Esophageal cancer—the five year survivors

BACKGROUND: Esophageal cancer in the United States carries a poor prognosis with overall 5 year survival rate of approximately 10%. Due to this dismal outcome, data analyzing factors predictive of survival for greater than 5 years are not available. METHODS: Single institution retrospective review of esophageal resection for curative intent from 1984 to 2004. We identified 50 actual 5 year survivors (long term survivors, LTS) out of 266 patients (19%) with invasive esophageal cancer and, using multivariate logistic regression, compared characteristics between the LTS, and short-term (<5 year) survivors (STS). RESULTS: There was no significant difference in clinical T stage or N stage by EUS (P = 0.81) or in the utilization of neoadjuvant therapy in the LTS versus STS (58% vs. 62%, respectively, P = 0.36). The LTS group was significantly more likely to have pathologic complete response (69% vs. 41%, P < 0.001), lower pathologic T stage, i.e., pT0, pTis, or pT1 (83% vs. 45%, P < 0.001), pN0 stage (97% vs. 68%, P < 0.001), favorable tumor differentiation (well or well to moderate, 39% vs. 13%, P < 0.001), and absence of angiolymphatic (88% vs. 69%, P < 0.01) or perineural invasion (95% vs. 83%, P = 0.04). In comparing the factors predictive of outcome in LTS versus the STS with increasing relative risk, absence of perineural invasion (RR 0.41 (0.27, 0.61)), negative margins (RR 0.41 (0.29, 0.57)), absence of angiolymphatic invasion (RR 0.39 (0.30, 0.51)), pN0 stage (RR 1.37 (1.23, 1.52)), pT0 or pT1 (RR 1.85 (1.64, 2.07)), pathologic complete response (RR 2.02 (1.76, 2.31)), and favorable tumor grade (RR 3.00 (2.49, 3.61)) were associated with improved survival. CONCLUSION: Tumor biological factors including favorable tumor grade may be the most important influence on 5 year actual survival in esophageal cancer.