TY - JOUR
T1 - Influence of treatment modality in outcomes for different stages of resectable esophageal adenocarcinomas
AU - Allan, Bassan J.
AU - Pedroso, Felipe
AU - Gennis, Elisabeth R.
AU - Livingstone, Alan S.
AU - Montero, Alberto
AU - Lally, Brian
AU - Ardalan, Bach
AU - Koniaris, Leonidas G.
AU - Solomon, Naveenraj L.
AU - Franceschi, Dido
N1 - There is no consensus on the most effective modality for the treatment of resectable esophageal adenocarcinomas (EAC). We theorized that treatment modality may influence survival differently depending on the stage of disease. A single-institution, retrospective examination of resectable EAC between 2000 and 2008 was performed.
PY - 2013/5
Y1 - 2013/5
N2 - Background: There is no consensus on the most effective modality for the treatment of resectable esophageal adenocarcinomas (EAC). We theorized that treatment modality may influence survival differently depending on the stage of disease. Methods: A single-institution, retrospective examination of resectable EAC between 2000 and 2008 was performed. Resectable EAC were stratified into early disease (stage 2a or less) and late disease (stage 2b or more) based on pretreatment endoscopic ultrasound (EUS). Patients with T4, >N2, and/or distant disease were excluded. Results: A total of 156 patients were included in this study. Most patients were white (97 %), male (83 %), and over 60 years of age (51 %). Patients with early disease on pretreatment EUS exhibited improved overall survival compared to patients with late disease (P < 0.001). Irrespective of treatment modality, there were no significant differences in overall 5-year survival for patients with early or late disease. Early and late disease patients whose disease responded to neoadjuvant chemotherapy (NAC) had significantly improved overall survival compared to nonresponsive disease (P < 0.05). The only negative independent predictors of overall 5-year survival were late stage disease on pretreatment EUS (hazard ratio 2.402, 95 % confidence interval 1.24-4.67, P = 0.01) and late stage disease on final pathological stage (hazard ratio 2.29, 95 % confidence interval 1.22-4.31, P = 0.01). Conclusions: Our data lack statistical power but reveal no difference in survival with the addition of neoadjuvant therapies to surgery for early or late resectable EAC. However, patients with disease that responded to NAC had improved outcomes at 5 years for both groups. Therefore, the prognosis for patients undergoing NAC may be optimized by immediate surgical resection if neoadjuvant therapies do not result in a dramatic clinical response. © 2013 Society of Surgical Oncology.
AB - Background: There is no consensus on the most effective modality for the treatment of resectable esophageal adenocarcinomas (EAC). We theorized that treatment modality may influence survival differently depending on the stage of disease. Methods: A single-institution, retrospective examination of resectable EAC between 2000 and 2008 was performed. Resectable EAC were stratified into early disease (stage 2a or less) and late disease (stage 2b or more) based on pretreatment endoscopic ultrasound (EUS). Patients with T4, >N2, and/or distant disease were excluded. Results: A total of 156 patients were included in this study. Most patients were white (97 %), male (83 %), and over 60 years of age (51 %). Patients with early disease on pretreatment EUS exhibited improved overall survival compared to patients with late disease (P < 0.001). Irrespective of treatment modality, there were no significant differences in overall 5-year survival for patients with early or late disease. Early and late disease patients whose disease responded to neoadjuvant chemotherapy (NAC) had significantly improved overall survival compared to nonresponsive disease (P < 0.05). The only negative independent predictors of overall 5-year survival were late stage disease on pretreatment EUS (hazard ratio 2.402, 95 % confidence interval 1.24-4.67, P = 0.01) and late stage disease on final pathological stage (hazard ratio 2.29, 95 % confidence interval 1.22-4.31, P = 0.01). Conclusions: Our data lack statistical power but reveal no difference in survival with the addition of neoadjuvant therapies to surgery for early or late resectable EAC. However, patients with disease that responded to NAC had improved outcomes at 5 years for both groups. Therefore, the prognosis for patients undergoing NAC may be optimized by immediate surgical resection if neoadjuvant therapies do not result in a dramatic clinical response. © 2013 Society of Surgical Oncology.
KW - Endosonography
KW - Humans
KW - Middle Aged
KW - Kaplan-Meier Estimate
KW - Proportional Hazards Models
KW - Adenocarcinoma/diagnostic imaging
KW - Esophagectomy
KW - Male
KW - Survival Rate
KW - Treatment Outcome
KW - Chemoradiotherapy, Adjuvant
KW - Neoplasm Recurrence, Local/pathology
KW - Esophageal Neoplasms/diagnostic imaging
KW - Time Factors
KW - Adult
KW - Female
KW - Neoadjuvant Therapy
KW - Retrospective Studies
KW - Chemotherapy, Adjuvant
KW - Neoplasm Staging
UR - https://www.scopus.com/pages/publications/84880069417
UR - https://www.scopus.com/pages/publications/84880069417#tab=citedBy
UR - https://www.mendeley.com/catalogue/de59329f-76c4-3a6a-a570-6545d2950d87/
U2 - 10.1245/s10434-012-2766-8
DO - 10.1245/s10434-012-2766-8
M3 - Article
C2 - 23456314
SN - 1068-9265
VL - 20
SP - 1660
EP - 1667
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 5
ER -