title: Predictive Factors of Recurrence in Patients with Pathological Complete Response After Esophagectomy Following Neoadjuvant Chemoradiotherapy for Esophageal Cancer: A Multicenter Study.
abstract: BACKGROUND
  Minimal data have previously emerged from studies regarding the factors associated with recurrence in patients with ypT0N0M0 status. The purpose of the study was to predict survival and recurrence in patients with pathological complete response (pCR) following chemoradiotherapy (CRT) and surgery for esophageal cancer (EC).
  
  
  METHODS
  Among 2944 consecutive patients with EC operations in 30 centers between 2000 and 2010, patients treated with neoadjuvant CRT followed by surgery who achieved pCR (n = 191) were analyzed. The factors associated with survival and recurrence were analyzed using a Cox proportional hazard regression analysis.
  
  
  RESULTS
  Among 593 patients who underwent neoadjuvant CRT followed by esophagectomy, pCR was observed in 191 patients (32.2 %). Recurrence occurred in 56 (29.3 %) patients. The median time to recurrence was 12 months. The factors associated with recurrence were postoperative complications grade 3-4 [odds ratio (OR): 2.100; 95 % confidence interval (CI) 1.008-4.366; p = 0.048) and adenocarcinoma histologic subtype (OR 2.008; 95 % CI 0.1.06-0.3.80; p = 0.032). The median overall survival was 63 months (95 % CI 39.3-87.1), and the median disease-free survival was 48 months (95 % CI 18.3-77.4). Age (>65 years) [hazard ratio (HR): 2.166; 95 % CI 1.170-4.010; p = 0.014), postoperative complications grades 3-4 [HR 2.099; 95 % CI 1.137-3.878; p = 0.018], and radiation dose (<40 Gy) (HR 0.361; 95 % CI 0.159-0.820; p = 0.015) were identified as factors associated with survival.
  
  
  CONCLUSIONS
  An intensive follow-up may be beneficial for patients with EC who achieve pCR and who develop major postoperative complications or the adenocarcinoma histologic subtype.
authors.affiliation: Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux, France. guillaume.luc33@yahoo.fr.|Inserm, Unit 1026, University of Bordeaux, Bordeaux, France. guillaume.luc33@yahoo.fr.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Luc
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez, University Hospital, Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.affiliation: Department of Digestive Surgery, Côte de Nacre University Hospital, Caen, France.
authors.forename: Gil
authors.initials: G
authors.lastname: Lebreton
authors.affiliation: Department of General and Digestive Surgery, Hautepierre University Hospital, Strasbourg, France.
authors.forename: Cecile
authors.initials: C
authors.lastname: Brigand
authors.affiliation: Department of General and Digestive Surgery and Liver Transplantation, Croix-Rousse University Hospital, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bail
authors.affiliation: Department of Hepatic and Digestive Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez, University Hospital, Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology*; D009367:Neoplasm Staging; D010984:Platinum / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D010984:Platinum; D005472:Fluorouracil
keywords: Chemoradiotherapy; Esophageal cancer; Pathological complete response; Recurrence; Survival