Early Recurrence of Esophagogastric junction adenoCarcinoma after Surgery: a multicentre analysis of risk factors (ERECS Trial)

Background Esophagogastric junction adenocarcinoma (EGJA) is characterized by a high recurrence rate after esophagectomy, which significantly affects patient survival. This study aimed to identify the risk factors contributing to early recurrence (ER) within 12 months after Ivor Lewis esophagectomy (ILE) in patients with EGJA. Methods A retrospective multicenter analysis was conducted across 7 high-volume Italian centers that included 594 patients with Siewert type I and II EGJAs who underwent ILE between January 2018 and December 2022. The clinicopathologic characteristics and postoperative outcomes were analyzed. ER was defined as cancer recurrence within 12 months after surgery. Univariate and multivariate analyses were performed to identify the independent risk factors for ER. Results The overall recurrence rate was 41.2% (245/594), with ER occurring in 24.4% (145/594) of patients. The 1-year overall survival rate was 87.7%, and the 1-year recurrence-free survival (RFS) rate was 70.6%. The median RFS was 32.1 months. Multivariate Cox regression analysis identified lower body mass index (hazard ratio [HR], 0.95; P =.009), poor or absent response to neoadjuvant treatment based on the Mandard classification (HR, 2.26; P =.013), and advanced stage (HR, 2.24; P <.001) as independent significant risk factors for ER in EGJA. Conclusion Identifying prognostic factors associated with ER allows for the stratification of a subgroup of patients with poor oncological outcomes who require a personalized treatment approach, distinct from the standard multimodal treatment.