Skip to main content
SpringerLink
Log in

Adjuvant Radiation Therapy and Lymphadenectomy in Esophageal Cancer: A SEER Database Analysis

  • 2012 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objectives

This study seeks to determine the effects of postoperative radiation therapy and lymphadenectomy on survival in esophageal cancer.

Methods

An analysis of patients with surgically resected esophageal cancer from the SEER database between 2004 and 2008 was performed to determine association of adjuvant radiation and lymph node dissection on survival. Survival curves were calculated according to the Kaplan–Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model.

Results

We identified 2109 patients who met inclusion criteria. Radiation was associated with increased survival in stage III patients (p = 0.005), no benefit in stage II (p = 0.075) and IV (p = 0.913) patients, and decreased survival in stage I patients (p < 0.0001). Univariate analysis revealed that radiation therapy was associated with a survival benefit node positive (N1) patients while it was associated with a detriment in survival for node negative (N0) patients. Removing >12 and >15 lymph nodes was associated with increased survival in N0 patients, while removing >8, >10, >12, >15, and >20 lymph nodes was associated with a survival benefit in N1 patients. MVA revealed that age, gender, tumor and nodal stage, tumor location, and number of lymph nodes removed were prognostic for survival in N0 patients. In N1 patients, MVA showed the age, tumor stage, number of lymph nodes removed, and radiation were prognostic for survival.

Conclusion

The number of lymph nodes removed in esophageal cancer is associated with increased survival. The benefit of adjuvant radiation therapy on survival in esophageal cancer is limited to N1 patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AJCC:

American Joint Committee on Cancer

SEER:

Surveillance Epidemiology End Results

HR:

hazard ratio

CI:

confidence interval

MVA:

multivariate analysis

References

  1. Siegel, R., et al., Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 61(4): p. 212–36.

  2. Sjoquist, K.M., et al., Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. The lancet oncology, 2011. 12(7): p. 681–92.

    Article  PubMed  Google Scholar 

  3. Douglass, H.O., Jr., et al., Survival after postoperative combination treatment of rectal cancer. N Engl J Med, 1986. 315(20): p. 1294–5.

    Article  PubMed  Google Scholar 

  4. Macdonald, J.S., et al., Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med, 2001. 345(10): p. 725–30.

    Article  PubMed  CAS  Google Scholar 

  5. Kalser, M.H. and S.S. Ellenberg, Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg, 1985. 120(8): p. 899–903.

    Article  PubMed  CAS  Google Scholar 

  6. Adelstein, D.J., et al., Mature results from a phase II trial of postoperative concurrent chemoradiotherapy for poor prognosis cancer of the esophagus and gastroesophageal junction. J Thorac Oncol, 2009. 4(10): p. 1264–9.

    Article  PubMed  Google Scholar 

  7. Tachibana, M., et al., Postoperative chemotherapy vs chemoradiotherapy for thoracic esophageal cancer: a prospective randomized clinical trial. Eur J Surg Oncol, 2003. 29(7): p. 580–7.

    Article  PubMed  CAS  Google Scholar 

  8. Shridhar, R., et al., Adjuvant Radiation Therapy Increases Overall Survival in Node-Positive Gastric Cancer Patients With Aggressive Surgical Resection and Lymph Node Dissection: A SEER Database Analysis. Am J Clin Oncol, 2011.

  9. Smith, D.D., R.R. Schwarz, and R.E. Schwarz, Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol, 2005. 23(28): p. 7114–24.

    Article  PubMed  Google Scholar 

  10. Lee, H.K., et al., Influence of the number of lymph nodes examined on staging of gastric cancer. Br J Surg, 2001. 88(10): p. 1408–12.

    Article  PubMed  CAS  Google Scholar 

  11. Chang, G.J., et al., Lymph node evaluation and survival after curative resection of colon cancer: systematic review. J Natl Cancer Inst, 2007. 99(6): p. 433–41.

    Article  PubMed  Google Scholar 

  12. Nelson, H., et al., Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst, 2001. 93(8): p. 583–96.

    Article  PubMed  CAS  Google Scholar 

  13. Greenstein, A.J., et al., Effect of the number of lymph nodes sampled on postoperative survival of lymph node-negative esophageal cancer. Cancer, 2008. 112(6): p. 1239–46.

    Article  PubMed  Google Scholar 

  14. Hsu, P.K., et al., The total number of resected lymph node is not a prognostic factor for recurrence in esophageal squamous cell carcinoma patients undergone transthoracic esophagectomy. J Surg Oncol, 2011. 103(5): p. 416–20.

    Article  PubMed  Google Scholar 

  15. Peyre, C.G., et al., The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg, 2008. 248(4): p. 549–56.

    PubMed  Google Scholar 

  16. Rizk, N.P., et al., Optimum lymphadenectomy for esophageal cancer. Ann Surg, 2010. 251(1): p. 46–50.

    Article  PubMed  Google Scholar 

  17. Schwarz, R.E. and D.D. Smith, Clinical impact of lymphadenectomy extent in resectable esophageal cancer. J Gastrointest Surg, 2007. 11(11): p. 1384–93; discussion 1393–4.

    Article  PubMed  Google Scholar 

  18. Lv, J., et al., Long-term efficacy of perioperative chemoradiotherapy on esophageal squamous cell carcinoma. World journal of gastroenterology : WJG, 2010. 16(13): p. 1649–54.

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of Interest

None to report for any of the authors

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, 33612, USA

    Ravi Shridhar & Sarah E. Hoffe

  2. Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, FL, USA

    Jill Weber, Khaldoun Almhanna, Richard Karl & Kenneth Meredith

Authors
  1. Ravi Shridhar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jill Weber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sarah E. Hoffe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Khaldoun Almhanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard Karl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenneth Meredith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ravi Shridhar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shridhar, R., Weber, J., Hoffe, S.E. et al. Adjuvant Radiation Therapy and Lymphadenectomy in Esophageal Cancer: A SEER Database Analysis. J Gastrointest Surg 17, 1339–1345 (2013). https://doi.org/10.1007/s11605-013-2192-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-013-2192-7

Keywords

Search

Navigation