An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)

Jessie A Elliott; Sheraz R Markar; Fredrik Klevebro; ENSURE Study Group; Asif Johar; Lucas Goense; Pernilla Lagergren; Giovanni Zaninotto; Richard van Hillegersberg; Mark I van Berge Henegouwen; Magnus Nilsson; George B Hanna; John V Reynolds

doi:10.1097/SLA.0000000000005378

An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)

Jessie A Elliott, Sheraz R Markar, Fredrik Klevebro, ENSURE Study Group, Asif Johar, Lucas Goense, Pernilla Lagergren, Giovanni Zaninotto, Richard van Hillegersberg, Mark I van Berge Henegouwen, Magnus Nilsson, George B Hanna, John V Reynolds^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Pages (from-to)	e1035-e1044
Number of pages	10
Journal	Annals of Surgery
Volume	277
Issue number	5
Early online date	27 Jan 2022
DOIs	https://doi.org/10.1097/SLA.0000000000005378
Publication status	Published - 1 May 2023
Externally published	Yes

Bibliographical note

Funding Information:
Funding: Supported by a fellowship award from the Health Research Board, Ireland, to Jessie A Elliott (HPF 2015-1013) and a grant award from the Surgical Research Society, United Kingdom and Ireland.

Publisher Copyright:
© 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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Elliott, J. A., Markar, S. R., Klevebro, F., ENSURE Study Group, Johar, A., Goense, L., Lagergren, P., Zaninotto, G., van Hillegersberg, R., van Berge Henegouwen, M. I., Nilsson, M., Hanna, G. B., & Reynolds, J. V. (2023). An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE). Annals of Surgery, 277(5), e1035-e1044. https://doi.org/10.1097/SLA.0000000000005378

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title = "An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)",

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.",

author = "Elliott, {Jessie A} and Markar, {Sheraz R} and Fredrik Klevebro and {ENSURE Study Group} and Asif Johar and Lucas Goense and Pernilla Lagergren and Giovanni Zaninotto and {van Hillegersberg}, Richard and {van Berge Henegouwen}, {Mark I} and Magnus Nilsson and Hanna, {George B} and Reynolds, {John V}",

note = "Funding Information: Funding: Supported by a fellowship award from the Health Research Board, Ireland, to Jessie A Elliott (HPF 2015-1013) and a grant award from the Surgical Research Society, United Kingdom and Ireland. Publisher Copyright: {\textcopyright} 2022 The Author(s). Published by Wolters Kluwer Health, Inc.",

year = "2023",

month = may,

day = "1",

doi = "10.1097/SLA.0000000000005378",

language = "English",

volume = "277",

pages = "e1035--e1044",

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Elliott, JA, Markar, SR, Klevebro, F, ENSURE Study Group, Johar, A, Goense, L, Lagergren, P, Zaninotto, G, van Hillegersberg, R, van Berge Henegouwen, MI, Nilsson, M, Hanna, GB & Reynolds, JV 2023, 'An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)', Annals of Surgery, vol. 277, no. 5, pp. e1035-e1044. https://doi.org/10.1097/SLA.0000000000005378

TY - JOUR

T1 - An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)

AU - Elliott, Jessie A

AU - Markar, Sheraz R

AU - Klevebro, Fredrik

AU - ENSURE Study Group

AU - Johar, Asif

AU - Goense, Lucas

AU - Lagergren, Pernilla

AU - Zaninotto, Giovanni

AU - van Hillegersberg, Richard

AU - van Berge Henegouwen, Mark I

AU - Nilsson, Magnus

AU - Hanna, George B

AU - Reynolds, John V

N1 - Funding Information: Funding: Supported by a fellowship award from the Health Research Board, Ireland, to Jessie A Elliott (HPF 2015-1013) and a grant award from the Surgical Research Society, United Kingdom and Ireland. Publisher Copyright: © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

PY - 2023/5/1

Y1 - 2023/5/1

N2 - 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.

AB - 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.

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U2 - 10.1097/SLA.0000000000005378

DO - 10.1097/SLA.0000000000005378

M3 - Article

C2 - 35129466

SN - 0003-4932

VL - 277

SP - e1035-e1044

JO - Annals of Surgery

JF - Annals of Surgery

IS - 5

ER -

An International Multicenter Study Exploring Whether Surveillance After Esophageal Cancer Surgery Impacts Oncological and Quality of Life Outcomes (ENSURE)

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