title: Factors associated with early recurrence and death after esophagectomy for cancer.
abstract: BACKGROUND
  Accurate selection of patients for radical treatment of esophageal cancer is essential to avoid early recurrence and death (ERD) after surgery. We sought to evaluate a large series of consecutive resections to assess factors that may be associated with this poor outcome.
  
  
  METHODS
  This was a cohort study including 680 patients operated for esophageal cancer between 2000 and 2010. The poor outcome group comprised 100 patients with tumor recurrence and death within 1 year of surgery. The comparison group comprised 267 long-term survivors, defined as those surviving more than 3 years from surgery. Pathological characteristics associated with poor outcome were analyzed using logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI).
  
  
  RESULTS
  On the adjusted model T stage and N stage predicted poor survival, with the greatest risk being patients with locally advanced tumors and three or more involved lymph nodes (OR 10.6, 95% CI 2.8-40.0). Poor differentiation (OR 2.8, 95% CI 1.4-5.5), chemotherapy response (OR 3.6, 95% CI 1.2-10.6), and involved resection margins (OR 2.7, 95% CI 1.2-6.0) were all significant independent prognostic markers in the multivariable model. There was a trend toward worse survival with lymphovascular invasion (OR 2.0, 95% CI 0.9-4.2) and low albumin (OR 1.9, 95% CI 0.8-4.4) but not of statistical significance in the adjusted model.
  
  
  CONCLUSIONS
  Esophageal cancer patients with poorly differentiated tumors and three or more involved lymph nodes have a particularly high risk of ERD after surgery. Accurate risk stratification of patients may identify a group who would be better served by alternative oncological treatment strategies.
authors.affiliation: Department of Surgery, St Thomas' Hospital, London, United Kingdom; Department of Surgery, Royal Marsden Hospital, London, United Kingdom; Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Division of Cancer Studies, King's College London, London, United Kingdom.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.forename: Andrew
authors.initials: A
authors.lastname: Pillai
authors.forename: Pranab
authors.initials: P
authors.lastname: Sinha
authors.forename: Harinderjeet
authors.initials: H
authors.lastname: Sandhu
authors.forename: Amina
authors.initials: A
authors.lastname: Adeniran
authors.forename: Fredrik
authors.initials: F
authors.lastname: Mattsson
authors.forename: Asif
authors.initials: A
authors.lastname: Choudhury
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Forshaw
authors.forename: James A
authors.initials: JA
authors.lastname: Gossage
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: William H
authors.initials: WH
authors.lastname: Allum
authors.forename: Robert C
authors.initials: RC
authors.lastname: Mason
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002454:Cell Differentiation; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008131:London / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: esophageal cancer; recurrence; surgery