- Ann Thorac Surg. 2005 Apr;79(4):1116-21.
Kesler KA, Helft PR, Werner EA, Jain NP, Brooks JA, DeWitt JM, Leblanc JK, Fineberg NS, Einhorn LH, Brown JW.
of Surgery, Thoracic Division, Indiana University School of Medicine,
Indianapolis, Indiana 46202, USA.
We conducted an institutional review of patients with locally advanced
esophageal cancer who had complete pretreatment and surgical staging to
identify variables predictive of outcome.
METHODS: From 1993 through
2002, 286 patients presented for surgical therapy of esophageal cancer.
Of these, 176 patients met criteria for review including pretreatment
endoscopic ultrasound stages IIA through IVA and a transthoracic
surgical approach with "two-field" lymph node dissection. This cohort
was primarily male (84.7%, n = 149) with adenocarcinoma (88.6%, n =
156), and 101 patients (57.3%) demonstrated endoscopic ultrasound stage
III or IVA.
RESULTS: Eighty-five (48.3%) patients presented to surgery
after receiving neoadjuvant chemoradiation therapy, and 91 (51.7%)
underwent surgery alone. Both groups were well matched with respect to
comorbidities and pretreatment stage. Patients receiving neoadjuvant
chemoradiation demonstrated a nonsignificant trend toward increased
operative mortality and nonfatal morbidity. The overall median survival
was 16.8 months, and there was no survival difference comparing
patients treated with neoadjuvant chemoradiation followed by surgery or
surgery alone (p = 0.82). The subset of 25 patients (29.4%)
demonstrating a complete pathologic response after neoadjuvant
chemoradiation therapy however had superior survival (median survival =
57.6 months, p < 0.01) as compared with neoadjuvant chemoradiation
patients demonstrating partial downstaging (n = 36, 42.3%), no
downstaging (n = 24, 28.2%), and surgery alone patients. Multivariate
analysis identified a complete pathologic response, endoscopic
ultrasound stage, and number of pathologically positive lymph nodes as
independent predictors of survival.
CONCLUSIONS: These data support the
use of neoadjuvant chemoradiation for locally advanced esophageal
cancer as the subset of patients who demonstrate a complete pathologic
response experienced significantly better survival.