Perioperative Therapy in cT1bN0M0G1-3 Esophageal/Gastroesophageal Junction Adenocarcinoma Treated with Esophagectomy: A National Cancer Database Analysis

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Conference Proceeding

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J Am Coll Surg


Introduction: Esophagectomy is recommended for cT1bN0M0G1-3 esophageal/gastroesophageal junction adenocarcinoma (EGAC); the role of perioperative therapy is not as well-defined. We aimed to evaluate outcomes of neoadjuvant (NAT) and adjuvant (AT) therapies in patients with cT1bN0M0G1-3 EGAC treated with esophagectomy. Methods: The National Cancer Database was queried for patients with cT1bN0M0G1-3 EGAC from 2010 to 2015. Those who underwent radical resection (R) were stratified into groups by perioperative therapy and grade (G): NAT+R(G1-2), NAT+R(G3), R(G1-2), R(G3), R+AT(G1-2), R+AT(G3). Demographic/clinicopathologic data were analyzed with univariate and multivariable Cox proportional hazard models. Overall survival was estimated from time of diagnosis using Kaplan-Meier curves and compared using log-rank tests with adjusted p values by Benjamini-Hochberg method. Analyses were performed using R, version 3.5.2, with significance established at p < 0.05. Results: Nine hundred and seventy patients with cT1bN0M0G1-3 EGAC were identified from 2010-2015, with no demographic differences between groups. Adjuvant groups had higher rates of pathologic T (p < 0.001) and N (p < 0.001) upstaging. Overall survivals were highest in the R(G1-2) and NAT+R(G1-2) groups, with no median survivals reached. Median follow-up time was 32.5 months. Median survivals: R(G3) = 76.8 months, R+AT(G1-2) = 63.8 months, R+AT(G3) = 45.8, NAT+R(G3) = 24.8 months. Overall survivals were significantly improved in the R vs perioperative therapy groups, and G1-2 vs G3 groups. Older age, fewer examined lymph nodes, and higher pN stage were associated with reduced survival by univariate and multivariable analyses (Figure). Conclusions: Esophagectomy alone was associated with improved overall survival in both G1-2 and G3 groups. This suggests that upfront esophagectomy should remain standard of care for cT1bN0M0G1-3 EGAC, with AT reserved for pathologic upstaging. [Figure presented]





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