655P - Conditional survival probability in patients with resected oesophageal adenocarcinoma receiving neoadjuvant chemotherapy

Date 08 October 2016
Event ESMO 2016 Congress
Session Poster Display
Topics Oesophageal Cancer
Presenter Donna Graham
Citation Annals of Oncology (2016) 27 (6): 207-242. 10.1093/annonc/mdw371
Authors D.M. Graham1, F.J. Bannon2, F. Noble3, R. O'Neill4, J.K. Blayney5, T.J. Underwood3, R.D. Kennedy1, R.C. Fitzgerald6, R.C. Turkington1
  • 1Centre For Cancer Research And Cell Biology, Queen's University Belfast, BT7 1NN - Belfast/GB
  • 2Centre For Public Health, Queen's University Belfast, Belfast/GB
  • 3Department Of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton/GB
  • 4Clinical Surgery, Edinburgh Cancer Research UK-University of Edinburgh, Edinburgh/GB
  • 5Department Of Bioinformatics, Centre For Cancer Research And Cell Biology, Queen's University Belfast, BT7 1NN - Belfast/GB
  • 6Hutchison/mrc Cancer Unit, University of Cambridge, Cambridge/GB

Abstract

Background

Traditional recurrence and survival figures are based upon factors determined at baseline and become less relevant for patients over time. Conditional survival (CS) estimates future prognosis based upon survival to a specific time point since treatment. We analysed CS and conditional recurrence-free survival (CRFS) data for patients in the United Kingdom undergoing surgery and neoadjuvant chemotherapy for gastro-oesophageal junction (GOJ) or oesophageal adenocarcinoma (OAC).

Methods

378 patients with GOJ/OAC treated with neoadjuvant chemotherapy and surgical resection from 2003-2012 were identified. Clinicopathological and survival data was collected as part of the Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) consortium. A multivariable parametric survival model was used to analyse factors associated with overall survival and recurrence from time of surgery.

Results

The cohort includes 305 males (80.7%) with median age 65 (range 28-83) years. 5-year RFS conditional on recurrence-free years to date increased over time (see table). For those with stage T3/4, moderately-poorly differentiated tumours with lymphovascular invasion, 5-year disease-specific survival (DSS) improved from 7.7% for those with node-positive, R1 disease to 45.4% conditional on 3 years post-treatment survival; compared with 55.6% actuarial 5-year DSS increasing to 86.7% conditional on 3 years post-treatment survival for patients with N0 R0 disease. Age, sex, year of surgery, and Siewert classification had no association with recurrence or mortality rate.

Recurrence-free survival (RFS) by prognostic factors

Poor Prognostic factor 5-year RFS (%) 5-year RFS conditional on 1 year (%) 5-year RFS conditional on 2 years (%) 5-year RFS conditional on 3 years (%)
T-stage: 3 or 4 Nodes positive Margins involved
1 1 1 7.2 13.2 28.7 49.5
1 1 0 35.4 45.1 61.2 75.8
1 0 1 25.6 35.1 52.4 69.5
1 0 0 58.5 66.2 77.6 86.7
0 1 1 20.0 29.1 46.7 65.0
0 1 0 53.1 61.5 74.1 84.4
0 0 1 43.5 52.7 67.4 80.0
0 0 0 72.0 77.7 85.6 91.6

Conclusions

CRFS and CS provide a more dynamic estimation of future recurrence risk and survival among patients who have accrued survival time, especially in patients with high-risk features, including positive resection margins. Margin and node positivity govern early relapse events but as the time from surgery increases these factors become less relevant.

Clinical trial identification

N/A

Legal entity responsible for the study

Queen's University Belfast

Funding

Queen's University Belfast

Disclosure

All authors have declared no conflicts of interest.