Post-recurrence survival in patients with previously resected esophageal adenocarcinoma (EAC).

Abstract

4075 Background: EAC recurrence after surgery with curative intent is believed to carry a uniformly dismal prognosis that may discourage further therapy. To date, the post-recurrence survival of patients has not been examined in EAC. Our aim was to examine site of recurrence in relation to outcome in EAC patients after surgery. Methods: Among EAC patients (N = 796) rendered margin-free at surgery performed at Mayo Clinic, most were T3-4 and lymph node (LN)-positive; none received neoadjuvant therapy. The patient subset who had documented disease recurrence (N = 401) formed the current study population. Cox models were used to examine overall survival (OS) post-recurrence. Results: Among patients with recurrence, median time to recurrence (TTR) was 11 months. Site of recurrence included loco-regional (regional LNs, esophagogastric, anastomosis), chest, abdomen, or distant sites in 97 (27%), 144 (40%), 181 (50%), and 88 (24%) patients, respectively. Most recurrences (66%) were limited to one site. Chest-involved recurrence was significantly associated with improved OS (hazard ratio [HR] 0.78, P = .047), even after adjusting for TTR, number of recurrence sites, tumor pathology, and palliative chemotherapy. This result was confirmed when multivariate analysis was restricted to patients who had only 1 recurrence site (Table) or who had biopsy-proven recurrence (P = .080). In separate models, abdomen-involved (HR = 1.3, P = .016) or bone-involved (HR = 1.6, P= .008) recurrences were independently associated with worse OS. Conclusions: Chest-involved recurrence of EAC independently predicts for improved survival, whereas abdominal and bony sites of recurrence predict for worse outcome. Primary tumor grade and node number were durable prognosticators after recurrence. These novel data provide useful prognostic information and have the potential to influence clinical decision-making. [Table: see text]