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

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

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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 (US)
Pages (from-to)1725-1735
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume156
Issue number4
DOIs
StatePublished - Oct 1 2018

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Induction Chemotherapy
Adjuvant Chemotherapy
Esophageal Neoplasms
Esophagectomy
Survival
Confidence Intervals
Odds Ratio
Therapeutics
Proportional Hazards Models
Inpatients
Length of Stay
Radiotherapy
Databases
Prospective Studies
Mortality

Keywords

  • chemotherapy
  • esophageal cancer
  • esophagectomy
  • lymph nodes

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Adjuvant chemotherapy for patients with pathologic node-positive esophageal cancer after induction chemotherapy is associated with improved survival. / Samson, Pamela; Puri, Varun; Lockhart, Albert; Robinson, Clifford; Broderick, Stephen; Patterson, G. Alexander; Meyers, Bryan; Crabtree, Traves.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 156, No. 4, 01.10.2018, p. 1725-1735.

Research output: Contribution to journalArticle

Samson, Pamela ; Puri, Varun ; Lockhart, Albert ; Robinson, Clifford ; Broderick, Stephen ; Patterson, G. Alexander ; Meyers, Bryan ; Crabtree, Traves. / Adjuvant chemotherapy for patients with pathologic node-positive esophageal cancer after induction chemotherapy is associated with improved survival. In: Journal of Thoracic and Cardiovascular Surgery. 2018 ; Vol. 156, No. 4. pp. 1725-1735.
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abstract = "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.",
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T1 - Adjuvant chemotherapy for patients with pathologic node-positive esophageal cancer after induction chemotherapy is associated with improved survival

AU - Samson, Pamela

AU - Puri, Varun

AU - Lockhart, Albert

AU - Robinson, Clifford

AU - Broderick, Stephen

AU - Patterson, G. Alexander

AU - Meyers, Bryan

AU - Crabtree, Traves

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

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