title: Characterising timing and pattern of relapse following surgery for localised oesophagogastric adenocarcinoma: a retrospective study.
abstract: BACKGROUND
  Oesophagogastric adenocarcinoma (OGA) has a poor prognosis, even for patients with operable disease. However, the optimal surveillance strategy following surgery is unknown.
  
  
  METHODS
  We performed a retrospective review of all patients with OGA who had undergone surgery with radical intent at the Royal Marsden between January 2001 and December 2010.
  
  
  RESULTS
  Of the 360 patients with OGA who underwent potentially curative surgery, 100/214 patients (47%) with oesophageal/gastro-oesophageal junction (GOJ) adenocarcinoma and 47/146 patients (32%) with gastric adenocarcinoma developed recurrent disease. 51, 79 and 92% of relapses occurred within 1, 2 and 3 years respectively and the majority of patients relapsed at distant sites. Of the patients who relapsed, 67% (67/100) with oesophageal/GOJ adenocarcinoma and 72% of patients with gastric cancer (34/47) were symptomatic at the time of relapse. The majority of asymptomatic relapses were first detected by a rise in tumour markers. There was no difference in disease-free survival between asymptomatic and symptomatic patients, but asymptomatic patients were more likely to receive further treatment and had a longer survival beyond relapse.
  
  
  CONCLUSIONS
  The majority of relapses occur within the first 3 years and at distant sites. Monitoring of tumour markers should be considered as part of a surveillance program.
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Singyu.moorcraft@rmh.nhs.uk.
authors.forename: Sing Yu
authors.initials: SY
authors.lastname: Moorcraft
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Elisa.fontana@rmh.nhs.uk.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fontana
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. David.cunningham@rmh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Clare.peckitt@rmh.nhs.uk.
authors.forename: Clare
authors.initials: C
authors.lastname: Peckitt
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Tom.waddell@rmh.nhs.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Waddell
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Elizabeth.smyth@rmh.nhs.uk.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Smyth
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. William.allum@rmh.nhs.uk.
authors.forename: William
authors.initials: W
authors.lastname: Allum
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Jeremy.thompson@rmh.nhs.uk.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Thompson
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Sheela.rao@rmh.nhs.uk.
authors.forename: Sheela
authors.initials: S
authors.lastname: Rao
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. David.watkins@rmh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Watkins
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. Naureen.starling@rmh.nhs.uk.
authors.forename: Naureen
authors.initials: N
authors.lastname: Starling
authors.affiliation: The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. ian.chau@rmh.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Chau
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies