What are the outcomes for long-term survivors after esophagectomy ? - Evidence from a randomized controlled trial (FFCD9901).
William B Robb, Julie Veziant, Laetitia Dahan, Fran��oise Mornex, Emilie Barbier, Xavier Beno��t D'Journo, Sylvain Manfredi, Val��rie Boige, Marine Jary, Niki Christou, C��me Lepage, Guillaume Piessen, FFCD, SFRO, UNICANCER, GERCOR and the FREGAT working group-FRENCH
Author Information
William B Robb: Department of Oesophageal and Gastric Surgery, Beaumont Hospital and the Royal College of Surgeons in Ireland, Ireland.
Julie Veziant: CHU Lille, Departement of Digestive and Oncological Surgery, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France. Electronic address: julie.veziant@chu-lille.fr.
Laetitia Dahan: Department of Digestive Oncology, La Timone Hospital, Aix-Marseille University, Marseille, France.
Fran��oise Mornex: Department of Radiotherapy, Pierre-B��nite Hospital, Lyon, France.
Emilie Barbier: FFCD EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche-Comt��, Dijon, France.
Xavier Beno��t D'Journo: Department of Thoracic Surgery, H��pital Nord, Marseille, France.
Sylvain Manfredi: FFCD EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche-Comt��, Dijon, France; Department of Gastroenterology, University Hospital of Dijon, France.
Val��rie Boige: Department of Cancer Medicine, Gustave Roussy, Villejuif, France.
Marine Jary: Department of Surgical and Medical Oncology, University Hospital of Clermont-Ferrand, France.
Niki Christou: Department of Digestive and Endocrine Surgery, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges, France; Laboratoire CAPTuR, INSERM U1308, Facult�� de M��decine de Limoges, 2 Rue Du Docteur Marcland, 87000 Limoges, France.
C��me Lepage: FFCD EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche-Comt��, Dijon, France; Department of Gastroenterology, University Hospital of Dijon, France.
Guillaume Piessen: CHU Lille, Departement of Digestive and Oncological Surgery, F-59000, Lille, France; Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France.
BACKGROUND: Little is known regarding long-term outcomes of survivors beyond 5 years after esophagectomy. This study assesses oncological outcomes of long-term survivors of esophageal cancer. METHODS: Data is derived from a multi-center randomized controlled trial comparing neoadjuvant chemoradiotherapy (NCRT) and surgery to surgery alone for clinically stage I and II esophageal cancers (FFCD9901). Only patients undergoing esophagectomy were included in this study. Clinicopathological variables of 5-year survivors were analyzed. Multivariate logistic regression analysis identified factors predictive of death prior to 5 years. Patterns of disease recurrence and second primary tumor development were established. RESULTS: From June 2000 until June 2009, 195 patients from 30 French centers were randomly assigned to NCRT followed by surgery or surgery alone. Of 170 patients who underwent esophagectomy, 70 patients were alive at 5 years - an overall 5-year survival of 41.2 %. In logistic regression multivariate analysis, WHO performance status of ���1 (p = 0.045), advanced pT category (p = 0.030) and post-operative complications (p = 0.047) predicted death prior to 5 years. Twenty patients died after the 5-year time point, 9 of these due to progression of their esophageal cancer. Nineteen patients developed a second primary malignancy, of whom 14 developed either a head and neck or lung cancers. CONCLUSIONS: Being alive 5 years after esophagectomy does not equate to cure. In clinically staged early disease, a distinct group of patients develop disease recurrence later than 5 years from treatment. Development of a second primary cancer in this population poses a clinical threat. Surveillance protocols should be adapted accordingly.
