Annals of Surgical Oncology

, Volume 20, Issue 5, pp 1660–1667 | Cite as

Influence of Treatment Modality in Outcomes for Different Stages of Resectable Esophageal Adenocarcinomas

  • Bassan J. Allan
  • Felipe Pedroso
  • Elisabeth R. Gennis
  • Alan S. Livingstone
  • Alberto Montero
  • Brian Lally
  • Bach Ardalan
  • Leonidas G. Koniaris
  • Naveenraj L. Solomon
  • Dido Franceschi
Thoracic Oncology

Abstract

Background

There is no consensus on the most effective modality for the treatment of resectable esophageal adenocarcinomas (EAC). We theorized that treatment modality may influence survival differently depending on the stage of disease.

Methods

A single-institution, retrospective examination of resectable EAC between 2000 and 2008 was performed. Resectable EAC were stratified into early disease (stage 2a or less) and late disease (stage 2b or more) based on pretreatment endoscopic ultrasound (EUS). Patients with T4, >N2, and/or distant disease were excluded.

Results

A total of 156 patients were included in this study. Most patients were white (97 %), male (83 %), and over 60 years of age (51 %). Patients with early disease on pretreatment EUS exhibited improved overall survival compared to patients with late disease (P < 0.001). Irrespective of treatment modality, there were no significant differences in overall 5-year survival for patients with early or late disease. Early and late disease patients whose disease responded to neoadjuvant chemotherapy (NAC) had significantly improved overall survival compared to nonresponsive disease (P < 0.05). The only negative independent predictors of overall 5-year survival were late stage disease on pretreatment EUS (hazard ratio 2.402, 95 % confidence interval 1.24–4.67, P = 0.01) and late stage disease on final pathological stage (hazard ratio 2.29, 95 % confidence interval 1.22–4.31, P = 0.01).

Conclusions

Our data lack statistical power but reveal no difference in survival with the addition of neoadjuvant therapies to surgery for early or late resectable EAC. However, patients with disease that responded to NAC had improved outcomes at 5 years for both groups. Therefore, the prognosis for patients undergoing NAC may be optimized by immediate surgical resection if neoadjuvant therapies do not result in a dramatic clinical response.

Notes

Conflict of Interest

None.

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Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Bassan J. Allan
    • 1
  • Felipe Pedroso
    • 4
  • Elisabeth R. Gennis
    • 1
  • Alan S. Livingstone
    • 1
  • Alberto Montero
    • 2
  • Brian Lally
    • 3
  • Bach Ardalan
    • 2
  • Leonidas G. Koniaris
    • 4
  • Naveenraj L. Solomon
    • 5
  • Dido Franceschi
    • 1
  1. 1.Division of Surgical Oncology, Dewitt Daughtry Department of SurgerySylvester Comprehensive Cancer Center, Miller School of Medicine, University of MiamiMiamiUSA
  2. 2.Division of Medical OncologySylvester Comprehensive Cancer Center, Miller School of Medicine, University of MiamiMiamiUSA
  3. 3.Division of Radiation OncologySylvester Comprehensive Cancer Center, Miller School of Medicine, University of MiamiMiamiUSA
  4. 4.Division of Surgical OncologyJefferson Medical Center, Thomas Jefferson UniversityPhiladelphiaUSA
  5. 5.Division of Surgical OncologyLoma Linda University Medical CenterLoma LindaUSA

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