Clinical T2N0 Esophageal Cancer

Identifying Pretreatment Characteristics Associated with Pathologic Upstaging and the Potential Role for Induction Therapy

Pamela Samson, Varun Puri, Clifford Robinson, Albert Lockhart, Danielle Carpenter, Stephen Broderick, Daniel Kreisel, A. Sasha Krupnick, G. Alexander Patterson, Bryan Meyers, Traves Crabtree

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2102-2111
Number of pages10
JournalAnnals of Thoracic Surgery
Volume101
Issue number6
DOIs
StatePublished - Jun 1 2016
Externally publishedYes

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Esophageal Neoplasms
Esophagectomy
Therapeutics
Survival
Logistic Models
Odds Ratio
Confidence Intervals
Neoplasms
Kaplan-Meier Estimate
Databases
Drug Therapy

ASJC Scopus subject areas

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

Cite this

Clinical T2N0 Esophageal Cancer : Identifying Pretreatment Characteristics Associated with Pathologic Upstaging and the Potential Role for Induction Therapy. / Samson, Pamela; Puri, Varun; Robinson, Clifford; Lockhart, Albert; Carpenter, Danielle; Broderick, Stephen; Kreisel, Daniel; Krupnick, A. Sasha; Patterson, G. Alexander; Meyers, Bryan; Crabtree, Traves.

In: Annals of Thoracic Surgery, Vol. 101, No. 6, 01.06.2016, p. 2102-2111.

Research output: Contribution to journalArticle

Samson, P, Puri, V, Robinson, C, Lockhart, A, Carpenter, D, Broderick, S, Kreisel, D, Krupnick, AS, Patterson, GA, Meyers, B & Crabtree, T 2016, 'Clinical T2N0 Esophageal Cancer: Identifying Pretreatment Characteristics Associated with Pathologic Upstaging and the Potential Role for Induction Therapy', Annals of Thoracic Surgery, vol. 101, no. 6, pp. 2102-2111. https://doi.org/10.1016/j.athoracsur.2016.01.033
Samson, Pamela ; Puri, Varun ; Robinson, Clifford ; Lockhart, Albert ; Carpenter, Danielle ; Broderick, Stephen ; Kreisel, Daniel ; Krupnick, A. Sasha ; Patterson, G. Alexander ; Meyers, Bryan ; Crabtree, Traves. / Clinical T2N0 Esophageal Cancer : Identifying Pretreatment Characteristics Associated with Pathologic Upstaging and the Potential Role for Induction Therapy. In: Annals of Thoracic Surgery. 2016 ; Vol. 101, No. 6. pp. 2102-2111.
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title = "Clinical T2N0 Esophageal Cancer: Identifying Pretreatment Characteristics Associated with Pathologic Upstaging and the Potential Role for Induction Therapy",
abstract = "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.",
author = "Pamela Samson and Varun Puri and Clifford Robinson and Albert Lockhart and Danielle Carpenter and Stephen Broderick and Daniel Kreisel and Krupnick, {A. Sasha} and Patterson, {G. Alexander} and Bryan Meyers and Traves Crabtree",
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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, Albert

AU - Carpenter, Danielle

AU - Broderick, Stephen

AU - Kreisel, Daniel

AU - Krupnick, A. Sasha

AU - Patterson, G. Alexander

AU - Meyers, Bryan

AU - Crabtree, Traves

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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.

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