Recurrent Disease After Esophageal Cancer Surgery
Annals of Surgery, vol. 276, pp. 806–813
Abstract
OBJECTIVE: This study investigated the patterns, predictors, and survival of recurrent disease following esophageal cancer surgery. BACKGROUND: Survival of recurrent esophageal cancer is usually poor, with limited prospects of remission. METHODS: This nationwide cohort study included patients with distal esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma after curatively intended esophagectomy in 2007 to 2016 (follow-up until January 2020). Patients with distant metastases detected during surgery were excluded. Univariable and multivariable logistic regression were used to identify predictors of recurrent disease. Multivariable Cox regression was used to determine the association of recurrence site and treatment intent with postrecurrence survival. RESULTS: Among 4626 patients, 45.1% developed recurrent disease a median of 11 months postoperative, of whom most had solely distant metastases (59.8%). Disease recurrences were most frequently hepatic (26.2%) or pulmonary (25.1%). Factors significantly associated with disease recurrence included young age (≤65 y), male sex, adenocarcinoma, open surgery, transthoracic esophagectomy, nonradical resection, higher T-stage, and tumor positive lymph nodes. Overall, median postrecurrence survival was 4 months [95% confidence interval (95% CI): 3.6-4.4]. After curatively intended recurrence treatment, median survival was 20 months (95% CI: 16.4-23.7). Survival was more favorable after locoregional compared with distant recurrence (hazard ratio: 0.74, 95% CI: 0.65-0.84). CONCLUSIONS: This study provides important prognostic information assisting in the surveillance and counseling of patients after curatively intended esophageal cancer surgery. Nearly half the patients developed recurrent disease, with limited prospects of survival. The risk of recurrence was higher in patients with a higher tumor stage, nonradical resection and positive lymph node harvest.
Authors 61
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Marianne C. Kalff corresponding
Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Sofie P. G. Henckens corresponding
Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Daan M. Voeten corresponding
Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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Amsterdam University Medical Centers
Affiliation as printed
Department of Radiotherapy, Amsterdam UMC, Amsterdam, The Netherlands
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Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Wietse J. Eshuis corresponding
Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
Department of Surgery, Martini Ziekenhuis, Groningen, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
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Baukje Brattinga corresponding
Affiliation as printed
Department of Surgery, MC Leeuwarden, Leeuwarden, The Netherlands
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Affiliation as printed
Department of Surgery, Gelre Ziekenhuis, Apeldoorn, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Affiliation as printed
Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
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Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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Affiliation as printed
Department of Surgery, Isala Klinieken, Zwolle, The Netherlands
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Affiliation as printed
Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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Affiliation as printed
Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
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Affiliation as printed
Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
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Affiliation as printed
Department of Surgery, Gelre Ziekenhuis, Apeldoorn, The Netherlands
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Affiliation as printed
Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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Affiliation as printed
Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
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Burak Görgeç corresponding
Affiliation as printed
Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
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Affiliation as printed
Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Elisabeth-TweeSteden Ziekenhuis
Affiliation as printed
Department of Surgery, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands
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University Medical Center Utrecht
Affiliation as printed
Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Department of Surgery, Martini Ziekenhuis, Groningen, The Netherlands
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University Medical Center Utrecht
Affiliation as printed
Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
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Affiliation as printed
Department of Surgery, Ziekenhuisgroep Twente, Almelo, The Netherlands
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Affiliation as printed
Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Affiliation as printed
Department of Surgery, Zuyderland, Heerlen, The Netherlands
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Philip P. van der Linden corresponding
Affiliation as printed
Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
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Affiliation as printed
Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
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Affiliation as printed
Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
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Affiliation as printed
Department of Surgery, Reinier de Graaf Groep, Delft, The Netherlands
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Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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Jean-Pierre E. N. Pierie corresponding
Affiliation as printed
Department of Surgery, MC Leeuwarden, Leeuwarden, The Netherlands
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Affiliation as printed
Department of Surgery, Isala Klinieken, Zwolle, The Netherlands
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Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Department of Surgery, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
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Canisius-Wilhelmina Ziekenhuis
Affiliation as printed
Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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University Medical Center Utrecht
Affiliation as printed
Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
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The Netherlands Cancer Institute
Affiliation as printed
Department of Surgery, Antoni van Leeuwenhoek Ziekenhuis, Amsterdam, The Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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Radboud University Medical Center
Affiliation as printed
Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Affiliation as printed
Department of Surgery, Zuyderland, Heerlen, The Netherlands
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Affiliation as printed
Department of Surgery, Zuyderland, Heerlen, The Netherlands
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Leiden University Medical Center
Affiliation as printed
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Hein B.A.C. Stockmann corresponding
Affiliation as printed
Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands
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Canisius-Wilhelmina Ziekenhuis
Affiliation as printed
Department of Surgery, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
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Affiliation as printed
Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
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Affiliation as printed
Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Affiliation as printed
Department of Surgery, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
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Marinus J. Wiezer corresponding
Affiliation as printed
Department of Surgery, St Antonius Ziekenhuis, Nieuwegein, The Netherlands
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Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Mark I. van Berge Henegouwen corresponding
Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Suzanne Sarah Gisbertz corresponding
Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam
Affiliation as printed
Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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