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Defining Cure for Esophageal Cancer: Analysis of Actual 5-Year Survivors Following Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Esophagectomy is the mainstay of curative treatment for localized esophageal cancer. However, what constitutes cure is not well defined. This study was undertaken to characterize actual 5-year survivors following esophagectomy and to determine prognostic factors for disease-specific survival (DSS) from 60 months.

Materials and Methods

Between 1987 and 2004, 398 consecutive patients underwent esophagectomy and had potential for 5 years follow-up. Clinicopathological factors associated with DSS from 5 years onward were analyzed.

Results

Median DSS was 25 months. Neoadjuvant therapy was administered to 159 of 398 (40%). There were 114 of 398 (29%) actual 5-year survivors. On multivariate analysis, 5-year survivors were significantly more likely to have lower T classification, N classification, and R0 resections compared with patients who died less than 5 years after surgery. There were 66 of 398 patients (17%) with positive margins, and 6 of these were 5-year survivors. Of the 114 5-year survivors, 17 (15%) subsequently died of esophageal cancer. Prognostic factors for DSS after surviving 5 years were age and T classification for patients treated with neoadjuvant therapy and surgery alone, respectively. Powerful prognostic factors from time of treatment, including nodal status, were no longer prognostic factors after surviving to 5 years.

Conclusions

No single clinicopathological variable negated survival to 5 years. Prognostication once surviving 5 years is difficult. The majority of 5-year survivors can be considered cured of esophageal cancer.

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Acknowledgment

We would like to thank Dr. Ian Martin for his clinical contributions and recruitment of patients. Research funding: Paul Mackay Bolton Scholarship 2009, Royal Australasian College of Surgeons.

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Authors and Affiliations

  1. Department of Surgery, The University of Queensland, St Lucia, Australia

    Jodi Hirst MBBS, Bernard Mark Smithers MBBS, David C. Gotley MD, MBBS & Andrew Barbour PhD, MBBS

  2. Department of Surgery, Princess Alexandra Hospital, Brisbane, Australia

    Janine Thomas BNurs

Authors
  1. Jodi Hirst MBBS
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  2. Bernard Mark Smithers MBBS
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  3. David C. Gotley MD, MBBS
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  4. Janine Thomas BNurs
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  5. Andrew Barbour PhD, MBBS
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Corresponding author

Correspondence to Andrew Barbour PhD, MBBS.

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Hirst, J., Smithers, B.M., Gotley, D.C. et al. Defining Cure for Esophageal Cancer: Analysis of Actual 5-Year Survivors Following Esophagectomy. Ann Surg Oncol 18, 1766–1774 (2011). https://doi.org/10.1245/s10434-010-1508-z

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  • DOI: https://doi.org/10.1245/s10434-010-1508-z

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