Adjuvant therapy for positive nodes after induction therapy and resection of esophageal cancer presented at the Fifty-first Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, Jan 24-28, 2015.

Alexander A. Brescia, Stephen Broderick, Traves D. Crabtree, Varun Puri, Joanne F. Musick, Jennifer M. Bell, Daniel Kreisel, A. Sasha Krupnick, G. Alexander Patterson, Bryan F. Meyers

Research output: Contribution to journalArticle

Abstract

Background The value of adjuvant chemotherapy for patients with positive lymph nodes (+LNs) after induction therapy and resection of esophageal cancer is controversial. This study assesses survival benefit of adjuvant chemotherapy in this cohort. Methods We analyzed our single-institution database for patients with +LNs after induction therapy and resection of primary esophageal cancer between 2000 and 2013. Factors associated with survival were analyzed using a Cox proportional hazards model. Results A total of 101 of 764 esophagectomy patients received induction and had +LNs on final pathologic examination. Forty-five also received adjuvant therapy: 37 of 45 (82%) received chemotherapy alone, 1 of 45 (2%) received radiation alone, and 7 of 45 (16%) received both. Pathologic stage was IIB in 21 (47%), IIIA in 19 (42%), and IIIB in 5 (11%). In 56 node-positive patients with induction but not adjuvant therapy, pathologic stage was IIB in 28 (50%), IIIA in 18 (32%), IIIB in 7 (13%), and IIIC in 3 (5%). Neither age nor comorbidity score differed between cohorts. Adjuvant patients experienced a shorter hospital length of stay (mean, 10 days [range, 6 to 33 days] versus 11 days [range, 7 to 67 days]; p = 0.03]. Median survival favored the adjuvant group: 24.0 months (95% confidence interval, 16.6 to 32.2 months) versus 18.0 months (95% confidence interval, 11.1 to 25.0 months); p = 0.033). Multivariate Cox regression identified adjuvant therapy, length of stay, and number of +LNs as influential for survival. Conclusions Optimal management of node-positive patients after induction therapy and esophagectomy remains unclear, but in this series, adjuvant therapy, length of stay, and number of +LNs impacted survival. A prospective trial may reduce potential bias and guide the evaluation of adjuvant therapy in this patient population.

Original languageEnglish (US)
Pages (from-to)200-208
Number of pages9
JournalAnnals of Thoracic Surgery
Volume101
Issue number1
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Esophageal Neoplasms
Length of Stay
Survival
Esophagectomy
Therapeutics
Adjuvant Chemotherapy
Confidence Intervals
Proportional Hazards Models
Comorbidity
Lymph Nodes
Databases
Radiation
Drug Therapy
Population

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Adjuvant therapy for positive nodes after induction therapy and resection of esophageal cancer presented at the Fifty-first Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, Jan 24-28, 2015. / Brescia, Alexander A.; Broderick, Stephen; Crabtree, Traves D.; Puri, Varun; Musick, Joanne F.; Bell, Jennifer M.; Kreisel, Daniel; Krupnick, A. Sasha; Patterson, G. Alexander; Meyers, Bryan F.

In: Annals of Thoracic Surgery, Vol. 101, No. 1, 01.01.2016, p. 200-208.

Research output: Contribution to journalArticle

Brescia, Alexander A. ; Broderick, Stephen ; Crabtree, Traves D. ; Puri, Varun ; Musick, Joanne F. ; Bell, Jennifer M. ; Kreisel, Daniel ; Krupnick, A. Sasha ; Patterson, G. Alexander ; Meyers, Bryan F. / Adjuvant therapy for positive nodes after induction therapy and resection of esophageal cancer presented at the Fifty-first Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, Jan 24-28, 2015. In: Annals of Thoracic Surgery. 2016 ; Vol. 101, No. 1. pp. 200-208.
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title = "Adjuvant therapy for positive nodes after induction therapy and resection of esophageal cancer presented at the Fifty-first Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, Jan 24-28, 2015.",
abstract = "Background The value of adjuvant chemotherapy for patients with positive lymph nodes (+LNs) after induction therapy and resection of esophageal cancer is controversial. This study assesses survival benefit of adjuvant chemotherapy in this cohort. Methods We analyzed our single-institution database for patients with +LNs after induction therapy and resection of primary esophageal cancer between 2000 and 2013. Factors associated with survival were analyzed using a Cox proportional hazards model. Results A total of 101 of 764 esophagectomy patients received induction and had +LNs on final pathologic examination. Forty-five also received adjuvant therapy: 37 of 45 (82{\%}) received chemotherapy alone, 1 of 45 (2{\%}) received radiation alone, and 7 of 45 (16{\%}) received both. Pathologic stage was IIB in 21 (47{\%}), IIIA in 19 (42{\%}), and IIIB in 5 (11{\%}). In 56 node-positive patients with induction but not adjuvant therapy, pathologic stage was IIB in 28 (50{\%}), IIIA in 18 (32{\%}), IIIB in 7 (13{\%}), and IIIC in 3 (5{\%}). Neither age nor comorbidity score differed between cohorts. Adjuvant patients experienced a shorter hospital length of stay (mean, 10 days [range, 6 to 33 days] versus 11 days [range, 7 to 67 days]; p = 0.03]. Median survival favored the adjuvant group: 24.0 months (95{\%} confidence interval, 16.6 to 32.2 months) versus 18.0 months (95{\%} confidence interval, 11.1 to 25.0 months); p = 0.033). Multivariate Cox regression identified adjuvant therapy, length of stay, and number of +LNs as influential for survival. Conclusions Optimal management of node-positive patients after induction therapy and esophagectomy remains unclear, but in this series, adjuvant therapy, length of stay, and number of +LNs impacted survival. A prospective trial may reduce potential bias and guide the evaluation of adjuvant therapy in this patient population.",
author = "Brescia, {Alexander A.} and Stephen Broderick and Crabtree, {Traves D.} and Varun Puri and Musick, {Joanne F.} and Bell, {Jennifer M.} and Daniel Kreisel and Krupnick, {A. Sasha} and Patterson, {G. Alexander} and Meyers, {Bryan F.}",
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T1 - Adjuvant therapy for positive nodes after induction therapy and resection of esophageal cancer presented at the Fifty-first Annual Meeting of the Society of Thoracic Surgeons, San Diego, CA, Jan 24-28, 2015.

AU - Brescia, Alexander A.

AU - Broderick, Stephen

AU - Crabtree, Traves D.

AU - Puri, Varun

AU - Musick, Joanne F.

AU - Bell, Jennifer M.

AU - Kreisel, Daniel

AU - Krupnick, A. Sasha

AU - Patterson, G. Alexander

AU - Meyers, Bryan F.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background The value of adjuvant chemotherapy for patients with positive lymph nodes (+LNs) after induction therapy and resection of esophageal cancer is controversial. This study assesses survival benefit of adjuvant chemotherapy in this cohort. Methods We analyzed our single-institution database for patients with +LNs after induction therapy and resection of primary esophageal cancer between 2000 and 2013. Factors associated with survival were analyzed using a Cox proportional hazards model. Results A total of 101 of 764 esophagectomy patients received induction and had +LNs on final pathologic examination. Forty-five also received adjuvant therapy: 37 of 45 (82%) received chemotherapy alone, 1 of 45 (2%) received radiation alone, and 7 of 45 (16%) received both. Pathologic stage was IIB in 21 (47%), IIIA in 19 (42%), and IIIB in 5 (11%). In 56 node-positive patients with induction but not adjuvant therapy, pathologic stage was IIB in 28 (50%), IIIA in 18 (32%), IIIB in 7 (13%), and IIIC in 3 (5%). Neither age nor comorbidity score differed between cohorts. Adjuvant patients experienced a shorter hospital length of stay (mean, 10 days [range, 6 to 33 days] versus 11 days [range, 7 to 67 days]; p = 0.03]. Median survival favored the adjuvant group: 24.0 months (95% confidence interval, 16.6 to 32.2 months) versus 18.0 months (95% confidence interval, 11.1 to 25.0 months); p = 0.033). Multivariate Cox regression identified adjuvant therapy, length of stay, and number of +LNs as influential for survival. Conclusions Optimal management of node-positive patients after induction therapy and esophagectomy remains unclear, but in this series, adjuvant therapy, length of stay, and number of +LNs impacted survival. A prospective trial may reduce potential bias and guide the evaluation of adjuvant therapy in this patient population.

AB - Background The value of adjuvant chemotherapy for patients with positive lymph nodes (+LNs) after induction therapy and resection of esophageal cancer is controversial. This study assesses survival benefit of adjuvant chemotherapy in this cohort. Methods We analyzed our single-institution database for patients with +LNs after induction therapy and resection of primary esophageal cancer between 2000 and 2013. Factors associated with survival were analyzed using a Cox proportional hazards model. Results A total of 101 of 764 esophagectomy patients received induction and had +LNs on final pathologic examination. Forty-five also received adjuvant therapy: 37 of 45 (82%) received chemotherapy alone, 1 of 45 (2%) received radiation alone, and 7 of 45 (16%) received both. Pathologic stage was IIB in 21 (47%), IIIA in 19 (42%), and IIIB in 5 (11%). In 56 node-positive patients with induction but not adjuvant therapy, pathologic stage was IIB in 28 (50%), IIIA in 18 (32%), IIIB in 7 (13%), and IIIC in 3 (5%). Neither age nor comorbidity score differed between cohorts. Adjuvant patients experienced a shorter hospital length of stay (mean, 10 days [range, 6 to 33 days] versus 11 days [range, 7 to 67 days]; p = 0.03]. Median survival favored the adjuvant group: 24.0 months (95% confidence interval, 16.6 to 32.2 months) versus 18.0 months (95% confidence interval, 11.1 to 25.0 months); p = 0.033). Multivariate Cox regression identified adjuvant therapy, length of stay, and number of +LNs as influential for survival. Conclusions Optimal management of node-positive patients after induction therapy and esophagectomy remains unclear, but in this series, adjuvant therapy, length of stay, and number of +LNs impacted survival. A prospective trial may reduce potential bias and guide the evaluation of adjuvant therapy in this patient population.

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