Cause of death during long-term follow-up for superficial esophageal adenocarcinoma.
BACKGROUND
The purpose of this study was to evaluate long-term prognosis and cause of death in patients with superficial esophageal adenocarcinoma (SEAC) after surgery.


METHODS
A total of 85 patients without adjuvant or neoadjuvant treatment underwent surgery for SEAC (pT1N0-1, M0) 1984-2011. Medical records and causes of death were reviewed, and 79 specimens (93 %) were reanalyzed for cancer penetration. Survival was calculated according to Kaplan-Meier and comparisons of survival with log-rank test. Multivariate survival was analyzed with Cox proportional hazards model.


RESULTS
Of 85 patients, 36 had transhiatal, 33 transthoracic en bloc, 6 minimally invasive en bloc, 5 vagal sparing esophageal resection and 5 endoscopic mucosal resections; 7 patients (8 %) had lymph node metastasis (LNM). Cancer penetration: 35 pT1a and 44 pT1b. Overall survival was 67 % at 5 years and 50 % at 10 years. Disease-specific survival was 82 % at 5 years and 78 % at 10 years. Recurrence-free survival was 80 % at 5 years. In a Cox multivariate model, poor overall survival was predicted only by LNM. Cumulative mortality during median follow-up of 5 years (0-25 years): 37 of 85 (44 %). Cause of death of these 37: SEAC recurrence for 15 (41 %), postoperative complications for 4 (11 %), another primary malignancy for 5 (14 %), non-cancer-related for 11 (30 %) and for 2 (5 %) cause unknown. Mortality after 5-year follow-up: 11 (30 %); 82 % of these deaths were unrelated to SEAC recurrence.


CONCLUSIONS
With SEAC recurrence as the single most common cause of death, disease-specific 5-year survival was good. Overall and late (> 5-year) survival is affected by diseases related to aging.
Clinic of General Thoracic and Esophageal Surgery, Helsinki University Central Hospital, Heart and Lung Center, Helsinki, Finland.
Juha
J
Kauppi
Ines
I
Gockel
Tuomo
T
Rantanen
Torsten
T
Hansen
Ari
A
Ristimäki
Hauke
H
Lang
Eero
E
Sihvo
Jari
J
Räsänen
Theodor
T
Junginger
Jarmo A
JA
Salo
D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors