title: Prognostic significance of initial recurrence site in hematogenous recurrence of esophageal squamous cell carcinoma.
abstract: OBJECTIVE
  Hematogenous recurrences of esophageal squamous cell carcinoma (ESCC) have dismal prognoses, but prognostic heterogeneity exists in this disease. The objectives of this study were to clarify the prognosis in this disease with regard to the initial recurrence site and to define the prognostic factors.
  
  
  METHODS
  We retrospectively reviewed the cases of 67 consecutive patients with hematogenous recurrence in major organs after esophagectomy for ESCC of the thoracic esophagus and the esophagogastric junction. We analyzed clinicopathological characteristics, survival probability, and potential prognostic factors.
  
  
  RESULTS
  Lung, liver, bone, and multiple-organ metastases occurred in 24, 19, 14, and 10 patients, respectively. Twenty-seven patients simultaneously had locoregional recurrence (combined recurrence). Among all 67 patients, the median disease-free interval (DFI) was 9.7 months, and the median survival time after the initial recurrence was 4.9 months. The patients with initial lung metastasis had most favorable prognosis with the median survival time of 9.8 months. A multivariate analysis identified that initial recurrence site, DFI, combined recurrence, and anti-cancer therapy were independent prognostic factors.
  
  
  CONCLUSIONS
  The initial recurrence site contributes to the prognostic heterogeneity of patients with hematogenous recurrence of ESCC. The prognostic factors identified in this study are useful to optimize the management of these patients.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Kosugi
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kanda
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Yajima
authors.forename: Kohei
authors.initials: K
authors.lastname: Akazawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology*; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies