title: Defining cure for esophageal cancer: analysis of actual 5-year survivors following esophagectomy.
abstract: BACKGROUND
  Esophagectomy is the mainstay of curative treatment for localized esophageal cancer. However, what constitutes cure is not well defined. This study was undertaken to characterize actual 5-year survivors following esophagectomy and to determine prognostic factors for disease-specific survival (DSS) from 60 months.
  
  
  METHODS
  Between 1987 and 2004, 398 consecutive patients underwent esophagectomy and had potential for 5 years follow-up. Clinicopathological factors associated with DSS from 5 years onward were analyzed.
  
  
  RESULTS
  Median DSS was 25 months. Neoadjuvant therapy was administered to 159 of 398 (40%). There were 114 of 398 (29%) actual 5-year survivors. On multivariate analysis, 5-year survivors were significantly more likely to have lower T classification, N classification, and R0 resections compared with patients who died less than 5 years after surgery. There were 66 of 398 patients (17%) with positive margins, and 6 of these were 5-year survivors. Of the 114 5-year survivors, 17 (15%) subsequently died of esophageal cancer. Prognostic factors for DSS after surviving 5 years were age and T classification for patients treated with neoadjuvant therapy and surgery alone, respectively. Powerful prognostic factors from time of treatment, including nodal status, were no longer prognostic factors after surviving to 5 years.
  
  
  CONCLUSIONS
  No single clinicopathological variable negated survival to 5 years. Prognostication once surviving 5 years is difficult. The majority of 5-year survivors can be considered cured of esophageal cancer.
authors.affiliation: Department of Surgery, The University of Queensland, St Lucia, Australia.
authors.forename: Jodi
authors.initials: J
authors.lastname: Hirst
authors.forename: Bernard Mark
authors.initials: BM
authors.lastname: Smithers
authors.forename: David C
authors.initials: DC
authors.lastname: Gotley
authors.forename: Janine
authors.initials: J
authors.lastname: Thomas
authors.forename: Andrew
authors.initials: A
authors.lastname: Barbour
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D017741:Survivors; D016896:Treatment Outcome
chemical_list: D015251:Epirubicin; D002945:Cisplatin; D005472:Fluorouracil