TY - JOUR
T1 - Clinical T2N0 Esophageal Cancer
T2 - Identifying Pretreatment Characteristics Associated with Pathologic Upstaging and the Potential Role for Induction Therapy
AU - Samson, Pamela
AU - Puri, Varun
AU - Robinson, Clifford
AU - Lockhart, Craig
AU - Carpenter, Danielle
AU - Broderick, Stephen
AU - Kreisel, Daniel
AU - Krupnick, A. Sasha
AU - Patterson, G. Alexander
AU - Meyers, Bryan
AU - Crabtree, Traves
N1 - Funding Information:
Pamela Samson, MD, MPHS, has grant support through NIH Cardiothoracic Surgery T32. Varun Puri, MD, MSCI, has grant funding through NIH K07CA178120 and K12CA167540-02. Additionally, the NCDB is a joint effort of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. These organizations have not verified and are not responsible for the analytic or statistical methodology used in this study, and the conclusions drawn are solely those of the authors.
Publisher Copyright:
© 2016 The Society of Thoracic Surgeons.
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background Although studies have suggested standard therapy for clinical T2N0 esophageal cancer should be primary surgery, we hypothesize there is a subgroup for whom induction therapy may result in improved overall survival. Methods Patients with cT2N0 esophageal cancer receiving induction therapy or upfront esophagectomy (UE) were identified in the National Cancer Data Base. The UE patients were dichotomized as (1) pathologically upstaged, or (2) same-staged or downstaged. Logistic regression models identified variables associated with upstaging, and Kaplan-Meier analysis compared median overall survival. Results From 2006 to 2012, 932 cT2N0 patients (52.2%) received UE, and 853 (47.8%) received induction therapy first. In all, 326 of 713 UE patients (45.7%) were upstaged: 87 of 326 (26.7%) had T upstaging; 98 of 326 (30.1%) had N upstaging; and 141 of 326 (43.3%) had both. Patients upstaged after UE had a higher tumor grade (35.1% versus 57.1% grade 3), and a higher rate of lymphovascular invasion (57.1% versus 17.7%; both p < 0.001). Variables associated with upstaging included lymphovascular invasion (odds ratio 6.0, 95% confidence interval: 2.9 to 12.5, p < 0.001) and tumor grade 3 (odds ratio 9.4, 95% confidence interval: 1.8 to 48.4, p = 0.007). Of upstaged UE patients, only 144 (44.2%) received adjuvant therapy. The median overall survival for cT2N0 patients upstaged after UE was 27.5 ± 2.5 months versus 43.9 ± 2.9 months for induction therapy patients (any resultant pathologic stage, p < 0.001). Conclusions Half of all cT2N0 patients were pathologically upstaged after UE, with worse survival compared with patients receiving induction therapy. Refining an upstaging model would help select patients for induction therapy and increase the rate of chemotherapy in patients at risk for systemic disease.
AB - Background Although studies have suggested standard therapy for clinical T2N0 esophageal cancer should be primary surgery, we hypothesize there is a subgroup for whom induction therapy may result in improved overall survival. Methods Patients with cT2N0 esophageal cancer receiving induction therapy or upfront esophagectomy (UE) were identified in the National Cancer Data Base. The UE patients were dichotomized as (1) pathologically upstaged, or (2) same-staged or downstaged. Logistic regression models identified variables associated with upstaging, and Kaplan-Meier analysis compared median overall survival. Results From 2006 to 2012, 932 cT2N0 patients (52.2%) received UE, and 853 (47.8%) received induction therapy first. In all, 326 of 713 UE patients (45.7%) were upstaged: 87 of 326 (26.7%) had T upstaging; 98 of 326 (30.1%) had N upstaging; and 141 of 326 (43.3%) had both. Patients upstaged after UE had a higher tumor grade (35.1% versus 57.1% grade 3), and a higher rate of lymphovascular invasion (57.1% versus 17.7%; both p < 0.001). Variables associated with upstaging included lymphovascular invasion (odds ratio 6.0, 95% confidence interval: 2.9 to 12.5, p < 0.001) and tumor grade 3 (odds ratio 9.4, 95% confidence interval: 1.8 to 48.4, p = 0.007). Of upstaged UE patients, only 144 (44.2%) received adjuvant therapy. The median overall survival for cT2N0 patients upstaged after UE was 27.5 ± 2.5 months versus 43.9 ± 2.9 months for induction therapy patients (any resultant pathologic stage, p < 0.001). Conclusions Half of all cT2N0 patients were pathologically upstaged after UE, with worse survival compared with patients receiving induction therapy. Refining an upstaging model would help select patients for induction therapy and increase the rate of chemotherapy in patients at risk for systemic disease.
UR - http://www.scopus.com/inward/record.url?scp=84964322248&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2016.01.033
DO - 10.1016/j.athoracsur.2016.01.033
M3 - Article
C2 - 27083246
AN - SCOPUS:84964322248
SN - 0003-4975
VL - 101
SP - 2102
EP - 2111
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -