Department of Surgery, Keio University School of Medicine, 35-Banchi, Shinano-Machi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
Division of Diagnostic Pathology, Keio University School of Medicine, 35-banchi, Shinano-machi, Shinjuku-ku, Tokyo, Japan.
Esophagus. 2023 Oct;20(4):679-690. doi: 10.1007/s10388-023-01014-y. Epub 2023 May 24.
Esophagectomy for esophageal cancer has a high incidence rate of early postoperative recurrence and death. This study aimed to identify the clinical and pathological features in early recurrence cases and to confirm the usefulness of prediction using these factors for effective adjuvant therapy and postoperative surveillance.
One hundred and twenty five patients who developed postoperative recurrence after undergoing radical esophagectomy for thoracic esophageal cancer were classified into two groups as follows: those with early recurrence at ≤ 6 months and those with nonearly recurrence at > 6 months after surgery. After identifying related factors of early recurrence, usefulness of these factors for prediction were examined in all patients with and without recurrence.
The analysis cohort consisted of 43 and 82 patients in the early and nonearly recurrence groups, respectively. In multivariate analysis, factors associated with early recurrence were higher initial levels of tumor markers (squamous cell carcinoma [SCC] ≥ 1.5 ng/ml in tumors, except for adenocarcinoma, and carcinoembryonic antigen [CEA] ≥ 5.0 ng/ml in adenocarcinoma) and higher venous invasion (v), i.e., ≥ 2 (p = 0.040 and p = 0.004, respectively). The usefulness of these two factors for recurrence prediction was confirmed in 378 patients, including 253 patients without recurrence. Patients with at least one of the two factors had significantly higher early recurrence rates than those without any factors in pStages II and III (odds ratio [OR], 6.333; p = 0016 and OR, 4.346; p = 0.008, respectively).
Early recurrence of thoracic esophageal cancer (i.e., during ≤ 6 months after esophagectomy) was associated with higher initial tumor marker levels and pathological findings of v ≥ 2. The combination of these two factors is useful as a simple and critical predictor of early postoperative recurrence.
食管癌切除术的术后早期复发率和死亡率较高。本研究旨在确定早期复发病例的临床和病理特征，并确认使用这些因素进行预测的有效性，以便为有效的辅助治疗和术后监测提供依据。
将 125 例接受根治性胸段食管癌切除术并发生术后复发的患者分为两组：早期复发组（术后 6 个月内）和非早期复发组（术后 6 个月以上）。在确定早期复发的相关因素后，在所有有和无复发的患者中，检查这些因素对预测的有效性。
分析队列中早期和非早期复发组分别有 43 例和 82 例患者。多因素分析显示，与早期复发相关的因素包括肿瘤标志物初始水平较高（除腺癌外，鳞癌[SCC]≥1.5ng/ml，腺癌中癌胚抗原[CEA]≥5.0ng/ml）和静脉侵犯程度较高（v≥2，p=0.040 和 p=0.004）。在包括 253 例无复发患者的 378 例患者中，证实了这两个因素对复发预测的有效性。至少有一个因素的患者在 pStages II 和 III 期的早期复发率明显高于无任何因素的患者（优势比[OR]，6.333；p=0.016 和 OR，4.346；p=0.008）。
胸段食管癌的早期复发（即术后 6 个月内）与较高的初始肿瘤标志物水平和 v≥2 的病理表现有关。这两个因素的组合可作为术后早期复发的简单且关键的预测因子。
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