title: Locally advanced esophageal cancer: What becomes of 5-year survivors?
abstract: OBJECTIVE
  To determine the long-term outcomes of patients with locally advanced esophageal cancer (LAEC) who underwent esophagectomy and survived at least 5 years, and the predictors of disease-free survival (DFS) beyond 5 years.
  
  
  METHODS
  This was a retrospective review of a prospective database to identify patients with clinical stage T2N0M0 or higher LAEC. Medical records were reviewed to obtain demographic, clinical, and pathological characteristics, as well as data on recurrence and survival. Multivariable analysis of predictors of DFS beyond 5 years was performed using a Cox regression model.
  
  
  RESULTS
  Between 1988 and 2009, 355 of 500 patients underwent esophagectomy for cT2N0M0 or higher disease. Of these 355 patients, 126 were alive and disease-free at the 5-year follow-up, for an actuarial 5-year DFS of 33%. Recurrent esophageal cancer developed in 8 patients after 5 years. Among the 126 surviving patients, the actuarial overall survival was 94% at 7 years and 80% at 10 years. On multivariable analysis, the sole significant predictor of DFS after the 5-year time point was non-en bloc resection at the original operation (P = .006). Pulmonary-related deaths accounted for 10 out of 22 noncancer deaths. A second primary cancer developed in 23 of the 126 surviving patients.
  
  
  CONCLUSIONS
  Prolonged survival can be obtained in one-third of patients with LAEC. An en bloc resection at the original operation is the most significant predictor of prolonged survival. Survivors experience a high rate of second primary cancer and an apparently high rate of deaths from pulmonary disease. Careful follow-up is necessary for these patients, even after the 5-year mark.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Galal
authors.initials: G
authors.lastname: Ghaly
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Kamel
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Abu
authors.initials: A
authors.lastname: Nasar
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.affiliation: Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY.
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York, NY. Electronic address: nkaltork@med.cornell.edu.
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000368:Aged; D002423:Cause of Death; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome
keywords: disease-free survival; en bloc resection; esophageal cancer; recurrence