P1.235. Clinicopathological Factors Associated With Early Recurrence Post-Surgery in Esophageal Squamous Cell Cancer
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Esophageal cancer is the sixth leading cause of cancer-related mortality; it has a very poor outcome despite multimodality treatment. Some of these cases recur early, even after aggressive, curative intent management. The aim of this study was to investigate factors associated with early recurrence (with a cut-off of 12 months post-surgery). We conducted a retrospective analysis of a prospectively maintained database. All patients operated for esophageal squamous cell cancer between January 2015 and December 2024 were included. Patients who had undergone upfront surgery, had R+ resection, or postoperative mortality were excluded. Analysis was done using SPSS version 25.1. Clinico-pathological factors like cT, cN stage, differentiation on biopsy, pT, pN stage, tumour regression grade (TRG) were evaluated. Multivariate Cox regression analysis was used to find the factors associated with a statistically significant difference between the cohort which had early recurrence and the cohort that did not recur early. Total of 1108 patients were operated during the study period, of which 183 patients had recurrence within 1 year of surgery. Median time to recurrence- 7 months. Mean age was 57 years. Male-to-female ratio was 1.59. 173 cases had T3, 1 had T4, and 134 (73.2%) had N+ disease on presentation. 77 (42.1%) had moderately differentiated, and 84 (46%) had poorly differentiated histology. After surgery, 110 (60%) had pT3, 3 had pT4. 108 (59%) had pN+ disease (49-N1, 42-N2, 17-N3). 136 (74.32%) had poor response to systemic therapy (30 had TRG-3, 60 had TRG-4, 46 had TRG-5). Common sites of disease recurrence were distant (liver, brain, bone metastasis) in 67 (37%), thorax in 35 (19%), nodal metastasis (local+ distant) in 75 (41%). On multivariate Cox regression analysis, pT, N, and TRG score were found to be statistically significant factors associated with early recurrence (p values of 0.014, 0.000, 0.009 respectively. Early recurrence has adverse impact on overall survival. In our study, pathological T and N status and TRG were predictive of early recurrences. Identification of this sub-group is important to explore the potential efficacy of further systemic therapy or immunotherapy to improve outcomes.