Background
Methods
Statistical analysis
Results
Patient characteristics
Oesophageal/GOJ (n = 214) | Gastric (n = 146) | |
---|---|---|
N (%) | N (%) | |
Gender | ||
Male | 188 (88 %) | 98 (67 %) |
Female | 26 (12 %) | 48 (33 %) |
Median age (range) | 64 years (33–83) | 70 years (24–89) |
ECOG performance status | ||
0 | 58 (27 %) | 40 (27 %) |
1 | 69 (32 %) | 41 (28 %) |
2 | 2 (1 %) | 10 (7 %) |
Unknown | 85 (40 %) | 55 (38 %) |
Site of primary tumour | ||
Oesophagus | 29 (14 %) | - |
Type 1 GOJ | 77 (36 %) | - |
Type 2 GOJ | 63 (29 %) | - |
Type 3 GOJ | 45 (21 %) | - |
Gastric | - | 146 (100 %) |
Elevated tumour markers pre-operatively | ||
Yes | 61 (29 %) | 27 (19 %) |
No | 122 (57 %) | 75 (51 %) |
Unknown | 31 (14 %) | 44 (30 %) |
Baseline PET performed | ||
Yes | 69 (32 %) | 24 (16 %) |
Treatment | ||
Neoadjuvanta
| 125 (58 %) | 30 (21 %) |
Peri-operativeb
| 51 (24 %) | 56 (38 %) |
Adjuvant | 5 (2 %) | 7 (5 %) |
Surgery only | 33 (15 %) | 53 (36 %) |
Surgery | ||
Oesophagogastrectomy | 178 (83 %) | 3 (2 %) |
Total gastrectomy | 35 (16 %) | 51 (35 %) |
Sub-total gastrectomy | 1 (1 %) | 92 (63 %) |
Differentiation | ||
Well | 8 (4 %) | 4 (3 %) |
Moderate | 84 (39 %) | 43 (30 %) |
Poor | 107 (50 %) | 94 (64 %) |
Unknown | 15 (7 %) | 5 (3 %) |
T stage | ||
T0 | 11 (5 %) | 7 (5 %) |
T1 | 48 (22 %) | 34 (23 %) |
T2 | 53 (25 %) | 66 (45 %) |
T3 | 89 (42 %) | 27 (19 %) |
T4 | 10 (5 %) | 9 (6 %) |
Tx | 3 (1 %) | 3 (2 %) |
N stage | ||
N0 | 105 (49 %) | 72 (49 %) |
N1 | 92 (43 %) | 40 (27 %) |
N2 | 10 (5 %) | 20 (14 %) |
N3 | 3 (1 %) | 11 (8 %) |
Nx | 4 (2 %) | 3 (2 %) |
M stagec
| ||
M0 | 204 (95 %) | 139 (95 %) |
M1 | 5 (2 %) | 4 (3 %) |
Mx | 5 (2 %) | 3 (2 %) |
Number of lymph nodes resected | ||
Median (range) | 28 (4–76) | 24 (3–69) |
Number of positive lymph nodes | ||
Median (range) | 1 (0–33) | 1 (0–35) |
Resection margin | ||
R0 | 161 (75 %) | 135 (92 %) |
R1 | 47 (22 %) | 7 (5 %) |
R2 | 0 (0 %) | 0 (0 %) |
unknown | 6 (3 %) | 4 (3 %) |
Survival outcomes
Patterns of relapse
Oesophageal/GOJ (n = 100) | Gastric (n = 47) | |
---|---|---|
N (%) | N (%) | |
Time to relapse | ||
< 12 months | 53 (53 %) | 22 (47 %) |
12–24 months | 29 (29 %) | 12 (25 %) |
24–36 months | 12 (12 %) | 7 (15 %) |
> 36 months | 6 (6 %) | 6 (13 %) |
Relapse type | ||
Local | 7 (7 %) | 4 (9 %) |
Distant | 79 (79 %) | 37 (79 %) |
Both | 14 (14 %) | 6 (13 %) |
Site of relapsea
| ||
Lymph nodes | 52 (52 %) | 14 (30 %) |
Anastomosis | 21 (21 %) | 10 (21 %) |
Peritoneum | 16 (16 %) | 18 (38 %) |
Liver | 18 (18 %) | 9 (19 %) |
Bone | 12 (12 %) | 4 (9 %) |
Abdominal wall | 3 (3 %) | 5 (11 %) |
Lung | 10 (10 %) | 2 (4 %) |
Brain | 10 (10 %) | 0 (0 %) |
Mediastinum | 9 (9 %) | 1 (2 %) |
Other | 8 (8 %) | 5 (11 %) |
Elevated tumour markers at relapse | ||
Yes | 63 (63 %) | 24 (51 %) |
No | 24 (24 %) | 16 (34 %) |
Unknown | 13 (13 %) | 7 (15 %) |
Symptoms at time of relapse | ||
Yes | 67 (67 %) | 34 (72 %) |
How relapse was first detected in asymptomatic patients | (n = 33) | (n = 12) |
Routine tumour markers | 22 (67 %) | 4 (33 %) |
Routine CT | 6 (18 %) | 4 (33 %) |
Concurrent routine CT/ markers | 1 (3 %) | 3 (25 %) |
Endoscopy | 2 (6 %) | 1 (8 %) |
Other | 2 (6 %) | 0 (0 %) |
ECOG performance status at relapse | ||
0 | 12 (12 %) | 3 (6 %) |
1 | 13 (13 %) | 7 (15 %) |
2 | 4 (4 %) | 2 (4 %) |
3–4 | 8 (8 %) | 4 (9 %) |
Unknown | 63 (63 %) | 31 (66 %) |
Further treatment for recurrent disease | ||
Yes | 72 (72 %) | 22 (47 %) |
Type of treatment for recurrent diseaseb
| ||
Chemotherapy | 63 (88 %) | 19 (86 %) |
Radiotherapy | 21 (29 %) | 3 (14 %) |
Chemoradiotherapy | 1 (1 %) | 0 (0 %) |
Surgery | 5 (7 %) | 1 (5 %) |
Prognostic variables
Disease-free survival | ||||||||
Oesophageal/GOJ adenocarcinoma | Gastric adenocarcinoma | |||||||
Covariate | N | Median DFS (months, 95 % CI) | Hazard ratio (95 % CI) | P -value | N | Median DFS (months, 95 % CI) | Hazard ratio (95 % CI) | P -value |
Elevated tumour markers | ||||||||
No | 24 | 12.2 (8.8–16.2) | 1.0 | 0.794 | 16 | 10.8 (5.0–13.7) | 1.0 | 0.081 |
Yes | 63 | 11.8 (8.4–13.6) | 1.07 (0.66–1.72) | 24 | 15.0 (10.6–24.8) | 0.56 (0.29–1.08) | ||
Differentiation | ||||||||
Poor | 107 | 12.3 (8.8–20.7) | 1.0 | <0.001 | 94 | 37.9 (21.5–71.8) | 1.0 | 0.020 |
Moderate/well | 92 | 85.9 (33.1 – NA) | 0.40 (0.27–0.58) | 47 | 99.2 (36.2 – NA) | 0.54 (0.32–0.91) | ||
Pathological T-stage | ||||||||
T0-2 | 112 | 111.7 (77.7 – NA) | 1.0 | <0.001 | 107 | 86.9 (51.4–99.6) | 1.0 | 0.010 |
T3/4 | 97 | 12.2 (8.7–18.0) | 2.89 (2.00–4.18) | 36 | 21.5 (12.7–40.5) | 1.91 (1.16–3.12) | ||
Pathological N-stage | ||||||||
N0 | 105 | 111.7 (77.7 – NA) | 1.0 | <0.001 | 72 | 87.1 (86.9 – NA) | 1.0 | <0.001 |
N1-3 | 105 | 11.8 (8.4–15.7) | 3.38 (2.32–4.94) | 71 | 21.1 (12.7 - 38.0) | 3.10 (1.89–5.10) | ||
Resection margin | ||||||||
R0 | 161 | 77.7 (26.1 – NA) | 1.0 | <0.001 | 135 | 71.8 (35.6–99.6) | 1.0 | 0.080 |
R1/R2 | 47 | 8.7 (7.0–14.8) | 2.87 (1.96–4.20) | 7 | 13.2 (0.3 – NA) | 2.13 (0.91–4.98) | ||
Presence of symptoms at time of relapse | ||||||||
No | 33 | 10.9 (7.9–14.8) | 1.0 | 0.793 | 13 | 11.5 (4.8–21.5) | 1.0 | 0.259 |
Yes | 67 | 11.8 (7.2–12.4) | 1.06 (0.70–1.61) | 34 | 13.2 (8.1–20.6) | 0.68 (0.35–1.32) | ||
Neoadjuvant, adjuvant or perioperative therapy | ||||||||
No | 33 | 140.0 (111.7 – NA) | 1.0 | 0.001 | 53 | 34.1 (13.1–87.1) | 1.0 | 0.100 |
Yes | 181 | 20.9 (14.3–27.2) | 3.57 (1.74–7.31) | 93 | 86.9 (41.7 – NA) | 0.67 (0.42–1.08) | ||
Overall survival | ||||||||
Oesophageal/GOJ adenocarcinoma | Gastric adenocarcinoma | |||||||
Covariate | N | Median OS (months, 95 % CI) | Hazard ratio (95 % CI) | P -value | N | Median OS (months, 95 % CI) | Hazard ratio (95 % CI) | P -value |
Elevated tumour markers | ||||||||
No | 24 | 28.8 (15.2–40.7) | 1.0 | 0.343 | 16 | 20.0 (9.6–29.1) | 1.0 | 0.842 |
Yes | 63 | 22.4 (14.9–31.5) | 1.28 (0.77–2.11) | 24 | 22.6 (15.9–34.4) | 0.91 (0.49–1.80) | ||
Differentiation | ||||||||
Poor | 107 | 21.5 (15.2–33.0) | 1.0 | <0.001 | 94 | 40.5 (28.5–86.9) | 1.0 | 0.011 |
Moderate/well | 92 | 85.9 (76.7 – NA) | 0.37 (0.25–0.55) | 47 | 99.2 (53.7 – NA) | 0.50 (0.29–0.85) | ||
Pathological T-stage | ||||||||
T0-2 | 112 | 111.7 (77.7 – NA) | 1.0 | <0.001 | 107 | 81.2 (53.9–99.6) | 1.0 | 0.002 |
T3/4 | 99 | 27.9 (14.9–35.2) | 2.96 (2.00–4.36) | 36 | 29.1 (17.2–40.5) | 2.19 (1.33–3.61) | ||
Pathological N-stage | ||||||||
N0 | 105 | 111.7 (77.7 – NA) | 1.0 | <0.001 | 72 | 87.1 (86.9 – NA) | 1.0 | <0.001 |
N1-3 | 105 | 25.1 (14.7–34.1) | 3.33 (2.23–4.97) | 71 | 28.5 (19.4–48.7) | 3.16 (1.90–5.26) | ||
Resection margin | ||||||||
R0 | 161 | 77.7 (51.9 - NA) | 1.0 | <0.001 | 135 | 81.2 (48.8–99.6) | 1.0 | 0.062 |
R1/R2 | 47 | 13.8 (8.6–36.1) | 2.83 (1.91–4.19) | 7 | 17.2 (0.3 - NA) | 2.25 (0.96–5.26) | ||
Type of relapse | ||||||||
None | 114 | 140.0 (111.7 – NA) | 1.0 | (<0.001) | 99 | 99.2 (63.9–110.5) | 1.0 | (<0.001) |
Local | 5 | 38.1 (23.8 – NA) | 3.72 (1.43–9.67) | 0.007 | 4 | 20.0 (17.2 - NA) | 5.61 (1.93–16.2) | 0.001 |
Distant | 79 | 19.4 (14.4–27.9) | 6.66 (4.25–10.4) | <0.001 | 37 | 20.9 (15.4–28.5) | 7.13 (4.17–12.2) | <0.001 |
Both | 14 | 26.3 (12.5 – NA) | 5.31 (2.55–11.1) | <0.001 | 6 | 23.1 (14.0 – NA) | 5.88 (2.39–14.5) | <0.001 |
Presence of symptoms at time of relapse | ||||||||
No | 33 | 26.3 (22.1–38.9) | 1.0 | 0.071 | 13 | 29.1 (15.4–53.7) | 1.0 | 0.137 |
Yes | 66 | 18.6 (13.2–28.4) | 1.52 (0.96–2.41) | 34 | 20.0 (14.7–26.9) | 1.68 (0.85–3.36) | ||
Neoadjuvant, adjuvant or perioperative therapy | ||||||||
No | 33 | 140 (111.7 – NA) | 1.0 | 0.006 | 53 | 34.4 (18.7–87.1) | 1.0 | 0.028 |
Yes | 181 | 39.8 (28.8–59.6) | 2.59 (1.31–5.14) | 93 | 86.9 (53.6 – NA) | 0.59 (0.37–0.94) |
Disease-free survival | Oesophageal/GOJ | Gastric | ||
---|---|---|---|---|
Covariate | Hazard ratio (95 % CI) |
P-value | Hazard ratio (95%CI) |
P-value |
Differentiation | 0.58 (0.39–0.86) | 0.007 | - | - |
N-stage | 1.59 (1.05–2.40) | 0.028 | - | - |
T-stage | - | - | 1.9 (1.13–3.13) | 0.015 |
Overall survival | Oesophageal/GOJ | Gastric | ||
Covariate | Hazard ratio (95 % CI) |
P-value | Hazard ratio (95%CI) |
P-value |
Differentiation | 0.47 (0.31–0.72) | 0.000 | 0.45 (0.26–0.78) | 0.005 |
N-stage | 1.64 (1.06–2.53) | 0.027 | - | - |
Local relapse | 2.92 (1.01–8.48) | 0.049 | 3.98 (1.36–11.69) | 0.012 |
Distant relapse | 5.40 (3.28–8.90) | 0.000 | 9.10 (5.13–16.14) | 0.000 |
Local and distant relapse | 3.61 (1.61–8.10) | 0.002 | 8.75 (3.44–22.24) | 0.000 |
Neoadjuvant, adjuvant or perioperative therapy | - | - | 0.31 (0.19–0.52) | 0.000 |