An international multicenter study exploring whether surveillance after esophageal cancer surgery impacts oncological and quality of life outcomes (ENSURE)

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• dc.contributor.author Elliott, Jessie A.
• dc.contributor.author Markar, Sheraz R.
• dc.contributor.author Klevebro, Fredrik
• dc.contributor.author Johar, Asif
• dc.contributor.author Goense, Lucas
• dc.contributor.author Lagergren, Pernilla
• dc.contributor.author Zaninotto, Giovanni
• dc.contributor.author van Hillegersberg, Richard
• dc.contributor.author van Berge Henegouwen, Mark I.
• dc.contributor.author Nilsson, Magnus
• dc.contributor.author Hanna, George B.
• dc.contributor.author Reynolds, John Vincent
• dc.contributor.author ENSURE Study Group
• dc.date.accessioned 2024-03-12T16:01:15Z
• dc.date.available 2024-03-12T16:01:15Z
• dc.date.issued 2023
• dc.description.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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Elliott JA, Markar SR, Klevebro F, Johar A, Goense L, Lagergren P, Zaninotto G, van Hillegersberg R, van Berge Henegouwen MI, Nilsson M, Hanna GB, Reynolds JV; ENSURE Study Group. An international multicenter study exploring whether surveillance after esophageal cancer surgery impacts oncological and quality of life outcomes (ENSURE). Ann Surg. 2023 May 1;277(5):e1035-e44. DOI: 10.1097/SLA.0000000000005378
• dc.identifier.doi http://dx.doi.org/10.1097/SLA.0000000000005378
• dc.identifier.issn 0003-4932
• dc.identifier.uri http://hdl.handle.net/10230/59389
• dc.language.iso eng
• dc.publisher Lippincott Williams & Wilkins
• dc.relation.ispartof Ann Surg. 2023 May 1;277(5):e1035-e44
• dc.rights © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC BY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword Computed tomography
• dc.subject.keyword Endoscopy
• dc.subject.keyword Esophageal cancer
• dc.subject.keyword Esophagectomy
• dc.subject.keyword Health-related quality of life
• dc.subject.keyword Oligometastatic
• dc.subject.keyword Positron emission tomography
• dc.subject.keyword Recurrence
• dc.subject.keyword Surveillance
• dc.subject.keyword Survival
• dc.title An international multicenter study exploring whether surveillance after esophageal cancer surgery impacts oncological and quality of life outcomes (ENSURE)
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion