Conditional survival probability in patients with resected oesophageal adenocarcinoma receiving neoadjuvant chemotherapy

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      Background: Traditional recurrence and survival figures are based upon factors determined at baseline and become less relevant for patients over time. Conditional survival (CS) estimates future prognosis based upon survival to a specific time point since treatment. We analysed CS and conditional recurrence-free survival (CRFS) data for patients in the United Kingdom undergoing surgery and neoadjuvant chemotherapy for gastro-oesophageal junction (GOJ) or oesophageal adenocarcinoma (OAC).

      Methods: 378 patients with GOJ/OAC treated with neoadjuvant chemotherapy and surgical resection from 2003-2012 were identified. Clinicopathological and survival data was collected as part of the Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) consortium. A multivariable parametric survival model was used to analyse factors associated with overall survival and recurrence from time of surgery.

      Results: The cohort includes 305 males (80.7%) with median age 65 (range 28-83) years. 5-year RFS conditional on recurrence-free years to date increased over time (see table). For those with stage T3/4, moderately-poorly differentiated tumours with lymphovascular invasion, 5-year disease-specific survival (DSS) improved from 7.7% for those with node-positive, R1 disease to 45.4% conditional on 3 years post-treatment survival; compared with 55.6% actuarial 5-year DSS increasing to 86.7% conditional on 3 years post-treatment survival for patients with N0 R0 disease. Age, sex, year of surgery, and Siewert classification had no association with recurrence or mortality rate.

      Recurrence-free survival (RFS) by prognostic factors
      POOR PROGNOSTIC FACTOR5-year RFS
      (%) 5-year RFS conditional on 1 year
      (%)5-year RFS conditional on 2 year
      (%)5-year RFS conditional on 3 year
      (%)
      T-stage: 3 or 4Nodes positiveMargins involved
      1117.213.228.749.5
      11035.445.161.275.8
      10125.635.152.469.5
      10058.566.277.686.7
      01120.029.146.765.0
      01053.161.574.184.4
      00143.552.767.480.0
      00072.077.785.691.6

      Conclusions: CRFS and CS provide a more dynamic estimation of future recurrence risk and survival among patients who have accrued survival time, especially in patients with high-risk features, including positive resection margins. Margin and node positivity govern early relapse events but as the time from surgery increases these factors become less relevant.

      DOI

      Original languageEnglish
      Number of pages1
      JournalAnnals of oncology : official journal of the European Society for Medical Oncology / ESMO
      Journal publication date11 Oct 2017
      Issue numbersupp6
      Volume27
      DOIs
      StatePublished - 11 Oct 2017
      EventESMO Congress 2016 - Copenhagen, Denmark

        Research areas

      • oesophageal cancer

      ID: 126190475