Medical Oncology

, Volume 27, Issue 2, pp 242–248 | Cite as

Risk stratification for recurrence in patients with esophageal and junctional carcinoma treated with neoadjuvant chemotherapy and surgery

  • S. DixitEmail author
  • M. Tilston
  • W. M. Peter
Original Paper


Aim To stratify the risk for recurrence in patients with esophageal cancer treated with neoadjuvant chemotherapy and surgery. Materials and Methods The prognostic and predictive factors were analyzed in 62 patients who underwent curative resection following chemotherapy. The factors found significant on multivariate analysis were stratified into good, intermediate and high risk groups for recurrence. Results Kaplan–Meier survival at 3 and 5 years was 32% and 20%, respectively, with a median survival of 19 months. Pathological response and percent node positive were the significant factors on multivariate analysis. Three groups were formed and their recurrence free survivals were calculated using Kaplan–Meier method. The low risk composed of good responders and patients with less than 20% positive lymph node; the intermediate risk composed of non-responders and patients with less than 20% positive lymph node and the high risk group composed of non-responders and patients with more than 20% positive lymph node. The median recurrence time was 8 months for the high risk group, 39 months for the intermediate group, and it has not reached in the low risk group. Hazard ratio was 0.39(95% C.I. 0.09–0.98) for the risk group low to intermediate, 0.1(95% C.I. 0.04–0.25) for the low to high risk group and 0.26(95% C.I. 0.11-0.66) for the intermediate to high risk group. Conclusions Pathological response rate and percent node positive were significant predictive factors on multivariate analysis. Stratification based on these two predictive factors may help in optimizing any adjuvant treatment.


Predictive factors Prognostic factors Neoadjuvant chemotherapy Esophagus Cancer Risk stratification Surgery 


  1. 1.
    Gebski V, et al. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in esophageal carcinoma: a meta-analysis. Lancet Oncol. 2007;8:226–34. doi: 10.1016/S1470-2045(07)70039-6.CrossRefPubMedGoogle Scholar
  2. 2.
    Kaklamanos IG, Walker GR, Ferry K, Franceschi D, Livingstone AS. Neoadjuvant treatment for resectable cancer of the esophagus and the gastroesophageal junction: a meta-analysis of randomized clinical trials. Ann Surg Oncol. 2003;10(7):754–61. doi: 10.1245/ASO.2003.03.078.CrossRefPubMedGoogle Scholar
  3. 3.
    Medical Research Council Esophageal Cancer Working Party. Surgical resection with or without preoperative chemotherapy in esophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–33. doi: 10.1016/S0140-6736(02)08651-8.CrossRefGoogle Scholar
  4. 4.
    Cunningham D, et al. Perioperative chemotherapy versus surgery alone or resectable gastroesophageal cancer. N Engl J Med. 2006;355:11–20. doi: 10.1056/NEJMoa055531.CrossRefPubMedGoogle Scholar
  5. 5.
    Macdonald JS, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345:725–30. doi: 10.1056/NEJMoa010187.CrossRefPubMedGoogle Scholar
  6. 6.
    Sobin LH, Wittekind C, editors. TNM classification of malignant tumours. 6th ed. New York, UICC: Wiley-Liss; 2002.Google Scholar
  7. 7.
    NCSS statistical software version 07.1.4. Kaysville: NCSS; 2007.Google Scholar
  8. 8.
    Korst RJ, et al. Down staging of T or N predicts long-term survival after preoperative chemotherapy and radical resection for esophageal carcinoma. Ann Thoracic Surg. 2006;82(2):480–5. doi: 10.1016/j.athoracsur.2006.03.072.CrossRefGoogle Scholar
  9. 9.
    Geh JI, et al. Preoperative ECF chemotherapy in gastro-oesophageal adenocarcinoma. Clin Oncol. 2000;12:182–7.Google Scholar
  10. 10.
    Bamias A, et al. Epirubicin cisplatin and protracted venous infusion of 5-fluorouracil for esophagogastric adenocarcinoma. Cancer. 1996;77:1978–85.CrossRefPubMedGoogle Scholar
  11. 11.
    Ajani JA, Correa AM, Swishe SG, Wu TT. For localized gastroesophageal cancer, you give chemoradiation before surgery, but then what happens? J Clin Oncol. 2007;25(27):4315–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Forastiere A, Orringer M, Perez-Tamayo C, Urba SG, Zahurak M. Preoperative chemoradiation followed by transhiatal esophagectomy for carcinoma of the esophagus: final report. J Clin Oncol. 1993;11:1118–23.PubMedGoogle Scholar
  13. 13.
    Mansour JC, et al. Does graded histologic response after neoadjuvant chemotherapy predict survival for completely resected gastric cancer? Ann Surg Oncol. 2007;14(12):3412–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Wu TT, et al. Excellent interobserver agreement on grading the extent of residual carcinoma after preoperative chemoradiation in esophageal and esophagogastric junction carcinoma: a reliable predictor of patient outcome. Am J Surg Pathol. 2007;31:58–64.CrossRefPubMedGoogle Scholar
  15. 15.
    Downey RJ, et al. Whole body 8FDG PET and the response of esophageal cancer to induction therapy: a prospective trial. J Clin Oncol. 2003;21:428–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Matsuyama J, et al. The effect of neoadjuvant chemotherapy on lymph node micrometastases in squamous cell carcinomas of the thoracic esophagus. Surgery. 2007;141(5):570–80.CrossRefPubMedGoogle Scholar
  17. 17.
    Yamashita K, et al. Lymph node metastasis density (ND)-factor association with malignant degree and ND40 as “non-curative factor” in gastric cancer. Anticancer Res. 2008;28(1B):435–41.PubMedGoogle Scholar
  18. 18.
    Saito H, et al. Prognostic significance of the ratio between metastatic and dissected lymph nodes (n ratio) in patients with advanced gastric cancer. J Surg Oncol. 2008;97(2):132–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Marchet A, et al. The prognostic value of N-ratio in patients with gastric cancer: validation in a large, multicenter series. Eur J Surg Oncol. 2008;34(2):159–65.PubMedGoogle Scholar
  20. 20.
    Rizk NP, et al. American Joint Committee on cancer staging does not accurately predict survival in patients receiving multimodality therapy for esophageal adenocarcinoma. J Clin Oncol. 2007;25:507–12.CrossRefPubMedGoogle Scholar
  21. 21.
    Ilson DH. Esophageal cancer: new developments in systemic therapy. Cancer Treat Rev. 2003;29:525–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Heath EI, et al. Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol. 2000;18:868–76.PubMedGoogle Scholar
  23. 23.
    NCCN Practice guideline in Oncology: Prostate cancer. V.1.2008.
  24. 24.
    Mekhail TM, et al. Validation and extension of the Memorial Sloan-Kettering prognostic factors model for survival in patients with previously untreated metastatic renal cell carcinoma. J Clin Oncol. 2005;23:832–41.CrossRefPubMedGoogle Scholar
  25. 25.
    Dexter SPL, et al. Circumferential resection margin involvement: an independent predictor of survival following surgery for esophageal cancer. Gut. 2001;48:667–70.CrossRefPubMedGoogle Scholar
  26. 26.
    Lagarde SM, Kate FJW, Reitsma JB, Busch ORC, Lanschot JJB. Prognostic factors in adenocarcinoma of the esophagus or gastroesophageal junction. J Clin Oncol. 2006;24(26):4347–55.CrossRefPubMedGoogle Scholar
  27. 27.
    Gockel I, Sultanov FS, Domeyer M, Goenner U, Jungiger TH. Developments in esophageal surgery for adenocarcinoma: a comparison of two decades. BMC Cancer. 2007;7:114.CrossRefPubMedGoogle Scholar

Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  1. 1.Department of Clinical Oncology, Castle Hill HospitalHull & East Yorkshire NHS TrustHullUK
  2. 2.Department of Surgical OncologyDiana Princess of Wales HospitalGrimsbyUK
  3. 3.Department of PathologyDiana Princess of Wales HospitalGrimsbyUK

Personalised recommendations