An optimized postsurgery follow-up strategy for patients with esophageal cancer - a cohort study

Sep 21, 2026

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An optimized, data-driven postsurgery follow-up strategy is developed for esophageal cancer patients after radical surgery to address the uncertainty of surveillance schedules and the time-varying risk of recurrence. The study recruits 4688 patients, uses recursive partition analysis for recurrence-risk stratification, and derives monthly recurrence probabilities. Markov decision-analytic modeling evaluates cost-effectiveness, and bootstrap plus external validation assess optimal surveillance protocols.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

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Background

Method

Results

Conclusion

Introduction

’Retrospective Cohort Study An optimized postsurgery follow-up strategy for patients with esophageal cancer: a cohort study Zihang Mai, PhDa,b,c , Jiaxin Xie, PhDd , Changsen Leng, PhDa,b,c , Xiuying Xie, BSa,b,c , Jing Wen, PhDb , Hong Yang, PhDa,b,c,* , Qianwen Liu, MDa,b,c,* , Jianhua Fu, MDa,b,c,* Background: After radical surgery, patients with esophageal cancer should undergo long-term surveillance of disease relapse. However, the optimal follow-up strategy remains to be explored. Method: A total of 4688 patients were recruited. Recursive partition analysis was applied to develop recurrence risk stratiﬁcation for patients. The follow-up strategies of each stratiﬁcation were developed based on monthly recurrence probability and validated by bootstrap validation and an external dataset. A Markov decision-analytic model was constructed to evaluate the cost-effectiveness of the follow-up strategies. Results: Patients were stratiﬁed into four groups according to four pathological features. The authors applied a random survival forest to calculate the monthly recurrence probability of each group. Based on the temporal distribution of recurrences, the authors further established surveillance strategies for four groups. The strategies were validated as optimal protocols by bootstrap resampling and another dataset. Markov cost-effective analysis indicated that our recommended strategies outperformed the mainstream protocols from guidelines. Using less than 12 visits across the ﬁrst 5 years on average, our follow-up strategies were more efﬁcient than the NCCN recommended strategies (14 visits average) . Our results also supported the computerized tomography from the neck to the upper abdomen as a routine examination and PETCT of distant metastasis for some groups with high risks. Conclusion: Our study provided data-driven evidence of personalized and economic follow-up strategies for esophageal cancer patients and shed light on follow-up optimization for other cancer types. Keywords: esophageal cancer, postsurgery follow-up, recurrence Introduction Esophageal cancer (EC), the sixth leading cause of cancer-related death, is a worldwide health threat[1] . For resectable EC, the standard treatment is esophagectomy, and neoadjuvant therapies are optional for local advanced diseases[2] . Despite receiving radical treatment, nearly a half of patients undergo postsurgery recurrence, threatening patients’ lives again[3–5] . Therefore, posttreatment surveillance is critical for early detection of disease recurrence as minimal and restricted lesions may be more sensitive to salvage treatments[6,7] . On the other hand, the intervals of recurrence surveillance might affect the observation of endpoints used in clinical trials, especially the progress-free survival[8] . Therefore, effective follow-up schedules might contribute to the development of clinical research on EC patients. Current follow-up guidelines, mostly on the ground of expert experiences gained from clinical trials, recommended that EC patients should receive lifelong surveillance, including repetitive physical and radiological examinations averagely per 3–6 months[2,9,10] in the ﬁrst 2 years and per 6–12 months hereafter. However, most of them were empirical, and few data supported the effectiveness of these guidelines[2] . Moreover, the risk of EC recurrence might be time-varying[10–12], so identical aDepartment of Thoracic Surgery, Sun Yat-sen University Cancer Center, bState Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, cGuangdong Esophageal Cancer Institute, Guangzhou and dNational Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People ’s Republic of China Zihang Mai, Jiaxin Xie, and Changsen Leng contributed equally to this work. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Correspond

FAQs

Why is post-surgery surveillance important for esophageal cancer patients?

After radical surgery, many patients still experience recurrence, so long-term surveillance is needed for early detection and timely salvage treatment. Surveillance intervals can also influence clinical trial endpoints such as progress-free survival.

How did the study design the follow-up strategies?

The researchers stratified 4688 patients using recursive partition analysis to generate recurrence-risk groups, estimated monthly recurrence probability for each group, and then constructed surveillance strategies based on the temporal distribution of recurrences.

What did the results show about effectiveness and efficiency?

Patients were grouped into four categories by pathological features, and the recommended strategies outperformed mainstream guideline protocols in cost-effective analysis. The approach used fewer visits in the first five years on average while supporting tailored imaging choices for higher-risk groups.

Sep 21, 2026

Uploaded by Jiven