SEARCHCOHORToncology, surgery

cohort·oncology, surgery, gastroenterology, epidemiology, clinical trial·PMC10082056

An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)

Annals of Surgery · 12 authors, 6 centres

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TL;DR

This international multicenter cohort study compared intensive surveillance (annual CT for 3 years) to standard surveillance after surgery for esophageal cancer. Across all patients, intensive surveillance did not improve overall survival, but it did improve survival in subgroups with early-stage disease or who had surgery alone.

Full summary

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At a median follow-up of 60 months, IS was associated with reduced symptomatic recurrence and increased tumor-directed therapy. However, after adjusting for confounders, no overall survival benefit was observed for all patients. Subgroup analysis revealed an overall survival benefit for IS in patients who underwent surgery alone (HR 0.60) and those with lower pathological T stages (Tis-2, HR 0.72). IS was also associated with greater patient anxiety.

STUDY TYPE

cohort

SPECIALTY

oncology

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ORIGINAL PAPER

PMC10082056

An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)

Annals of Surgery

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ABSTRACT

Objective: To determine the impact of surveillance on recurrence pattern, treatment, survival and health-related quality-of-life (HRQL) following curative-intent resection for esophageal cancer. Summary Background Data: Although therapies for recurrent esophageal cancer may impact survival and HRQL, surveillance protocols after primary curative treatment are varied and inconsistent, reflecting a lack of evidence. Methods: European iNvestigation of SUrveillance after Resection for Esophageal cancer was an international multicenter study of consecutive patients undergoing surgery for esophageal and esophagogastric junction cancers (2009–2015) across 20 centers ( NCT03461341 ). Intensive surveillance (IS) was defined as annual computed tomography for 3 years postoperatively. The primary outcome measure was overall survival (OS), secondary outcomes included treatment, disease-specific survival, recurrence pattern, and HRQL. Multivariable linear, logistic, and Cox proportional hazards regression analyses were performed. Results: Four thousand six hundred eighty-two patients were studied (72.6% adenocarcinoma, 69.1% neoadjuvant therapy, 45.5% IS). At median followup 60 months, 47.5% developed recurrence, oligometastatic in 39%. IS was associated with reduced symptomatic recurrence (OR 0.17 [0.12–0.25]) and increased tumor-directed therapy (OR 2.09 [1.58–2.77]). After adjusting for confounders, no OS benefit was observed among all patients (HR 1.01 [0.89–1.13]), but OS was improved following IS for those who underwent surgery alone (HR 0.60 [0.47–0.78]) and those with lower pathological (y)pT stages (Tis-2, HR 0.72 [0.58–0.89]). IS was associated with greater anxiety ( P =0.016), but similar overall HRQL. Conclusions: IS was associated with improved oncologic outcome in select cohorts, specifically patients with early-stage disease at presentation or favorable pathological stage post neoadjuvant therapy. This may inform guideline development, and enhance shared decision-making, at a time when therapeutic options for recurrence are expanding.

CITATION EXPORT

Jessie A. Elliott, Sheraz R. Markar, Fredrik Klevebro et al.. An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE). Annals of Surgery. (2023). https://doi.org/10.1097/SLA.0000000000005378

AUTHORS

12 · 6 CENTRES

Jessie A. Elliott, Sheraz R. Markar, Fredrik Klevebro, Asif Johar, Lucas Goense, Pernilla Lagergren, Giovanni Zaninotto, Richard van Hillegersberg, Mark I. van Berge Henegouwen, Magnus Nilsson, George B. Hanna, John V. Reynolds

*Trinity St. James’s Cancer Institute, Trinity College Dublin, and St. James’s Hospital, Dublin, Ireland;
†Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, London, UK;
‡Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden;
§CLINTEC, Karolinska Institutet, Stockholm, Sweden;
¶Department of Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; and
||Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Jessie A. Elliott, Sheraz R. Markar, Fredrik Klevebro et al.. An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE). Annals of Surgery. (2023). https://doi.org/10.1097/SLA.0000000000005378