Adjuvant Therapy for Node-Positive Esophageal Cancer After Induction and Surgery: A Multisite Study

Abstract

Background. The benefit of adjuvant treatment for esophageal cancer patients with positive lymph nodes after induction therapy and esophagectomy is uncertain. This in-depth multicenter study assessed the benefit of adjuvant therapy in this population.Methods. A retrospective cohort study from 9 institutions included patients who received neoadjuvant treatment, underwent esophagectomy from 2000 to 2014, and had positive lymph nodes on pathology. Factors associated with administration of adjuvant therapy were assessed using multilevel random-intercept modeling to account for institutional variation in practice. Kaplan-Meier analyses were performed based on adjuvant treatment status. Variables associated with survival were identified using Cox proportional hazards modeling.Results. The study analyzed 1082 patients with node-positive cancer after induction therapy and esophagectomy: 209 (19.3%) received adjuvant therapy and 873 (80.7%) did not. Administration of adjuvant treatment varied significantly from 3.2% to 50.0% between sites (P < .001). Accounting for institution effect, factors associated with administration of adjuvant therapy included clinically positive and negative prognostic characteristics: younger age, higher pathologic stage, pathologic grade, no neoadjuvant radiotherapy nonsmoking status, and absence of postoperative infection. Kaplan-Meier analysis showed patients receiving adjuvant therapy had a longer median survival of 2.6 years vs 2.3 years (P [ .02). Cox modeling identified adjuvant treatment as independently associated with improved survival, with a 24% reduction in mortality (hazard ratio, 0.76; P [ .005).Conclusions. Adjuvant therapy was associated with improved overall survival. Therefore, consideration should be given to administration of adjuvant therapy to esophageal cancer patients who have persistent nodepositive disease after induction therapy and esophagectomy and are able to tolerate additional treatment.

Moderately differentiated esophageal squamous cell carcinoma has a poor prognosis after neoadjuvant chemoradiotherapy

“…Moreover, it is critical for patients with positive lymph nodes to receive adjuvant treatment. A previous study reported that adjuvant treatment could significantly improve the median OS of patients with lymph node metastasis after surgery (36).…”

Nomograms for predicting overall and recurrence‐free survival after trimodality therapy for esophageal adenocarcinoma

“…Currently, adjuvant chemotherapy is not supported by level one evidence for patients who undergo neoadjuvant chemoradiation followed by a complete surgical resection with esophagectomy regardless of tumor regression grade or other clinicopathologic features 16 . However, some recent studies have demonstrated improved survival for patients with esophageal cancer who received adjuvant chemotherapy for persistent lymph node disease after trimodality therapy 17–19 . Brescia et al 17 demonstrated that adjuvant chemotherapy improved median overall survival by 6 months (24 months vs. 18 months [ p = .03]) after trimodality therapy in a cohort of 101 patients.…”

“…A large cohort study using the National Cancer Database demonstrated that adjuvant chemotherapy after trimodality therapy was associated with a 30% lower risk of death among esophageal carcinoma patients with residual nodal disease 18 . In addition, a multisite retrospective cohort study demonstrated that patients who received adjuvant chemotherapy after trimodality therapy had longer (2.6 years vs. 2.3 years [ p = .020]) median OS 19 . Clearly, there is a need for more effective systemic therapies for high‐risk patients who have completed trimodality therapy of locally advanced esophageal carcinoma.…”

A Phase II Study Demonstrates No Feasibility of Adjuvant Treatment with Six Cycles of S-1 and Oxaliplatin in Resectable Esophageal Adenocarcinoma, with ERCC1 as Biomarker for Response to SOX

“…However, patients included in the aforementioned studies did not receive preoperative chemoradiotherapy. The lower likelihood of completing adjuvant treatment following pretreatment prior to surgery has been reported [ 17 ]. This is supported by the low completion rates of postoperative treatment (42–50%) achieved in studies with gastroesophageal cancer patients assigned to both pre- and postoperative treatment, which are in line with our completion rate [ 18 , 19 , 20 ].…”