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ToolsSerralheiro, Pedro, Rankin, Adeline, Clark, Allan, Holyoake, Daniel and Cheong, Edward (2020) Pre- and postoperative prognostic factors for resectable esophageal adenocarcinoma. Annals of Surgical Oncology, 35. pp. 132-138. ISSN 0960-7404
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Abstract
Background: Prognostication for esophageal cancer has traditionally relied on postoperative tissue specimens. This study aimed to use a histologically homogenous cohort to investigate the relationship between clinical, pathological or radiological variables and overall survival in patients undergoing esophagectomy for adenocarcinoma. Methods: A single-centre study of patients who underwent esophagectomy for adenocarcinoma over 10 years in a tertiary centre was performed. By regression analysis, variables available preoperatively and postoperatively were studied for prognostication. The primary outcome was overall survival. Results: 254 cases were analyzed. Over a median follow-up period of 31.8 months (IQR = 42.5), overall survival was 51.5 months (95% confidence interval: 33.0–69.9). According to hazard ratios (HR) for all-cause death, adverse prognostic factors included: a higher postoperative N-stage (HR ≥ 1.29; p ≤ 0.024), histopathological tumor length ≥25 mm (HR = 2.04; p = 0.03), poorer tumor differentiation (HR ≥ 2.86; p ≤ 0.042), and R1 status (HR = 2.33; p = 0.02). A lymph node yield ≥35 was a favorable prognostic factor (HR = 0.022; p < 0.001). Demographic and radiological variables, preoperative TNM stages, postoperative T-stage, and neoadjuvant/adjuvant treatment were not associated with overall survival. Conclusions: This study identifies several postoperatively factors which are available for the prognostication and identifies factors that should not be used to exclude patients from curative surgery.
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