, Otsuka Pharmaceutical Factory Inc., Shionogi, Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Astellas Pharma, Medicon Inc., Dainippon Sumitomo Pharma, Taisho Toyama Pharmaceutical Company, Kyowa Hakko Kirin, Pfizer Japan Inc., Ono Pharmaceutical, Nihon Pharmaceutical Co., Ltd., Japan Blood Products Organization, Medtronic Japan Co., Ltd., Sanofi K.K., Eisai, Tsumura and Company, KCI Licensing Inc., Abbott Japan, Fujifilm Toyama Chemical Co., Ltd.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Kazuaki Matsui, Hirofumi Kawakubo, Satoru Matsuda, Yuki Hirata, Tomoyuki Irino, Kazumasa Fukuda, Rieko Nakamura & Yuko Kitagawa

  2. Division of Diagnostic Pathology, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, Japan

    Hajime Okita

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  1. Kazuaki Matsui
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Corresponding author

Correspondence to Hirofumi Kawakubo.

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Ethical Statement

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1964 and later versions.

Conflict of interest

Yuko Kitagawa received grants from Taiho Pharmaceutical Co., Ltd.; Chugai Pharmaceutical Co., Ltd.; Yakult Honsha Co., Ltd.; Daiichi Sankyo; Merck Serono Co., Ltd.; Asahi Kasei Co., Ltd.; EA Pharma Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Otsuka Pharmaceutical Factory Inc.; Shionogi & Co., Ltd.; Kaken Pharmaceutical Co., Ltd.; Kowa Pharmaceutical Co., Ltd.; Astellas Pharma Inc.; Medicon Inc.; Dainippon Sumitomo Pharma Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Kyowa Hakko Kirin Co., Ltd.; Pfizer Japan Inc.; Ono Pharmaceutical Co., Ltd.; Nihon Pharmaceutical Co., Ltd.; Japan Blood Products Organization; Medtronic Japan Co., Ltd.; Sanofi K.K.; Eisai Co., Ltd.; Tsumura & Co.; KCI Licensing Inc.; Abbott Japan Co., Ltd.; and Fujifilm Toyama Chemical Co., Ltd. outside the submitted work. Kazuaki Matsui, Hirofumi Kawakubo, Satoru Matsuda, Yuki Hirata, Tomoyuki Irino, Kazumasa Fukuda, Rieko Nakamura, and Hajime Okita declare no conflicts of interest.

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Matsui, K., Kawakubo, H., Matsuda, S. et al. Clinical predictors of early postoperative recurrence after radical esophagectomy for thoracic esophageal cancer. Esophagus 20, 679–690 (2023). https://doi.org/10.1007/s10388-023-01014-y

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