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Bouckaert A, Moons J, Lerut T, Coosemans W, Depypere L, Van Veer H, Nafteux P. Primary Surgery Not Inferior to Neoadjuvant Chemoradiotherapy for Esophageal Adenocarcinoma. Ann Thorac Surg 2023; 116:571-578. [PMID: 37003580 DOI: 10.1016/j.athoracsur.2023.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND The current gold standard for treatment of locally advanced esophageal adenocarcinoma is neoadjuvant chemotherapy or chemoradiotherapy followed by surgery. The shift toward neoadjuvant chemoradiotherapy (nCRT) was driven by the Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS) trial. This study reassessed, in daily practice, the presumed advantage of nCRT followed by surgery on long-term survival compared with primary surgery, in a group of all adenocarcinomas treated through a transthoracic approach with extensive 2-field lymphadenectomy. METHODS This retrospective cohort study with propensity score-matched analysis included all surgically treated patients between 2000 and 2018 with locally advanced adenocarcinoma (cT1/2 N+ or cT3/4 N0/+). For appropriate comparison, exclusion criteria of the CROSS trial were applied. Patients were matched on age, Charlson comorbidity score, clinical tumor length, and lymph node status. The primary end point was 5-year overall survival. RESULTS There were 473 eligible patients who underwent primary surgery (225 patients) or nCRT + surgery (248 patients). After propensity score-matched analysis, 149 matched cases were defined in each group for analysis. There was no significant difference after 5 years between the matched groups in median overall survival (32.5 and 35.0 months, P = .41) and median disease-free survival (14.3 and 13.5 months, P = .16). nCRT was associated with significantly more postoperative complications (mean Comprehensive Complication Index score: 21.0 vs 30.5, P < .0001) and longer mean stay in the hospital (14.0 vs 18.2 days, P = .05) and intensive care unit (11.7 vs 37.7 days, P = .05). CONCLUSIONS Our propensity score-matched results indicate that primary surgery, performed through transthoracic approach with extensive 2-field lymphadenectomy, can offer a comparable overall and disease-free survival after 5 years, with potentially fewer postoperative complications and shorter hospital and intensive care unit stay compared with nCRT followed by surgery.
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Affiliation(s)
- Andreas Bouckaert
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium.
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Toni Lerut
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, BREATHE, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
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Lerut T. What has the past taught us about the future in esophageal cancer? Personal reflections. J Surg Oncol 2023; 127:221-227. [PMID: 36630089 DOI: 10.1002/jso.27159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/08/2022] [Accepted: 11/17/2022] [Indexed: 01/12/2023]
Abstract
Since the first successful esophagectomy for cancer in 1913 spectacular advancements have been made in diagnosis, staging, and therapy. Refinement of imaging, surgery, perioperative management together with multidisciplinary collaboration are the cornerstones. Today therapy with curative option is offered to more patients than ever. Further innovations in imaging, molecular biology, genetics, artificial intelligence, machine learning, robotics, nanotechnology will have an increasing impact. The end result being a unique therapeutic plan shaped on each patient's individual profile.
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Affiliation(s)
- Toni Lerut
- University of Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospital Leuven, Leuven, Belgium
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Gao X, Wen YW, van Lanschot JJB, Chao YK. Neoadjuvant Therapy Versus Upfront Surgery for Patients With Clinical Stage 2 or 3 Esophageal Squamous Cell Carcinoma: A Cost-Effectiveness Analysis. Ann Surg Oncol 2022; 29:3644-3653. [PMID: 35018592 DOI: 10.1245/s10434-021-11207-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although neoadjuvant therapy followed by surgery (NT) is the standard of care for esophageal cancer in Western countries, upfront surgery (US) followed by adjuvant therapy (when indicated) still is commonly used in Asia to minimize overtreatment. This study investigated the cost-effectiveness of NT versus US for patients with esophageal squamous cell carcinoma (ESCC). METHODS Patients with a diagnosis of ESCC between 2010 and 2015 were divided into NT or US according to the intention to treat. Two propensity score-matched groups of patients with clinical stage 2 (135 pairs) or stage 3 (194 pairs) disease were identified and compared in terms of overall survival (OS) and direct costs incurred within 3 years after diagnosis. RESULTS The esophagectomy rates after NT were 82% for stage 2 and 88% for stage 3 disease. Compared with US, surgery after NT was associated with higher R0 resection rates, a lower number of dissected lymph nodes, and similar postoperative mortality. On an intention-to-treat analysis, stage 3 patients who received NT had a significantly better 3-year OS rate (45%) than those treated with US (37%) (p = 0.029) without significant cost increases (p = 0.89). However, NT for clinical stage 2 disease neither increased costs nor improved 3-year OS rates (47% vs 47%; p = 0.88). At a willingness-to-pay level of US$50,000 per life-year, the probability of NT being cost-effective was 92% for stage 3 versus 59% for stage 2 ESCC. CONCLUSION Because of its higher cost-effectiveness, NT is preferable to US for patients with clinical stage 3 ESCC, but US remains a viable option for stage 2 disease.
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Affiliation(s)
- Xing Gao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.,Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Yu-Wen Wen
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | | | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan.
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Semenkovich TR, Yan Y, Subramanian M, Meyers BF, Kozower BD, Nava R, Patterson GA, Kreisel D, Puri V. A Clinical Nomogram for Predicting Node-positive Disease in Esophageal Cancer. Ann Surg 2021; 273:e214-e221. [PMID: 31274650 PMCID: PMC6940556 DOI: 10.1097/sla.0000000000003450] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE We developed and validated a nomogram predicting the likelihood of occult lymph node metastases in surgically resectable esophageal cancers. BACKGROUND Patients with esophageal cancer with positive lymph nodes benefit from neoadjuvant therapy, but limitations in current clinical staging techniques mean nodal metastases often go undetected preoperatively. METHODS The National Cancer Database was queried for patients with clinical T1-3N0M0 cancer undergoing upfront esophagectomy from 2004 to 2014. Multivariable logistic regression was used to develop the risk model using both statistical significance and clinical importance criteria for variable selection. Predictive accuracy was assessed and bootstrapping was used for validation. A nomogram was constructed for presentation of the final model. RESULTS Of 3186 patients, 688 (22%) had pathologic lymph node involvement (pN+) and 2498 (78%) had pN0 status. Variables associated with pN+ status included histology [adenocarcinoma vs squamous: odds ratio (OR) 1.75], tumor stage (T1: reference, T2: OR 1.90, T3: OR 2.17), tumor size (<1 cm: reference, 1-2 cm: OR 2.25, 2-3 cm: OR 3.82, 3-4 cm: OR 5.40, 4-5 cm: OR 5.66, ≥5 cm: OR 6.02), grade (1: reference, 2: OR 2.62, 3: OR 4.39, 4: OR 4.15, X: OR 1.87), and presence of lymphovascular invasion (absent: reference, present: OR 4.70, missing: OR 1.87), all P < 0.001. A nomogram with these variables had good predictive accuracy (Brier score: 0.14, calibration slope: 0.97, c-index: 0.77). CONCLUSIONS We created a nomogram predicting the likelihood of pathologic lymph node involvement in patients with esophageal cancer who are clinically node negative using a generalizable dataset. Risk stratification with this nomogram could improve delivery of appropriate perioperative care.
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Affiliation(s)
- Tara R Semenkovich
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - Yan Yan
- Division of Public Health Sciences, Department of Surgery, and Division of Biostatistics, Washington University, St Louis, MO
| | - Melanie Subramanian
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - Bryan F Meyers
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - Ruben Nava
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - G Alexander Patterson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - Daniel Kreisel
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, MO
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Yang H, Wang K, Wang T, Li M, Li B, Li S, Yuan L. The Combination Options and Predictive Biomarkers of PD-1/PD-L1 Inhibitors in Esophageal Cancer. Front Oncol 2020; 10:300. [PMID: 32195194 PMCID: PMC7066251 DOI: 10.3389/fonc.2020.00300] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/20/2020] [Indexed: 12/19/2022] Open
Abstract
Esophageal cancer (EC) is one of the most common cancers with poor survival in the world. Nowadays, a generous number of clinical trials are underway on the use of immunotherapy in EC patients, especially the programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) inhibitors. However, only a few patients could benefit from single-agent therapy. Others need combination therapies to enhance the response rate and survival. In this review, we focus on PD-1/PD-L1 inhibitors and its combination options in EC patients. We also summarized the potential predictive biomarkers for PD-1/PD-L1 inhibitors treatment.
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Affiliation(s)
| | | | | | | | | | | | - Ling Yuan
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Case Volume-to-Outcome Relationship in Minimally Invasive Esophagogastrectomy. Ann Thorac Surg 2019; 108:1491-1497. [DOI: 10.1016/j.athoracsur.2019.05.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/08/2019] [Accepted: 05/20/2019] [Indexed: 01/26/2023]
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Drake J, Tauer K, Portnoy D, Weksler B. Adjuvant chemotherapy is associated with improved survival in patients with nodal metastases after neoadjuvant therapy and esophagectomy. J Thorac Dis 2019; 11:2546-2554. [PMID: 31372291 DOI: 10.21037/jtd.2019.05.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Studies supporting adjuvant chemotherapy after complete resection of esophageal cancer are scarce, and current clinical guidelines recommend either adjuvant chemotherapy or observation. We aimed to clarify the role of adjuvant chemotherapy in patients found to have persistent nodal metastases after neoadjuvant chemoradiation and complete resection of esophageal adenocarcinoma. Methods We queried the National Cancer Database (NCDB) for all patients from 2006 to 2012 with esophageal adenocarcinoma who received neoadjuvant chemoradiotherapy, underwent esophagectomy with complete resection, and were found to have lymph node metastases on final pathology. We compared patients who received adjuvant chemotherapy with patients followed by observation only. After performing propensity-score matching to create a well-balanced cohort, we compared survival using the Kaplan-Meier method. Results We identified 2,046 patients with lymph node metastases after neoadjuvant chemoradiotherapy and esophagectomy; 295 received adjuvant chemotherapy, and 1,751 did not. The median survival in the unmatched cohort was 2.6 years with adjuvant chemotherapy and 2.1 years with observation only (P=0.0185). Five-year survival was 27.9% with adjuvant chemotherapy and 21.5% with observation only. When we examined survival in a balanced cohort of 295 propensity-matched pairs, median survival was 2.6 years with adjuvant chemotherapy and 2.0 years with observation only (P=0.031). Five-year survival was 27.9% with adjuvant chemotherapy and 20.2% with observation only. Conclusions In a large, propensity-matched cohort, adjuvant chemotherapy was associated with significantly improved survival for patients with node-positive esophageal adenocarcinoma after neoadjuvant therapy and complete resection. This finding supports the use of adjuvant therapy for patients with node-positive adenocarcinoma after neoadjuvant therapy and surgery.
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Affiliation(s)
- Justin Drake
- Division of Thoracic Surgery, Department of Surgery, University of Tennessee Health Science Center, and West Cancer Center, Memphis, TN, USA
| | - Kurt Tauer
- Division of Medical Oncology, Department of Medicine, University of Tennessee Health Science Center, and West Cancer Center, Memphis, TN, USA
| | - David Portnoy
- Division of Medical Oncology, Department of Medicine, University of Tennessee Health Science Center, and West Cancer Center, Memphis, TN, USA
| | - Benny Weksler
- Division of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, PA, USA
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Sarkaria IS, Rizk NP, Goldman DA, Sima C, Tan KS, Bains MS, Adusumilli PS, Molena D, Bott M, Atkinson T, Jones DR, Rusch VW. Early Quality of Life Outcomes After Robotic-Assisted Minimally Invasive and Open Esophagectomy. Ann Thorac Surg 2019; 108:920-928. [PMID: 31026433 DOI: 10.1016/j.athoracsur.2018.11.075] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/25/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Minimally invasive esophagectomy may improve some perioperative outcomes over open approaches; effects on quality of life are less clear. METHODS A prospective trial of robotic-assisted minimally invasive esophagectomy (RAMIE) and open esophagectomy was initiated, measuring quality of life via the Functional Assessment of Cancer Therapy-Esophageal and Brief Pain Inventory. Mixed generalized linear models assessed associations between quality of life scores over time and by surgery type. RESULTS In total, 106 patients underwent open esophagectomy; 64 underwent minimally invasive esophagectomy (98% RAMIE). The groups did not differ in age, sex, comorbidities, histologic subtype, stage, or induction treatment (P = .42 to P > .95). Total Functional Assessment of Cancer Therapy-Esophageal scores were lower at 1 month (P < .001), returned to near baseline by 4 months, and did not differ between groups (P = .83). Brief Pain Inventory average pain severity (P = .007) and interference (P = .004) were lower for RAMIE. RAMIE had lower estimated blood loss (250 vs 350 cm3; P < .001), shorter length of stay (9 vs 11 days; P < .001), fewer intensive care unit admissions (8% vs 20%; P = .033), more lymph nodes harvested (25 vs 22; P = .05), and longer surgical time (6.4 vs 5.4 hours; P < .001). Major complications (39% for RAMIE vs 52% for open esophagectomy; P > .95), anastomotic leak (3% vs 9%; P = .41), and 90-day mortality (2% vs 4%; P = .85) did not differ between groups. Pulmonary (14% vs 34%; P = .014) and infectious (17% vs 36%; P = .029) complications were lower for RAMIE. CONCLUSIONS RAMIE is associated with lower immediate postoperative pain severity and interference and decreased pulmonary and infectious complications. Ongoing data accrual will assess mid-term and long-term outcomes in this cohort.
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Affiliation(s)
- Inderpal S Sarkaria
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Nabil P Rizk
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Debra A Goldman
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Camelia Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Manjit S Bains
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniela Molena
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew Bott
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Atkinson
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Valerie W Rusch
- Thoracic Division, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Hsu PK, Chen HS, Liu CC, Wu SC. Neoadjuvant Chemoradiation Versus Upfront Esophagectomy in Clinical Stage II and III Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 2018; 26:506-513. [PMID: 30430325 DOI: 10.1245/s10434-018-7060-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The benefits of neoadjuvant chemoradiation (NCRT) compared to upfront esophagectomy (UE) in esophageal squamous cell carcinoma (ESCC) is controversial. Our purpose was to determine whether clinical stages based on the 8th edition American Joint Committee on Cancer Tumor-Node-Metastasis staging system could guide treatment decision. METHODS Data from 2503 patients with clinical stages II and III ESCC diagnosed between 2008 and 2014 were obtained from a nationwide database. Propensity score matching was used to identify well-balanced pairs of patients. Cox proportional hazards regression and log-rank test were used in the survival analysis. The outcomes of patients receiving "NCRT followed by surgery" or "UE" strategies were compared. RESULTS The treatment modality (UE or NCRT) was not a prognostic factor in clinical stage II ESCC (HR: 0.97; p = 0.778). In contrast, the UE group demonstrated a significantly worse outcome compared with the NCRT group in clinical stage III ESCC (HR: 1.39; p < 0.001). After matching, patients who underwent UE for clinical stage II ESCC had median survival/3-year overall survival (OS) rates of 27.8 months/39.2% compared with 32.7 months/49.8% in the NCRT group (p = 0.508). The patients who underwent UE for clinical stage III ESCC had median survival/3-year OS rates of 17.9 months/28.2% in the UE group compared with 24.0 months/41.8% in the NCRT group (p < 0.001). CONCLUSIONS Our data suggest that NCRT strategy improved survival compared with UE in clinical stage III ESCC but not in clinical stage II tumors.
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Affiliation(s)
- Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Hui-Shan Chen
- Department of Health Care Administration, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
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10
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Chen HS, Hsu PK, Liu CC, Wu SC. Upfront surgery and pathological stage-based adjuvant chemoradiation strategy in locally advanced esophageal squamous cell carcinoma. Sci Rep 2018; 8:2180. [PMID: 29391589 PMCID: PMC5794775 DOI: 10.1038/s41598-018-20654-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/22/2018] [Indexed: 01/10/2023] Open
Abstract
Adjuvant chemoradiation is reported to have a survival benefit for esophageal squamous cell carcinoma (ESCC). We evaluated the “upfront surgery and pathological stage-based adjuvant chemoradiation” strategy, in which adjuvant therapy is guided by pathological stage, in locally advanced ESCC. Data from 2976 clinical stage II/III ESCC patients, including 1735 in neoadjuvant chemoradiation and 1241 in upfront surgery groups, were obtained from a nationwide database. Patients in the upfront surgery group were further categorized into the “upfront surgery and pathological stage-based adjuvant chemoradiation” and “upfront surgery only” groups. The 3-year overall survival (OS) rates in the “neoadjuvant chemoradiation”, “upfront surgery and pathological stage-based adjuvant chemoradiation”, and “upfront surgery only” groups were 41.5%, 45.8%, and 28.5%, respectively. In propensity score matched patients, the 3-year OS rate was 41.7% in the neoadjuvant chemoradiation group, compared to 35.6% in the “upfront surgery and pathological stage-based adjuvant chemoradiation” group (p = 0.147), and 20.3% in the “upfront surgery only” group (p < 0.001). No survival difference was observed between the “neoadjuvant chemoradiation followed by surgery” protocol and the “upfront surgery and pathological stage-based adjuvant chemoradiation” strategy.
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Affiliation(s)
- Hui-Shan Chen
- Department of Health Care Administration, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Po-Kuei Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chia-Chuan Liu
- Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
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Gabriel E, Attwood K, Narayanan S, Brady M, Nurkin S, Hochwald S, Kukar M. Does neoadjuvant/perioperative chemotherapy improve overall survival for T2N0 gastric adenocarcinoma? J Surg Oncol 2017; 117:659-670. [DOI: 10.1002/jso.24894] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/05/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Emmanuel Gabriel
- Department of Surgery; Section of Surgical Oncology; Mayo Clinic; Jacksonville Florida
| | - Kristopher Attwood
- Department of Biostatistics; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Sumana Narayanan
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Maureen Brady
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Steven Nurkin
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Steven Hochwald
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
| | - Moshim Kukar
- Department of Surgical Oncology; Roswell Park Cancer Institute Buffalo; Buffalo New York
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12
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Hsu PK, Chen HS, Liu CC, Huang CS, Hsieh CC, Hsu HS, Wu SC. Pre- versus postoperative chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 2017; 154:732-740.e2. [DOI: 10.1016/j.jtcvs.2017.03.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 02/17/2017] [Accepted: 03/06/2017] [Indexed: 02/04/2023]
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Woodard GA, Crockard JC, Clary-Macy C, Zoon-Besselink CT, Jones K, Korn WM, Ko AH, Gottschalk AR, Rogers SJ, Jablons DM. Hybrid minimally invasive Ivor Lewis esophagectomy after neoadjuvant chemoradiation yields excellent long-term survival outcomes with minimal morbidity. J Surg Oncol 2016; 114:838-847. [PMID: 27569043 DOI: 10.1002/jso.24409] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/31/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is a clear survival benefit to neoadjuvant chemoradiation prior to esophagectomy for patients with stages II-III esophageal cancer. A minimally invasive esophagectomy approach may decrease morbidity but is more challenging in a previously radiated field and therefore patients who undergo neoadjuvant chemoradiation may experience more postoperative complications. METHODS A prospective database of all esophageal cancer patients who underwent attempted hybrid minimally invasive Ivor Lewis esophagectomy was maintained between 2006 and 2015. The clinical characteristics, neoadjuvant treatments, perioperative complications, and survival outcomes were reviewed. RESULTS Overall 30- and 90-day mortality rates were 0.8% (1/131) and 2.3% (3/131), respectively. The majority of patients 58% (76/131) underwent induction treatment without significant adverse impact on mortality, major complications, or hospital stay. Overall survival at 1, 3, and 5 years was 85.9%, 65.3%, and 53.9%. Five-year survival by pathologic stage was stage I 68.9%, stage II 54.0%, and stage III 29.6%. CONCLUSIONS The hybrid minimally invasive Ivor Lewis esophagectomy approach results in low perioperative morbidity and mortality and is well tolerated after neoadjuvant chemoradiation. Good long-term overall survival rates likely resulted from combined concurrent neoadjuvant chemoradiation in the majority of patients, which did not impact the ability to safely perform the operation or postoperative complications rates. J. Surg. Oncol. 2016;114:838-847. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Gavitt A Woodard
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Jane C Crockard
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Carolyn Clary-Macy
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Clara T Zoon-Besselink
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kirk Jones
- Department of Pathology, University of California San Francisco, San Francisco, California
| | - Wolfgang Michael Korn
- Division of Hematology and Oncology, University of California San Francisco, San Francisco, California
| | - Andrew H Ko
- Division of Hematology and Oncology, University of California San Francisco, San Francisco, California
| | - Alexander R Gottschalk
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - David M Jablons
- Department of Surgery, University of California San Francisco, San Francisco, California.
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14
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A Propensity-matched Analysis Comparing Survival After Esophagectomy Followed by Adjuvant Chemoradiation to Surgery Alone for Esophageal Squamous Cell Carcinoma. Ann Surg 2016; 264:100-6. [DOI: 10.1097/sla.0000000000001410] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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15
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Winger DG, Nason KS. Propensity-score analysis in thoracic surgery: When, why, and an introduction to how. J Thorac Cardiovasc Surg 2016; 151:1484-7. [DOI: 10.1016/j.jtcvs.2016.02.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/04/2016] [Accepted: 02/16/2016] [Indexed: 11/28/2022]
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16
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Nason KS. Minimal or maximal surgery for esophageal cancer? J Thorac Cardiovasc Surg 2016; 151:633-635. [DOI: 10.1016/j.jtcvs.2015.09.118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 02/07/2023]
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