BACKGROUND: For patients with locally advanced esophageal cancer, prospective randomized clinical trials have reported no added value of surgical resection to chemoradiation alone. Using a large regional cancer registry, our objective was to determine whether curative-intent esophageal resection provided a survival advantage in the multimodality management of esophageal cancer. MATERIALS AND METHODS: Using the Los Angeles County Cancer Surveillance Program (CSP), we identified all patients with local and regional (i.e., AJCC Stages I-III) esophageal cancer during the years 1988-2006. Clinical and pathologic data included patient demographics, tumor information, indication for surgery, lymph node status, and timing of therapy. Overall survival was assessed by the Kaplan-Meier method, and multivariate Cox-regression analysis was performed. RESULTS: From CSP, 2233 patients with esophageal cancer were identified. Median survival (MS) of the entire cohort was 13.1 months. We stratified this cohort into patients who received chemoradiation alone (n = 645) and patients who received trimodality therapy (n = 286) (i.e., chemoradiation and surgery). Patients had significantly improved survival with trimodality therapy compared with chemoradiation alone (MS 25.2 vs. 12.3 months, respectively; P < 0.001). The survival advantage with trimodality therapy was observed for patients with squamous cell carcinoma (MS 24.5 vs. 12.8 months, respectively; P < 0.001) and adenocarcinoma (MS 25.9 vs. 10.6 months, respectively; P < 0.001). By multivariate analysis, trimodality therapy was a significant prognostic factor for improved survival in patients with esophageal cancer (hazard ratio [HR] 0.66, 95% confidence interval [95% CI]: 0.56-0.77, P < 0.001). CONCLUSIONS: Our data indicate that surgical resection remains an important component of the multimodality management of esophageal cancer.
BACKGROUND: For patients with locally advanced esophageal cancer, prospective randomized clinical trials have reported no added value of surgical resection to chemoradiation alone. Using a large regional cancer registry, our objective was to determine whether curative-intent esophageal resection provided a survival advantage in the multimodality management of esophageal cancer. MATERIALS AND METHODS: Using the Los Angeles County Cancer Surveillance Program (CSP), we identified all patients with local and regional (i.e., AJCC Stages I-III) esophageal cancer during the years 1988-2006. Clinical and pathologic data included patient demographics, tumor information, indication for surgery, lymph node status, and timing of therapy. Overall survival was assessed by the Kaplan-Meier method, and multivariate Cox-regression analysis was performed. RESULTS: From CSP, 2233 patients with esophageal cancer were identified. Median survival (MS) of the entire cohort was 13.1 months. We stratified this cohort into patients who received chemoradiation alone (n = 645) and patients who received trimodality therapy (n = 286) (i.e., chemoradiation and surgery). Patients had significantly improved survival with trimodality therapy compared with chemoradiation alone (MS 25.2 vs. 12.3 months, respectively; P < 0.001). The survival advantage with trimodality therapy was observed for patients with squamous cell carcinoma (MS 24.5 vs. 12.8 months, respectively; P < 0.001) and adenocarcinoma (MS 25.9 vs. 10.6 months, respectively; P < 0.001). By multivariate analysis, trimodality therapy was a significant prognostic factor for improved survival in patients with esophageal cancer (hazard ratio [HR] 0.66, 95% confidence interval [95% CI]: 0.56-0.77, P < 0.001). CONCLUSIONS: Our data indicate that surgical resection remains an important component of the multimodality management of esophageal cancer.
Authors: Andrew Feber; Liqiang Xi; Arjun Pennathur; William E Gooding; Santhoshi Bandla; Maoxin Wu; James D Luketich; Tony E Godfrey; Virginia R Litle Journal: Ann Thorac Surg Date: 2011-03-21 Impact factor: 4.330
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Authors: N K S Cheedella; A Suzuki; L Xiao; W L Hofstetter; D M Maru; T Taketa; K Sudo; M A Blum; S H Lin; J Welch; J H Lee; M S Bhutani; D C Rice; A A Vaporciyan; S G Swisher; J A Ajani Journal: Ann Oncol Date: 2012-12-17 Impact factor: 32.976
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Authors: Yuki Hayashi; Lianchun Xiao; Akihiro Suzuki; Mariela A Blum; Bradley Sabloff; Takashi Taketa; Dipen M Maru; James Welsh; Steven H Lin; Brian Weston; Jeffrey H Lee; Manoop S Bhutani; Wayne L Hofstetter; Stephen G Swisher; Jaffer A Ajani Journal: Eur J Cancer Date: 2012-07-31 Impact factor: 9.162