Analysis Of Recurrence And Survival After Esophagectomy Following Neoadjuvant Therapy In Patients With Locally Advanced Esophageal Squamous Cell Cancer

ObjectiveNeoadjuvant therapy is currently the preferred management approach for locally advanced esophageal cancer.Tumour recurrence following oesophagectomy for oesophageal cancer is common despite neoadjuvant treatment.Reports documenting recurrence risk stratification and survival rates in esophageal squamous cell cancer(ESCC)patients with recurrent disease after neoadjuvant therapy are scarce.The recurrence patterns and therapeutic outcomes of patients following oesophagectomy in the era of neoadjuvant therapy are not fully understood.Understanding patterns of relapse and the efficacy of rescue treatment or esophageal cancer after neoadjuvant treatment might provide insights into the development of comprehensive treatment for esophageal cancer.The aim of this study is to investigate recurrence patterns and survival outcomes,and to identify factors associated with recurrence risk and survival of ESCC after neoadjuvant therapy.MethodPatients with ESCC who underwent neoadjuvant therapy followed by esophagectomy in the Affiliated Cancer Hospital of Zhengzhou University between2011 and 2015 were retrospectively reviewed.Data on Recurrence pattern,site,timing,frequency and survival were analyzed.The Kaplan–Meier method was used to calculate overall survival(OS)and recurrence-free survival(RFS)rates.Using?~2test for categorical predictor variables and Wilcoxon rank sum test for continuous predictor variables.Univariate and multivariate Cox-regression analyses were performed to identify independent prognostic factors associated with recurrence and survival.ResultA total of 275 patients were eligible for this study.152 patients(55.3%)were identified as having disease recurrence.Locoregional recurrence(LR)?distant metasi(DM)and LR plus DM were observed in 77(50.6%)?34(23.4%)and33(21.7%)patients,respectively.Among patients with LR,the rates of lymph node(LN)metastasis were 32.7%supraclavicular/neck,64.5%mediastinal,and 12.7%upper abdominal lymph nodes.The most common sites of DR were lung(49.3%),liver(23.9%)and bone(20.9%).The median time to locoregional recurrence and distant metastases was 10.5 and 10.6 months(P=0.569).21.1%of the patients with pCR experienced late relapses after 3 years of follow-up evaluation,whereas almost all relapses occurred within the first 3 years after surgery.The 1-?2-and 3-year overall survival rates after recurrence were 36.0%?15.1%and 5.2%.Patients who received chemoradiotherapy?radiotherapy?chemotherapy and best supportive had a median post recurrence survival of 11.7?7.8?5.3 and 2.7 months,respectively.Multivariable analysis identified ypT stage and ypN stage as independently associated with recurrence,ypTNM stage and treatment for recurrence as the independent prognostic factors.ConclusionIn conclusion,locoregional recurrence was the most common cause of treatment failure after multimodality neoadjuvant treatment and curative resection among patients with ESCC,and the recurrence was mainly distributed in the supraclavicular,neck,mediastinum,and upper abdomen lymph node regions.A more intensive follow-up within the first 3 years may be beneficial for adenocarcinoma patients who do not achieve pCR.But given some late recurrences that can occur in pCR patients,follow-up every 6 months from years 3 to 5 may be warranted.Patients who received chemoradiotherapy or radiotherapy after recurrence had significantly better survival than those untreated,especially locally recurrent.Multicenter and prospective validation is warranted.