The effect of smoking history on response and survival outcomes patients with in esophageal cancer treated with neoadjuvant concurrent chemoradiotherapy followed by surgery.

Background: There is limited information on the impact of current or former smoking status on survival outcomes in esophageal cancer patients treated with trimodality therapy. Methods: Patients with esophageal carcinoma who completed neoadjuvant concurrent chemoradiotherapy and underwent surgical resection between October 2002 and April 2010 at Roswell Park Cancer Institute were analyzed. Smoking history was abstracted from consultation notes at initial presentation. Survival was compared between patients with any self-reported history of smoking (current or former smokers) and patients who denied any prior history of smoking (never smokers). Follow up was calculated from the date of diagnosis to the date of death or last follow up. Unknown disease status was categorized as a recurrence. Unpaired t-tests were used for statistical comparisons. Results: A total of 115 patients were analyzed, of whom 11% were female and 77% of patients reported a current or former history of smoking. There was no difference in histology, mean radiotherapy dose delivered, chemoradiotherapy completion time, pathologic complete response rates, or total follow up time between groups. Never smokers had a much higher proportion of women as compared with current or former smokers (30.8% vs. 5.6%, p=0.0003). With a median follow-up time of 28 months, there was no difference in disease recurrence, disease specific mortality, or overall survival by self-reported smoking status (current or former vs. never smokers). Conclusions: In esophageal cancer patients receiving neoadjuvant concurrent chemoradiotherapy followed by surgery, data suggest that a history of current or former smoking has no impact on pathologic complete response, recurrence, or survival. Analyses may be confounded by a higher proportion of women in the never smoking population.