title: What are the factors that predict outcome at relapse after previous esophagectomy and adjuvant therapy in high-risk esophageal cancer?
abstract: OBJECTIVE
  The present study investigated factors affecting outcome at relapse after previous surgery and adjuvant chemoradiation (crt) in high-risk esophageal cancer patients.
  
  
  METHODS
  From 1989 to 1999, we followed high-risk resected esophageal cancer patients who had completed postoperative crt therapy. Patients who relapsed with a disease-free interval of less than 3 months were treated with palliative crt when appropriate. Patients with a disease-free interval of 3 months or more were treated with best supportive care. Post-recurrence survival was estimated using the Kaplan-Meier technique, and statistical comparisons were made using log-rank chi-square tests and Cox regression.
  
  
  RESULTS
  Of the 69 patients treated with adjuvant crt after esophagectomy, 46 experienced recurrence. Median time to relapse was 28 months (range: 0.1-40 months). Among the 46 relapsed patients, median age was 61 years (range: 37-82 years), and 42 were men. At the initial staging, 44 of 46 were node-positive; 31 of 46 had adenocarcinoma. In 33 of 46, post-esophagectomy resection margins were clear. Median follow-up after recurrence was 30.5 months (range: 1.3-100 months). Median overall survival after recurrence was 5.8 months, and the 12-month, 24-month, and 36-month survival rates were 20%, 10%, and 5% respectively. Of the prognostic factors analyzed, only resection margin status and interval to recurrence were statistically significant for patient outcome in univariate and multivariate analysis. Patients who had positive resection margins and who relapsed 12 or fewer months after surgery and adjuvant crt had a median post-recurrence overall survival of 0.85 months as compared with 6.0 months in other patients (more than 12 months to relapse, or negative resection margins, or both; log-rank p = 0.003).
  
  
  CONCLUSIONS
  Resection margin status and interval to disease relapse are significant independent prognostic factors for patient outcome after adjuvant crt therapy.
authors.affiliation: Department of Oncology, Division of Radiation Oncology, London Health Sciences Center, University of Western Ontario, London, ON.
authors.forename: E
authors.initials: E
authors.lastname: Yu
authors.forename: P
authors.initials: P
authors.lastname: Tai
authors.forename: R
authors.initials: R
authors.lastname: Malthaner
authors.forename: L
authors.initials: L
authors.lastname: Stitt
authors.forename: G
authors.initials: G
authors.lastname: Rodrigues
authors.forename: R
authors.initials: R
authors.lastname: Dar
authors.forename: B
authors.initials: B
authors.lastname: Yaremko
authors.forename: J
authors.initials: J
authors.lastname: Younus
authors.forename: M
authors.initials: M
authors.lastname: Sanatani
authors.forename: M
authors.initials: M
authors.lastname: Vincent
authors.forename: B
authors.initials: B
authors.lastname: Dingle
authors.forename: D
authors.initials: D
authors.lastname: Fortin
authors.forename: R
authors.initials: R
authors.lastname: Inculet