Recurrence Rate

One of the most disheartening things about EC is that the recurrence rate is very high. Just reading about folks on this board who have had the surgery then had a recurrence after all they have been thru is cruel. There are exceptions of course but it seems to be high. Without surgery, there is, according to the numbers a less than 5% survival rate at 5 years. I'm at 20 months as a stage IV and feel very lucky as we have lost many from this board after less than 6 months. I try not to focus on grimm stats and not worry about anything past this afternoon. It becomes depressing otherwise. Sam

Hi Heeran,
My understanding
Hi Heeran,
My understanding is the rate varies based on the pathology report post surgery. We were told at post-op visit that the recurrence rate in John's case was 12% based on the fact that the pathology report showed NED in tumor and 29 lymph nodes. I read a summary of a research paper regarding recurrence(I copied the summary below). Dr. Meredith told us if the cancer did come back there was still the possibility of surgery but very risky. I think he was very specific with John regarding issues of recurrences because John still smokes and that is one of the risk factors for EC. By the way he is trying to quit but not very successful with it. I have never smoked so I do not know the issue with quitting. I am trying to live each day and not project into future for me it does no good. I did that in beginning and all the horrible things I imagined did NOT happen. I lost a LOT of sleep and did not appreciate the day when I was projecting the future. FEAR is in the future and I am going to live in the PRESENT (well at least I try most days) LOL!
I'm here cheering you and your Mom on as you prepare for the surgery day.
Love and hugs
Erica

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http://www.ncbi.nlm.nih.gov/pubmed

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Ann Surg Oncol. 2010 Apr;17(4):1159-67. Epub 2010 Feb 6.
Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer.
Meredith KL, Weber JM, Turaga KK, Siegel EM, McLoughlin J, Hoffe S, Marcovalerio M, Shah N, Kelley S, Karl R.
Source
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA. kenneth.meredith@moffitt.org
Abstract
BACKGROUND:
Esophageal cancer remains a malignancy with high morbidity and mortality despite improvements to diagnosis, staging, chemotherapy, radiation, and surgery. Neoadjuvant therapy (NT) may improve oncologic outcome in many patients, however the degree to which patients benefit remains unclear. We examined the relationship between pathologic response to NT and magnitude of benefit in patients with esophageal cancer.
METHODS:
Using a comprehensive esophageal cancer database, we identified patients who underwent esophagectomy between 1994 and 2008. Pathologic response was denoted as complete (pCR), partial (pPR), and nonresponse (NR). Clinical and pathologic data were compared using Fisher's exact and chi-square when appropriate, while Kaplan-Meier estimates were used for survival analysis.
RESULTS:
We identified 347 patients who underwent esophagectomy, and 262 (75.5%) were treated with NT. The median age was 66 years (28-86 years) with median follow-up of 20 months (1-177 months). There were 106 (40.5%) patients exhibiting pCR, 95 (36.3%) with pPR, and 61 (23.3%) with NR. The rate of R0 resections was higher amongst pCR (100%) compared with 94.7% in pPR (P = 0.02) and 87.5% in NR (P = 0.0007). There were 15 (14.2%) recurrences in pCR, 22 (23.7%) in pPR, and 17 (28.8%) in NR (P = 0.04). Patients achieving pCR had 5-year disease-free survival (DFS) and overall survival (OS) of 52% and 52%, respectively, compared with 36% and 38% in pPR and 22% and 19% in NR (P < 0.0001, P < 0.0001).
CONCLUSIONS:
Esophageal cancer patients frequently succumb to their disease. However, patients treated with neoadjuvant therapy who achieve pCR have a higher rate of R0 resections, fewer recurrences, and improved 5-year OS and DFS.
PMID:
20140529
[PubMed - indexed for MEDLINE]

TerryV said:

I'm with Sam on this...
"I try not to focus on grimm stats and not worry about anything past this afternoon. It becomes depressing otherwise" ~Sam

There is so much unknown with EC and the "black & white" stats found elsewhere on the Internet are pretty dark. I would rather look to our pioneers here - William, Paul, Sandra, etc. and hope & pray that my husband is more like them and not one of the "other" stats.

All our love & many hugs,

Terry

Beware of statistics
One of the first things my doctors all told me when I was diagonsed was to pay no attention to statistics. Please remember that by definition, statistics are aggregate in nature and NONE of them is based on your mother's case. Each case is different, depending on a huge variety of factors including stage, general health of the patient, age of the patient, risk factors such as smoking, high blood pressure, etc., and global statistics generally take none of that into account. They just lump all patients - or all members of whatever population they're developing stats on - together and say, for example, X% of EC patients survive X number of months after surgery, or after diagnosis, or whatever. Even if you're reading stats on recurrence in Stage 3 patients, stats generally won't identify how many in the target population were over 50, or over 70, or smoked, or had previously had other cancers, etc.

I knew from the start that I am incredibly lucky to have been diagnosed at very early Stage 1, and as such I'm in an unfortunately small minority of EC patients, so any stats about survivability or recurrence probably have a correspondingly small percentage of relevence to my case. So I took my doctors' advice and have paid no attention to such things. On the other hand, Heeran, if it were my mother I'd probably be trying to look ahead at what she may be in for. But please don't focus much of your valuable energy on what "may be" - I'd encourage you to deal with what "is" and focus your energy and your love on the "hear and now" in your mother's specific case.

You know that we all wish her - and you - the very best.

Bob
T1aN0M0
dx 8/3/11
MIE 9/23/11

I understand that radiation
I understand that radiation cannot be administered a second time to the same location. If you're looking at stats, let's hope your mom is in the stats group that never needs rads or chemo again!

Keep on keeping on!