Adjuvant chemotherapy for patients with pathologic node-positive esophageal cancer after induction chemotherapy is associated with improved survival

Pamela Samson, Varun Puri, A. Craig Lockhart, Clifford Robinson, Stephen Broderick, G. Alexander Patterson, Bryan Meyers, Traves Crabtree

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Objectives: The study objectives were to identify variables associated with the use of adjuvant chemotherapy among patients with node-positive esophageal cancer who received induction therapy and to evaluate its relationship with overall survival. Methods: Treatment data for patients with esophageal cancer receiving induction chemotherapy ± radiotherapy and esophagectomy were abstracted from the National Cancer Data Base. Pathologic node-positive patients were dichotomized by whether they received 2 or more cycles of adjuvant chemotherapy or none. Kaplan–Meier survival curves were generated, and a Cox proportional hazards model was done to identify factors associated with overall survival. Results: From 2006 to 2012, 3100 patients had pathologic positive nodes after induction therapy and esophagectomy. A total of 2625 patients (84.7%) did not receive adjuvant chemotherapy, and 475 patients (15.3%) did. N3 nodal stage was associated with an increased likelihood of receiving adjuvant chemotherapy (reference: N1, odds ratio, 1.82, 95% confidence interval, 1.15-2.97, P =.01), whereas increasing age (by year, odds ratio, 0.97, confidence interval, 0.96-0.98, P <.001), induction chemoradiation therapy (reference: induction chemotherapy, odds ratio, 0.39, confidence interval, 0.30-0.52, P <.001), and increasing inpatient length of stay after esophagectomy (per day: odds ratio, 0.98, confidence interval, 0.97-0.99, P =.007) were associated with a decreased likelihood. Patients receiving adjuvant chemotherapy had improved overall survival at each pathologic nodal stage: 31.6 months versus 22.7 months for N1 disease (P <.001), 32.4 months versus 19.2 months for N2 disease (P =.035), and 19.5 months versus 10.4 months for N3 disease (P <.001). Adjuvant therapy was independently associated with decreased mortality hazard (hazard ratio, 0.69, 95% confidence interval, 0.57-0.83, P <.001). Conclusions: Patients receiving adjuvant chemotherapy after induction therapy and esophagectomy show a survival benefit at all positive nodal stages. Prospective studies may help further delineate this benefit.

Original languageEnglish
Pages (from-to)1725-1735
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Issue number4
StatePublished - Oct 2018


  • chemotherapy
  • esophageal cancer
  • esophagectomy
  • lymph nodes


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