Pamela Samson1, Clifford Robinson2, Jeffrey Bradley2, A Craig Lockhart3, Varun Puri1, Stephen Broderick4, Daniel Kreisel1, A Sasha Krupnick1, G Alexander Patterson1, Bryan Meyers1, Traves Crabtree5. 1. Division of Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, Missouri. 2. Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri. 3. Division of Hematology and Oncology, Washington University in St. Louis, St. Louis, Missouri. 4. Division of Cardiothoracic Surgery, Johns Hopkins University, Baltimore, Maryland. 5. Division of Cardiothoracic Surgery, Washington University in St. Louis, St. Louis, Missouri. Electronic address: crabtreet@wustl.edu.
Abstract
OBJECTIVES: The aim of this study was to evaluate differences in pathologic complete response (pCR) rates and overall survival among patients receiving either neoadjuvant chemotherapy or chemoradiation before esophagectomy for locally advanced esophageal cancer. METHODS: Patients with esophageal cancer receiving either neoadjuvant chemotherapy or chemoradiation before esophagectomy were identified using the National Cancer Database. Univariate analysis compared patient, tumor, and postoperative outcome characteristics. Logistic regression was performed to identify variables associated with achieving pCR. Kaplan-Meier analysis was performed to compare overall median survival by neoadjuvant therapy type and pCR status. Finally, a Cox proportional hazards model was fitted to identify variables associated with increased mortality hazard. RESULTS: From 2006 to 2012, a total of 916 of 7338 of patients (12.5%) received neoadjuvant chemotherapy whereas 6422 (87.5%) received neoadjuvant chemoradiation. Patients who received neoadjuvant chemoradiation were more likely to achieve a pCR (17.2% versus 6.4%, p < 0.001) and less likely to have positive margins (5.6% versus 11.5%, p < 0.001) than were patients who received neoadjuvant chemotherapy, with no difference in 30- or 90-day mortality. Achieving a pCR was associated with improved overall median survival (59.5 ± 4.0 months versus 30.1 ± 0.76 months for those with persistent disease, p < 0.001). On logistic regression, neoadjuvant chemoradiation therapy was independently associated with achieving a pCR (OR = 2.75, 95% confidence interval: 2.01-3.77, p < 0.001). Despite improvement in the pCR rate with neoadjuvant chemoradiation, neoadjuvant therapy type was not independently associated with long-term survival (hazard ratio = 1.12; 95% confidence interval: 0.97-1.30, p = 0.12). CONCLUSIONS: Although neoadjuvant chemoradiation is more successful in downstaging esophageal cancer before esophagectomy, it was not independently prognostic for improved long-term survival. Other factors affecting long-term survival among pathologic complete responders and among patients with persistent disease should be investigated to clarify this association.
OBJECTIVES: The aim of this study was to evaluate differences in pathologic complete response (pCR) rates and overall survival among patients receiving either neoadjuvant chemotherapy or chemoradiation before esophagectomy for locally advanced esophageal cancer. METHODS:Patients with esophageal cancer receiving either neoadjuvant chemotherapy or chemoradiation before esophagectomy were identified using the National Cancer Database. Univariate analysis compared patient, tumor, and postoperative outcome characteristics. Logistic regression was performed to identify variables associated with achieving pCR. Kaplan-Meier analysis was performed to compare overall median survival by neoadjuvant therapy type and pCR status. Finally, a Cox proportional hazards model was fitted to identify variables associated with increased mortality hazard. RESULTS: From 2006 to 2012, a total of 916 of 7338 of patients (12.5%) received neoadjuvant chemotherapy whereas 6422 (87.5%) received neoadjuvant chemoradiation. Patients who received neoadjuvant chemoradiation were more likely to achieve a pCR (17.2% versus 6.4%, p < 0.001) and less likely to have positive margins (5.6% versus 11.5%, p < 0.001) than were patients who received neoadjuvant chemotherapy, with no difference in 30- or 90-day mortality. Achieving a pCR was associated with improved overall median survival (59.5 ± 4.0 months versus 30.1 ± 0.76 months for those with persistent disease, p < 0.001). On logistic regression, neoadjuvant chemoradiation therapy was independently associated with achieving a pCR (OR = 2.75, 95% confidence interval: 2.01-3.77, p < 0.001). Despite improvement in the pCR rate with neoadjuvant chemoradiation, neoadjuvant therapy type was not independently associated with long-term survival (hazard ratio = 1.12; 95% confidence interval: 0.97-1.30, p = 0.12). CONCLUSIONS: Although neoadjuvant chemoradiation is more successful in downstaging esophageal cancer before esophagectomy, it was not independently prognostic for improved long-term survival. Other factors affecting long-term survival among pathologic complete responders and among patients with persistent disease should be investigated to clarify this association.
Authors: Thomas P Kole; Osarhieme Aghayere; Jason Kwah; Ellen D Yorke; Karyn A Goodman Journal: Int J Radiat Oncol Biol Phys Date: 2012-01-26 Impact factor: 7.038
Authors: Dirk J Bosch; Christina T Muijs; Véronique E M Mul; Jannet C Beukema; Geke A P Hospers; Johannes G M Burgerhof; John Th M Plukker Journal: Ann Surg Oncol Date: 2013-10-08 Impact factor: 5.344
Authors: F Klevebro; G Johnsen; E Johnson; A Viste; T Myrnäs; E Szabo; A-B Jacobsen; S Friesland; J A Tsai; S Persson; M Lindblad; L Lundell; M Nilsson Journal: Eur J Surg Oncol Date: 2015-04-08 Impact factor: 4.424
Authors: Jennifer A Dorth; John A Pura; Manisha Palta; Christopher G Willett; Hope E Uronis; Thomas A D'Amico; Brian G Czito Journal: Cancer Date: 2014-04-07 Impact factor: 6.860
Authors: Steven H Lin; Ritsuko Komaki; Zhongxing Liao; Caimiao Wei; Bevan Myles; Xiaomao Guo; Matthew Palmer; Radhe Mohan; Stephen G Swisher; Wayne L Hofstetter; Jaffer A Ajani; James D Cox Journal: Int J Radiat Oncol Biol Phys Date: 2012-03-13 Impact factor: 7.038
Authors: Robert J Korst; Amanda L Kansler; Jeffrey L Port; Paul C Lee; Yaniv Kerem; Nasser K Altorki Journal: Ann Thorac Surg Date: 2006-08 Impact factor: 4.330
Authors: Jingya Wang; Caimiao Wei; Susan L Tucker; Bevan Myles; Matthew Palmer; Wayne L Hofstetter; Stephen G Swisher; Jaffer A Ajani; James D Cox; Ritsuko Komaki; Zhongxing Liao; Steven H Lin Journal: Int J Radiat Oncol Biol Phys Date: 2013-08-01 Impact factor: 7.038
Authors: F Klevebro; G Alexandersson von Döbeln; N Wang; G Johnsen; A-B Jacobsen; S Friesland; I Hatlevoll; N I Glenjen; P Lind; J A Tsai; L Lundell; M Nilsson Journal: Ann Oncol Date: 2016-01-17 Impact factor: 32.976
Authors: Nasser Davarzani; Gordon G A Hutchins; Nicholas P West; Lindsay C Hewitt; Matthew Nankivell; David Cunningham; William H Allum; Elizabeth Smyth; Nicola Valeri; Ruth E Langley; Heike I Grabsch Journal: Histopathology Date: 2018-03-25 Impact factor: 5.087