OA04.3. 2-Year Overall Survival in Patients Undergoing Active Surveillance in the Prospective SANO-2 Cohort Study

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ID: 326154
2026
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Abstract
Abstract Topic Esophageal Cancer: Non-Surgical Treatment of Esophageal Cancer Background Active surveillance may be offered as an alternative to standard surgery in patients with clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. While awaiting long-term outcomes of the SANO trial, patients with cCR who opted for active surveillance after decision counseling were registered in the SANO-2 study. Methods The SANO-2 study is a multicenter prospective observational cohort study. Patients with histologically proven resectable esophageal or junctional adenocarcinoma or squamous cell carcinoma treated with CROSS were assessed for clinical response. Patients with a cCR at 12 weeks post-nCRT were offered active surveillance, whereas patients with residual tumour underwent esophagectomy. Patients who gave informed consent and underwent the second clinical response evaluation (CRE-2) between 31 May 2021 and 31 December 2023 were included, allowing for a minimum potential follow-up of 24 months. Follow-up data were censored at 31 December 2025. Overall survival was defined as the interval from the date of cCR (i.e., date of biopsies taken at CRE-2) to all-cause mortality, censored at last follow-up. Survival was estimated using the Kaplan–Meier method. Patient characteristics and outcomes were compared with patients from the SANO trial. Results A total of 415 patients underwent the first clinical response evaluation (CRE-1), of whom 176 patients (42%) achieved cCR at CRE-2. The median age was 69 years (IQR 60-73), 132 patients (75%) were male, and 135 patients (77%) had adenocarcinoma. These and other baseline characteristics of the included patients were largely consistent with those of patients in the SANO trial. The median follow-up time was 30 months (IQR 23–38). During active surveillance, 69 patients (39%) had persistent cCR, 79 patients (45%) developed isolated locoregional regrowth, and 28 patients (16%) developed distant metastases. At 24 months, overall survival was 79% (95% CI 73–85) in patients undergoing active surveillance. Median overall survival was not reached. Conclusion In this multicenter prospective observational cohort study, two-year overall survival on active surveillance was consistent with results from the randomized SANO trial. These findings support an active surveillance strategy in cCR patients after neoadjuvant chemoradiotherapy outside a randomized setting.
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Authors C. Klint, Charlène J. van der Zijden, Bianca Mostert, Leonieke W. Kranenburg, Jan J.V. Busschbach, J Jan B van Lanschot, M. C. W. Spaander, Jan Willem T Dekker, W. Edward Fiets, H.H. Hartgrink, Wouter L Hazen, Ewout A Kouwenhoven, Grard A P Nieuwenhuijzen, Camiel Rosman, Johanna W. van Sandick, Meindert N. Sosef, Edwin S. van der Zaag, Sjoerd M. Lagarde, Bas P L Wijnhoven
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Journal diseases of the esophagus : official journal of the international society for diseases of the esophagus
Year 2026
DOI
10.1093/dote/doag077.032
URL
https://academic.oup.com/dote/article-pdf/39/Supplement_1/doag077.032/70760718/doag077.032.pdf
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