Formulating a surveillance strategy following surgery for oesophagogastric cancer.

Abstract

153 Background: Oesophagogastric adenocarcinoma (OGA) has a poor prognosis, even for patients (pts) with operable disease. We conducted a retrospective study to assess relapse characteristics to see if these could influence follow-up strategies. Methods: We performed a retrospective review of all pts with OGA who had surgery with radical intent at the Royal Marsden between January 2001 – December 2010. Details of first relapse, including date, site, symptoms, method of relapse detection, tumour markers and treatment were recorded. Association of survival outcomes with relapse characteristics was determined by Cox regression univariate analysis. Results: 360 pts with OGA had surgery and 72.8% received neoadjuvant or peri-operative chemotherapy. After a median follow-up of 61.7 months, the median disease-free survival (DFS) was 35.6 months (95% CI 27.0 – 65.4) and median overall survival (OS) was 59.6 months (95% CI 40.7 – 81.2). 147 pts (40.8%) had disease recurrence. 51.0%, 78.9% and 91.8% of relapses occurred within 1, 2 and 3 years respectively. 78.9% of pts had distant relapse only, 7.5% had anastomotic recurrence and 13.6% had both. R1/2 resection was associated with a shorter time to distant relapse (p <0.001) and OS (13.8 months vs 77.7 months, HR 2.76, 95% CI 1.97 – 3.88, p < 0.001). At relapse, 101 pts (68.7%) were symptomatic. The 46 asymptomatic relapses were detected by tumour markers (n = 30, 65.2%), routine CT (n = 10, 21.7%) and endoscopy (n = 3, 6.5%). Symptomatic pts were less likely to receive further treatment than asymptomatic pts (55.5% vs 82.6%, p = 0.001), had worse OS from the time of surgery (18.9 months vs 26.3 months, HR 1.57, 95% CI 1.07 – 2.30, p = 0.02) and worse survival beyond relapse (5.1 months vs 14.6 months, HR 2.05, 95% CI 1.40 – 3.00, p < 0.001). There was no difference in DFS between these two groups (HR 0.90, 95% CI 0.63 – 1.27, p = 0.539), thus excluding a lead time bias. Conclusions: In pts undergoing surgery for localised OGA, over 90% of relapses occurred within the first 3 years. Pts with asymptomatic relapses were more likely to receive further treatment with resultant prolonged OS. A more intensive surveillance program with regular tumour marker measurement should be considered for the first 3 years post surgery.