Abstract
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.
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.
| Original language | English |
|---|---|
| Pages (from-to) | vi222 |
| Number of pages | 1 |
| Journal | Annals of oncology : official journal of the European Society for Medical Oncology / ESMO |
| Volume | 27 |
| Issue number | supp6 |
| DOIs | |
| Publication status | Published - 11 Oct 2017 |
| Event | ESMO Congress 2016 - Copenhagen, Denmark Duration: 07 Oct 2016 → 10 Oct 2016 |
Keywords
- oesophageal cancer
ASJC Scopus subject areas
- Medicine(all)
- Biochemistry, Genetics and Molecular Biology(all)