title: Post-chemoradiation surgical pathology stage can customize the surveillance strategy in patients with esophageal adenocarcinoma.
abstract: Current algorithms for surveillance of patients with esophageal adenocarcinoma (EAC) after chemoradiation and surgery (trimodality therapy [TMT]) remain empiric. The authors hypothesized that the frequency, type, and timing of relapses after TMT would be highly associated with surgical pathology stage (SPS), and therefore SPS could be used to individualize the surveillance strategy. Between 2000 and 2010, 518 patients with EAC were identified who underwent TMT at The University of Texas MD Anderson Cancer Center and were frequently surveyed. Frequency, type, and timing of the first relapse (locoregional and/or distant) were tabulated according to SPS. Standard statistical approaches were used. The median follow-up time after esophageal surgery was 55.4 months (range, 1.0-149.2 months). Disease relapse occurred in 215 patients (41.5%). Higher SPS was associated with a higher rate of relapse (0/I vs II/III, P≤.001; 0/I vs II, P=.002; SPS 0/I vs III, P≤.001; and SPS II vs III, P=.005) and with shorter time to relapse (P<.001). Irrespective of the SPS, approximately 95% of all relapses occurred within 36 months of surgery. The 3- and 5-year overall survival rates were shorter for patients with a higher SPS than those with a lower SPS (0/I vs II/III, P≤.001; 0/I vs II, P≤.001; 0/I vs III, P≤.001; and II vs III, P=.014). The compelling data show an excellent association between SPS and frequency/type/timing of relapses after TMT in patients with EAC. Thus, the surveillance strategy can potentially be customized based on SPS. These data can inform a future evidence-based surveillance strategy that can be efficient and cost-effective.
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Takashi
authors.initials: T
authors.lastname: Taketa
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sudo
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Roopma
authors.initials: R
authors.lastname: Wadhwa
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Hironori
authors.initials: H
authors.lastname: Shiozaki
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Elena
authors.initials: E
authors.lastname: Elimova
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Maria-Claudia
authors.initials: MC
authors.lastname: Campagna
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Heath D
authors.initials: HD
authors.lastname: Skinner
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Ritsuko U
authors.initials: RU
authors.lastname: Komaki
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Weston
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.affiliation: From the Departments of Gastrointestinal Medical Oncology; Thoracic and Cardiovascular Surgery; Internal Medicine; Radiation Oncology; Gastroenterology, Hepatology, and Nutrition; and Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D012189:Retrospective Studies