What are the outcomes for long-term survivors after esophagectomy ? - Evidence from a randomized controlled trial (FFCD9901)☆

Background: Little is known regarding long-term outcomes of survivors beyond 5 years after esophagectomy. This study assesses oncological outcomes of long-term survivors of esophageal cancer. Methods: Data is derived from a multi-center randomized controlled trial comparing neoadjuvant chemoradiotherapy (NCRT) and surgery to surgery alone for clinically stage I and II esophageal cancers (FFCD9901). Only patients undergoing esophagectomy were included in this study. Clinicopathological variables of 5-year survivors were analyzed. Multivariate logistic regression analysis identified factors predictive of death prior to 5 years. Patterns of disease recurrence and second primary tumor development were established. Results: From June 2000 until June 2009, 195 patients from 30 French centers were randomly assigned to NCRT followed by surgery or surgery alone. Of 170 patients who underwent esophagectomy, 70 patients were alive at 5 years - an overall 5-year survival of 41.2 %. In logistic regression multivariate analysis, WHO performance status of >= 1 (p = 0.045), advanced pT category (p = 0.030) and post-operative complications (p = 0.047) predicted death prior to 5 years. Twenty patients died after the 5-year time point, 9 of these due to progression of their esophageal cancer. Nineteen patients developed a second primary malignancy, of whom 14 developed either a head and neck or lung cancers. Conclusions: Being alive 5 years after esophagectomy does not equate to cure. In clinically staged early disease, a distinct group of patients develop disease recurrence later than 5 years from treatment. Development of a second primary cancer in this population poses a clinical threat. Surveillance protocols should be adapted accordingly.