ORIGINAL SCIENTIFIC REPORT
Treatment Outcomes and Prognostic Factors After Recurrence
of Esophageal Squamous Cell carcinoma
Published online: 29 December 2017
Internationale de Chirurgie 2017
Background The evaluation of treatment outcomes and detection of prognostic factors after recurrence are very
important for tailoring optimal therapies for individual patients with recurrent esophageal cancer.
Methods We reviewed 133 patients in whom esophageal squamous cell carcinoma (ESCC) recurred after curative
surgery, and assessed recurrence patterns, treatment outcomes and prognostic factors.
Results Recurrence in 57 (42.9%), 54 (40.6%) and 22 (16.5%) patients was locoregional, distant and combined,
respectively. The median amounts of elapsed time until recurrence and median survival after recurrence for all
patients were 9.1 and 8.3 months, respectively. Univariate and multivariate analyses selected time to recurrence
(hazard ratio [HR], 0.98; 95% conﬁdence interval [CI], 0.97–0.999; p = 0.04), recurrence location (locoregional vs.
distant: HR, 1.63; 95% CI, 1.03–2.61; p = 0.04), number of organs with recurrence (1 vs. 3: HR, 3.49; 95% CI,
1.23–9.87; p = 0.02) and treatment after recurrence (best supportive care, [BSC] vs. chemotherapy [CT] or radiation
therapy [RT]: HR, 0.37; 95% CI, 0.15–0.94; p = 0.04; BSC vs. CT and RT: HR, 0.50; 95% CI, 0.26–0.94; p = 0.03;
BSC vs. surgery: HR, 0.47; 95% CI, 0.25–0.88; p = 0.02) as independent factors for survival after recurrence.
Seventeen (12.8%) patients who had localized lymph node recurrence and lung oligometastasis and received mul-
tidisciplinary therapy after recurrence survived for [3 years thereafter.
Conclusion Despite the poor survival of patients with ESCC and early or distant recurrence or recurrence in C3
recurrent organs, appropriate multimodal therapies should be tailored for individual patients with recurrent ESCC.
Surgery is the mainstay of curative treatment for esopha-
geal cancer patients . Improvements in multimodality
therapies [2, 3], operative procedures [4, 5], perioperative
management  and nutritional intervention  have
achieved both short- and long-term beneﬁts for many
patients with esophageal cancer. However, the overall
5-year survival rate is generally only 25–50% [1–3], and
30–50% of patients develop recurrence within only a few
years after curative surgery and perioperative adjuvant
therapy [3, 8–17].
The prognosis is very poor after developing esophageal
cancer recurrence, and the survival range is 3–10 months
[8–17]. Although recurrent esophageal cancer is often
treated with systemic chemotherapy, the types and loca-
tions of recurrence considerably differ among individual
patients. Therefore, the treatment strategies should differ
among individual patients with recurrent esophageal can-
cer. Furthermore, understanding which prognostic factors
that affect post-recurrence survival is critically important
for tailoring appropriate therapies for recurrent esophageal
& Yoichi Hamai
Department of Surgical Oncology, Research Institute for
Radiation Biology and Medicine, Hiroshima University, 1-2-
3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
World J Surg (2018) 42:2190–2198