Patterns, Timing, and Survival of Recurrence After Surgery for Esophageal and Junctional Adenocarcinoma in the European Multicentre ENSURE Study

BACKGROUND: Following surgery for esophageal cancer, approximately half of patients develop disease recurrence. Analyzing recurrence site, timing, and their impact on postrecurrence survival can guide refinements in postoperative surveillance and therapy. This study aimed to describe the pattern and timing of esophageal cancer recurrence and assess survival patterns by recurrence location. METHODS: This study included patients from the ENSURE study who underwent resection for esophageal and junctional adenocarcinoma between 2009 and 2015 across 20 centers in Europe and Canada. Only patients with disease recurrence were included in the final analysis. Sites of first recurrence were stratified into different groups and survival outcomes postrecurrence detection were estimated using Kaplan-Meier curves. RESULTS: Of 3,299 patients who underwent surgery for esophageal adenocarcinoma, 1,310 patients developed recurrence and had sufficient follow-up data available. First recurrence was detected at multiple distant sites (n = 469; 37.3%) or at a single distant site (n = 463; 33.7%), whereas isolated local recurrence occurred in 189 (14.4%) patients. Recurrence in the liver-only presented significant earlier (median 9.0 months), whereas recurrence in lung-only (15.2 months) and local-only recurrence (17.8 months) were observed later. Patients with multiple-sites and liver-only recurrence had significant worse median postrecurrence survival (7.4 and 8.3 months, respectively) compared with lung- or local-only recurrence (10.4 and 15.9 months, respectively). CONCLUSIONS: This study highlights that time to recurrence varies by location and significantly impacts postrecurrence survival outcomes. Multiple sites and liver-only recurrence had the poorest prognosis.