Predictors of Early Recurrence After Neoadjuvant Chemoradiotherapy and Esophagectomy

Introduction: Despite advancements in medical and surgical treatments, esophageal cancer 5-year overall survival (OS) rate following esophagectomy remains under 40%. Recurrence is a significant factor impacting OS, with rates as high as 40%. This study aims to identify clinical factors associated with early cancer recurrence in patients undergoing esophagectomy and to improve targeted interventions for high-risk patients. Methods: A retrospective review of a multi-institutional database was performed for patients who underwent neoadjuvant chemoradiotherapy followed by esophagectomy for esophageal cancer between 2008 and 2023. Patients were grouped based on timing of recurrence. Demographic and clinical data, including tumor characteristics and post-operative surveillance outcomes, were collected. Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess recurrence-free survival (RFS) and overall survival (OS), as well as to identify predictors of early recurrence. Results: There were 187 patients that met inclusion criteria with early recurrence in 31.6% (33/187) of patients. Patients with early recurrence had larger tumors and higher median positive lymph nodes ( P = .008). Lymphovascular invasion (LVI) was a significant predictor of early recurrence, with a hazard ratio of 2.1 ( P = .05). Distant recurrence was the most common pattern, occurring in 57.6% of early recurrences. Conclusion: Lymphovascular invasion and nodal involvement are critical predictors of early recurrence in esophageal cancer. Early identification of high-risk patients is crucial for optimizing post-operative surveillance and improving survival outcomes. Further research is needed to evaluate the potential role of adjuvant therapies, such as immunotherapy, in mitigating early recurrence in this population.