Prognostic Factors and Causes of Death in Patients Cured of Esophageal Cancer |
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Authors: | Tomoyuki Kakuta MD Shin-ichi Kosugi MD PhD Tatsuo Kanda MD PhD Takashi Ishikawa MD PhD Takaaki Hanyu MD PhD Tsutomu Suzuki MD PhD Toshifumi Wakai MD PhD |
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Affiliation: | 1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan 2. Department of Surgery, Sanjo General Hospital, Niigata, Japan
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Abstract: | Background The number of patients cured of esophageal cancer after esophagectomy is gradually increasing owing to advances in surgical techniques, perioperative management, and adjuvant therapies. This study assessed the clinical course and sought to identify the prognostic factors of these patients. Methods A series of 220 consecutive patients who underwent esophagectomy and survived for more than 5 years with no relapse were enrolled. Survival analysis was performed using 25 variables including patient characteristics and operative and perioperative factors. Potential prognostic factors were identified by univariate and multivariate analyses, and the development of other primary cancers and the causes of death were retrospectively reviewed. Results The overall 10-, 15-, and 20-year survival rates were 71.6, 50.1, and 32.2 %, respectively, with a median survival time of 180 months (range, 61–315 months). The negative independent prognostic factors identified were age at surgery [hazard ratio (HR), 1.05; P < .01], being male (HR, 2.62; P = .02), pulmonary comorbidities (HR, 2.03; P = .02), synchronous presence of other cancers (HR, 2.35; P < .01), colonic/jejunal interposition (HR, 1.76; P = .03), perioperative blood transfusion (HR, 1.92; P = .02), development of pulmonary complications (HR, 1.71; P = .02), and adjuvant radiotherapy (HR, 2.13; P = .01). Pulmonary diseases and other primary cancers were found to be the most common causes of death. Conclusions Careful follow-up including the surveillance of other primary cancers is required for long-term survivors of esophageal cancer after esophagectomy. |
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