Fonseca Sarah, Ramos Igor Gabriel Silva, Maegawa Felipe Antonio Boff, Uson Junior Pedro Luiz Serrano, Tustumi Francisco
Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil.
Centro Universitário Lusíada, Department of Evidence-Based Medicine - Santos (SP), Brazil.
Arq Bras Cir Dig. 2025 Aug 4;38:e1889. doi: 10.1590/0102-67202025000020e1889. eCollection 2025.
Esophageal cancer remains one of the most aggressive malignancies of the gastrointestinal tract, with high rates of recurrence and mortality despite curative-intent surgery and adjuvant therapies. Identifying factors associated with recurrence is crucial for improving outcomes and guiding personalized treatment.
The aim of this study was to evaluate pretreatment and treatment-related variables associated with recurrence in patients with esophageal cancer undergoing surgical resection.
This retrospective study analyzed data from patients with stage I-III esophageal carcinoma who underwent esophagectomy between 2000 and 2025, using the Fundação Oncocentro de São Paulo (FOSP) database. Clinical, histological, and treatment-related variables were evaluated. Disease-free survival and recurrence patterns were assessed using Cox proportional hazards models and Fine-Gray subdistribution hazard models.
A total of 2,057 patients were included, with a mean follow-up of 36.5 months (±44.8). In the multivariate analysis, advanced tumor stage (stage II: HR 1.68, 95%CI 1.21-2.33; stage III: HR 3.23, 95%CI 2.29-4.56; both p<0.01), location (middle esophagus: HR 1.31, 95%CI 1.11-1.54; p=0.001; upper esophagus: HR 1.54, 95%CI 1.21-1.96; p<0.001), and histological subtype (rare histologies: HR 2.17, 95%CI 1.35-3.49; p=0.001) were associated with worse disease-free survival. Multimodal therapy improved disease-free survival (HR 0.40, 95%CI 0.24-0.66) in stage III tumors. Squamous cell carcinoma was independently associated with locoregional recurrence (SHR 1.52, 95%CI 1.05-2.20; p=0.027). For distant recurrence, squamous cell carcinoma showed a protective effect (SHR 0.52, 95%CI 0.31-0.88; p=0.015), while high tumor grade (grade II: SHR 3.65, 95%CI 1.98-6.72; p<0.001) was associated with an increased risk. Multimodal treatments influenced recurrence patterns but did not independently predict outcomes after adjustment.
Tumor stage, location, and histology were strong predictors of disease-free survival after surgery for esophageal cancer. Histological subtypes significantly influenced recurrence patterns. Squamous cell carcinoma was associated with a higher risk of locoregional recurrence but a lower risk of distant metastasis compared to adenocarcinoma. Multimodal therapy demonstrated a protective effect in stage III disease.
食管癌仍然是胃肠道最具侵袭性的恶性肿瘤之一，尽管进行了根治性手术和辅助治疗，其复发率和死亡率仍然很高。识别与复发相关的因素对于改善治疗效果和指导个性化治疗至关重要。
本研究的目的是评估接受手术切除的食管癌患者中与复发相关的术前和治疗相关变量。
这项回顾性研究分析了2000年至2025年间在圣保罗肿瘤中心（FOSP）数据库中接受食管切除术的I-III期食管癌患者的数据。评估了临床、组织学和治疗相关变量。使用Cox比例风险模型和Fine-Gray亚分布风险模型评估无病生存期和复发模式。
共纳入2057例患者，平均随访36.5个月（±44.8）。在多变量分析中，肿瘤晚期（II期：HR 1.68，95%CI 1.21-2.33；III期：HR 3.23，95%CI 2.29-4.56；两者p<0.01）、位置（食管中段：HR 1.31，95%CI 1.11-1.54；p=0.001；食管上段：HR 1.54，95%CI 1.21-1.96；p<0.001）和组织学亚型（罕见组织学类型：HR 2.17，95%CI 1.35-3.49；p=0.001）与较差的无病生存期相关。多模式治疗改善了III期肿瘤的无病生存期（HR 0.40，95%CI 0.24-0.66）。鳞状细胞癌与局部区域复发独立相关（SHR 1.52，95%CI 1.05-2.20；p=0.027）。对于远处复发，鳞状细胞癌显示出保护作用（SHR 0.52，95%CI 0.31-0.88；p=0.015），而高肿瘤分级（II级：SHR 3.65，95%CI 1.98-6.72；p<0.001）与风险增加相关。多模式治疗影响复发模式，但调整后不能独立预测预后。
肿瘤分期、位置和组织学是食管癌手术后无病生存期的强有力预测因素。组织学亚型显著影响复发模式。与腺癌相比，鳞状细胞癌局部区域复发风险较高，但远处转移风险较低。多模式治疗在III期疾病中显示出保护作用。
