Postoperative follow-up strategy based on event dynamics for esophageal squamous cell carcinoma

Background: Despite the improvements in radical surgery for esophageal squamous cell carcinoma (ESCC), a large number of patients still develop recurrence. This research sought to graphically depict patterns in ESCC recurrence following curative surgical treatment using event dynamics and clarify approaches to postsurgical follow-up on the basis of recurrence time. Methods: This study included 717 individuals with ESCC who received radical surgery in the Thoracic Department at Fujian Medical University Union Hospital between 2013 and 2016. Event dynamics analysis was performed on the basis of hazard rates. An initial event was defined as the occurrence of local recurrence, distant metastasis, or both. Results: After complete resection, patients were followed up for a median of 44 months (range, 2-83 months). A total of 223 (31.1%) patients developed recurrence, including 122 (17.0%) patients who developed only locoregional recurrence, and 101 (14.1%) patients who developed only distant metastasis or both locoregional recurrence and distant metastasis. Recurrences were concentrated mainly (98.2%) in the first 4 years of follow-up among all recurrences, with 100 cases (44.8%) in the first year, 69 cases (30.9%) in the second year, and 50 cases (22.4%) in the third and fourth years. Conclusions: After curative surgery in a multimodal setting, a significant number of patients still experienced recurrence within 4 years after surgery, which suggests that current postoperative esophageal cancer follow-up strategies may need to be modified.