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Management of Clinical T2N0 Esophageal and Gastroesophageal Junction Adenocarcinoma: What Is the Optimal Treatment?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The current standard of care for locally advanced esophageal and gastroesophageal junction (GEJ) adenocarcinoma includes neoadjuvant chemoradiation and surgery. The optimal treatment for clinical T2N0M0 (cT2N0) disease is debated. This study aims to determine the optimal treatment in these patients.

Methods

The National Cancer Database was used to identify patients who underwent surgery for cT2N0 esophageal and GEJ adenocarcinoma from 2004 to 2017. Patients were grouped into surgery-alone, neoadjuvant therapy (NAT), and adjuvant therapy (AT) groups. Subgroups of high-risk patients (tumor ≥ 3 cm, poor differentiation, or lymphovascular invasion) and patients upstaged after upfront surgery were identified. Kaplan–Meier method and Cox proportional hazard ratios were used to compare overall survival.

Results

Of 2160 patients included, 957 (44.3%) underwent surgery-alone, 821 (38.0%) underwent NAT and surgery, and 382 (17.7%) underwent surgery and AT. One thousand six hundred nineteen (75.0%) patients had high-risk features. Six hundred fourteen (45.9%) patients were upstaged after upfront surgery. In the overall cohort, AT was associated with improved survival compared to NAT (HR 0.618, p < 0.001) and surgery-alone (HR 0.699, p < 0.001). There was no difference in survival between NAT and surgery-alone (HR 1.132, p = 0.112). Similar results were observed in high-risk patients. Patients upstaged after upfront surgery who received AT had improved survival compared to those initially treated with NAT (HR 0.613, p < 0.001).

Conclusion

This analysis suggests that cT2N0 esophageal and GEJ adenocarcinomas may not benefit from the intensive multimodality therapy utilized in locally advanced disease. Selective use of AT for patients who are upstaged pathologically, or have high-risk features, is associated with improved outcomes.

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Acknowledgements

The National Cancer Database (NCDB) is a joint project of the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society. The CoC’s NCDB and the hospitals participating in the CoC’s NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Rolfy A. Perez Holguin, Elizabeth J. Olecki, Kelly A. Stahl, William G. Wong, Charles C. Vining, Matthew E. B. Dixon & June S. Peng

  2. Division of Surgical Oncology, Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, H07017033, USA

    Charles C. Vining, Matthew E. B. Dixon & June S. Peng

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  1. Rolfy A. Perez Holguin
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Contributions

Perez Holguin, Olecki, Stahl, Wong, Peng: design, analysis, interpretation, drafting for important intellectual content, final approval, agreement of accountability for all aspects of the work.

Vining, Dixon: analysis, interpretation, drafting for important intellectual content, final approval, agreement of accountability for all aspects of the work.

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Correspondence to June S. Peng.

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Perez Holguin, R.A., Olecki, E.J., Stahl, K.A. et al. Management of Clinical T2N0 Esophageal and Gastroesophageal Junction Adenocarcinoma: What Is the Optimal Treatment?. J Gastrointest Surg 26, 2050–2060 (2022). https://doi.org/10.1007/s11605-022-05441-7

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