Tumor recurrence in long-term survivors after treatment of carcinoma of the esophagus

To evaluate the status of tumor, recurrence and the possible factors relevant to tumor recurrence among patients who survived more than 5 years after subtotal esophagectomy for the treatment of squamous cell carcinoma of the esophagus, a total of 104 patients who received treatment between 1959 and 1986 were reviewed. In 18 of these 104 patients, local or distant tumor recurrence developed, for a tumor recurrence rate of 17.3%. Eleven (61.1%) of these 18 patients eventually died of carcinomatosis despite further radiotherapy or chemotherapy, or both, and 4 patients with the disease are still alive. Three patients continue to survive after aggressive therapy was instituted for control of the locally recurrent tumor. Sixty-nine of the 104 patients are alive without tumor recurrence after the initial esophagectomy, and the remaining 17 patients died of miscellaneous causes. Tumor recurrence appears to be the most important factor affecting the prognosis in long-term survivors with resectable esophageal carcinoma. Among the 11 patients who died of tumor recurrence, 10 died within 5 to 9 years of their esophagectomy. The incidence of various modes of tumor recurrence among these 18 patients was as follows: blood-borne metastasis, 61%; lymph node recurrence, 33%; and locoregional organ recurrence, 33%. Factors that may be pertinent to a higher tumor recurrence rate include male sex, moderate to poor tumor differentiation, the presence of lymph node metastasis, and late stage of disease (stage IIb or worse). However, we could not find any statistical significance among these possible factors. These results suggest that the character of tumor recurrence in long-term survivors may differ from that in patients suffering from early tumor recurrence, and this may warrant further investigation. As time elapses, metachronous tumor resulting from an esophageal remnant or a secondary primary neoplasm originating from another site should be differentiated from primary tumor recurrence.