Long term survival in gastro-oesophageal cancer

Abstract Background Globally, oesophageal cancer incidence continues to increase. In recent years, surgical and oncological advancements have increased survival rates. Despite this, survival remains <50% at five-years for patients treated with curative oesophagectomy. Previous data has suggested post-operative complications may play a role in long-term increased mortality in oesophageal cancer patients. This study aimed to examine the effect of adverse in-hospital events following oesophagectomy on the long-term prognosis for oesophageal cancer, including assessing the effect of cumulative complication burden using data from a single high-volume academic unit in the UK. Methods Retrospective analysis of patients undergoing oesophagectomy for oesophageal adenocarcinoma or squamous cell carcinoma was performed to assess the relationship between in-hospital events and long-term survival. Analysis was limited to patients who survived to 90 days post-oesophagectomy (n = 380). Complications were graded according to the Clavien-Dindo (CD) classification and the Comprehensive Complication Index (CCI). Survival was estimated using Kaplan Meier survival curves and multivariate cox-regression, adjusting for variables known to influence survival. The absolute magnitude of effect of complications on survival was assessed using the risk-adjusted population attributable fraction (PAF), which estimates the percentage improvement in survival if specified complications were removed. Results Complications occurred in 251 patients (66.1%). ≥CD3a complications (HR1.65, 95%CI 1.15-2.38, p < 0.010) and unplanned critical care admissions (HR2.24, 95%CI 1.45-3.46, p < 0.001) were independently associated with worse prognosis whereas pulmonary complications and anastomotic leak were not. A CCI >30 was the optimum cut-point for OS (HR1.94, 95%CI 1.36-2.78, p < 0.001), and after weighting to remove confounding bias median survival was shorter with CCI>30 (28vs72 months, p < 0.001). There was no difference in median survival when CCI>30 occurred from major or multiple minor complications (31 vs 21 months, p = 0.096). The risk adjusted PAF for CCI>30 was 8.5% (95%CI 3.6-13.1%). Conclusions Long-term survival following oesophagectomy for oesophageal cancer is significantly affected by major complications and unplanned critical care admissions. The cumulative effect of multiple post-operative minor complications is comparable to the effect of major complications on long-term survival from oesophageal cancer, and cause a substantial number of potentially preventable deaths, even in patients who survive to discharge.

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Impact of hospital volume on long-term survival after resection for oesophageal cancer: a population-based study in Taiwan†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezu377 ◽

2014 ◽

Vol 46 (6) ◽

pp. e127-e135 ◽

Cited By ~ 6

Author(s):

Po-Kuei Hsu ◽

Hui-Shan Chen ◽

Shiao-Chi Wu ◽

Bing-Yen Wang ◽

Chao-Yu Liu ◽

...

Keyword(s):

Oesophageal Cancer ◽

Hospital Volume ◽

Population Based ◽

Term Survival ◽

Population Based Study ◽

Long Term Survival

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Six-month postoperative quality of life predicts long-term survival after oesophageal cancer surgery

European Journal of Cancer ◽

10.1016/j.ejca.2010.10.014 ◽

2011 ◽

Vol 47 (4) ◽

pp. 530-535 ◽

Cited By ~ 46

Author(s):

Therese Djärv ◽

Pernilla Lagergren

Keyword(s):

Quality Of Life ◽

Oesophageal Cancer ◽

Cancer Surgery ◽

Term Survival ◽

Long Term Survival ◽

Postoperative Quality

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The impact of Intensive Care stay post oesophagectomy for oesophageal cancer on long‐term survival

Surgical Practice ◽

10.1111/1744-1633.12510 ◽

2021 ◽

Author(s):

Alan Askari ◽

Joshua Wong ◽

Josh Rabinowitz ◽

Amjid Riaz

Keyword(s):

Intensive Care ◽

Oesophageal Cancer ◽

Term Survival ◽

Long Term Survival ◽

Intensive Care Stay ◽

The Impact

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Patient demographics and lifestyle factors influencing long-term survival of oesophageal cancer and gastric cardia cancer in a nationwide study in Sweden

European Journal of Cancer ◽

10.1016/j.ejca.2008.04.002 ◽

2008 ◽

Vol 44 (11) ◽

pp. 1566-1571 ◽

Cited By ~ 47

Author(s):

Martin Sundelöf ◽

Jesper Lagergren ◽

Weimin Ye

Keyword(s):

Oesophageal Cancer ◽

Gastric Cardia ◽

Cardia Cancer ◽

Term Survival ◽

Long Term Survival ◽

Nationwide Study ◽

Patient Demographics ◽

Factors Influencing ◽

Gastric Cardia Cancer

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O-OGC01 Development and validation of multivariate prediction model of long-term survival after oesophagectomy in patients with oesophageal cancer

British Journal of Surgery ◽

10.1093/bjs/znab429.033 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Rohan R Gujjuri ◽

Jonathan M Clarke ◽

Jessie A Elliot ◽

John V Reynolds ◽

Sheraz R Markar ◽

...

Keyword(s):

Prediction Model ◽

Oesophageal Cancer ◽

Prediction Models ◽

Good Discrimination ◽

Term Survival ◽

Long Term Survival ◽

Survival Probabilities ◽

Time To Recurrence ◽

Good Agreement

Abstract Background Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can help clinicians identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed and evaluated a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer. Methods Patients who underwent curative surgery between June 2009-2015 from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and Random Survival Forest (RSF). Model performance was evaluated using discrimination (time-dependent area under the curve (tAUC)) and calibration (visual comparison of predicted and observed survival probabilities). Results This study included 4719 patients with an OS of 47.7% and DFS of 48.4% at 5 years. Sixteen variables were included in the final model. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% (95% CI 77.4-79.1%) and 77.1% (95% CI 76.1-78.1%) for OS and a tAUC of 79.4% (95% CI 78.5-80.2%) and 78.6% (95% CI 77.5-79.5%) respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20-80% and moderate agreement in the <20% and >80% quintile groups. Conclusions This study demonstrated the ability of a statistical model to accurately predict long-term survival and time-to-recurrence after surgery for oesophageal cancer, with CPH and RSF models showing good discrimination and calibration. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by enhancing selection of treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to improve understanding of the clinical utility derived from prognostic model use.

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Effect of anastomotic leaks on long-term survival after oesophagectomy for oesophageal cancer: systematic review and meta-analysis

Diseases of the Esophagus ◽

10.1093/dote/doaa085 ◽

2020 ◽

Author(s):

Rohan R Gujjuri ◽

Sivesh K Kamarajah ◽

Sheraz R Markar

Keyword(s):

Oesophageal Cancer ◽

Early Recognition ◽

Meta Analysis ◽

Immunological Response ◽

Prognostic Impact ◽

Curative Surgery ◽

Term Survival ◽

Long Term Survival ◽

The Impact

Summary Introduction Long-term survival after curative surgery for oesophageal cancer surgery remains poor, and the prognostic impact of anastomotic leak (AL) remains unknown. A meta-analysis was conducted to investigate the impact of AL on long-term survival. Methods A systematic electronic search for articles was performed for studies published between 2001 and 2020 evaluating the long-term oncological impact of AL. Meta-analysis was performed using the DerSimonian-Laird random-effects model to compute hazard ratios and 95% confidence intervals. Results Nineteen studies met the inclusion criteria, yielding a total of 9885 patients. Long-term survival was significantly reduced after AL (HR: 1.79, 95% CI: 1.33–2.43). AL was associated with significantly reduced overall survival in studies within hospital volume Quintile 1 (HR: 1.35, 95% CI: 1.12–1.63) and Quintile 2 (HR: 1.83, 95% CI: 1.35–2.47). However, no significant association was found for studies within Quintile 3 (HR: 2.24, 95% CI: 0.85–5.88), Quintile 4 (HR: 2.59, 95% CI: 0.67–10.07), and Quintile 5 (HR: 1.29, 95% CI: 0.92–1.81). AL was significantly associated with poor long-term survival in patients with associated overall Clavien Dindo Grades 1–5 (HR: 2.17, 95% CI: 1.31–3.59) and severe Clavien Dindo Grades 3–5 (HR: 1.42, 95% CI: 1.14–1.78) complications. Conclusions AL has a negative prognostic impact on long-term survival after restorative resection of oesophageal cancers, particularly in low-volume centers. Future efforts must be focused on strategies to minimize the septic and immunological response to AL with early recognition and treatment thus reducing the impact on long-term survival.

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