Determinants of Long-Term Survival after Resection for Esophageal Cancer: Implications for Neoadjuvant and Adjuvant Therapy
Abstracts
|
Background: Adjuvant and neoadjuvant therapy have not been shown to reliably improve long-term survival in patients undergoing resection for esophageal cancer. We sought to identify factors that influence long-term outcomes in patients with esophageal cancer to help understand potentially confounding variables for survival. Methods: We performed a retrospective analysis of patients who survived esophagectomy for cancer (1980-2000). Univariate analyses of demographic, preoperative, and operative data identified variables for inclusion in multivariable analyses of long-term survival. Results: Of 230 men and 62 women (mean age of 60.4 years) who underwent resection, survivors included 195 men and 56 women with a median survival of 16 months and a 5-year survival of 24%. Univariate analysis identified pathologic stage, prior myocardial infarction, performance status, age, albumin, creatinine, histology, weight loss, FEV1%, and any tobacco use as potential covariates. Multivariable analysis (stratified by stage) revealed two significant covariates for long-term survival: age (odds ratio (OR) for a 10-year increase = 1.18; 95% confidence interval (CI) 1.02 to 1.37; p=0.031) and FEV1% (OR for a 10-point decrease = 1.10; CI 1.02 to 1.18; p=0.012). Including stage as a covariate, multivariable analysis identified three significant covariates for long-term survival: advanced stage (OR=3.02; CI 2.16 to 4.23; p=0.001); age (OR=1.16; CI 1.00 to 1.34; p=0.05) and FEV1% (OR=1.08; CI 1.01 to 1.16; p=0.03). Conclusions: Pulmonary function is a determinant of long-term survival after esophagectomy for cancer. Adjuvant or neoadjuvant therapy may result in deterioration of lung function, which may in turn have an adverse influence on long-term survival in patients undergoing multimodality therapy. |
