Induction chemoradiation therapy prior to esophagectomy is associated with superior long‐term survival for esophageal cancer. Issue 8 (12th September 2014)

• Record Type: Journal Article
• Authors: Speicher, P. J.; Wang, X.; Englum, B. R.; Ganapathi, A. M.; Yerokun, B.; Hartwig, M. G.; D'Amico, T. A.; Berry, M. F.
• Is Part Of: Diseases of the esophagus. Volume 28:Issue 8(2015)
• Page Start: 788
• Page End: 796
• Publication Date: 2014-09-12
• Subjects: esophageal cancer -- esophageal surgery -- induction therapy -- National Cancer Database -- outcome; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1111/dote.12285
• Languages: English
• ISSNs: 1120-8694

Abstract

Summary: The purpose of this study was to examine the role of induction chemoradiation in the treatment of potentially resectable locally advanced (T2‐3N0 and T1‐3N+) esophageal cancer utilizing a large national database. The National Cancer Data Base (NCDB) was queried for all patients undergoing esophagectomy for clinical T2‐3N0 and T1‐3N+ esophageal cancer of the mid‐ or lower esophagus. Patients were stratified by the use of induction chemoradiation therapy versus surgery‐first. Trends were assessed with the Cochran–Armitage test. Predictors of receiving induction therapy were evaluated with multivariable logistic regression. A propensity‐matched analysis was conducted to compare outcomes between groups, and the Kaplan–Meier method was used to estimate long‐term survival. Within the NCDB, 7921 patients were identified, of which 6103 (77.0%) were treated with chemoradiation prior to esophagectomy, while the remaining 1818 (23.0%) were managed with surgery‐first. Use of induction therapy increased over time, with an absolute increase of 11.8% from 2003–2011 ( P < 0.001). As revealed by the propensity model, induction therapy was associated with higher rates of negative margins and shorter hospital length of stay, but no differences in unplanned readmission and 30‐day mortality rates. In unadjusted survival analysis, induction therapy was associated with better long‐term survival compared to a strategy of surgery‐first, with 5‐year survival rates of 37.2% versus 28.6%, P < 0.001. Following propensity score matching analysis, the use of induction therapy maintained a significant survival advantage over surgery‐first (5‐year survival: 37.9% vs. 28.7%, P < 0.001). Treatment with induction chemoradiation therapy prior to surgical resection is associated with significant improvement in long‐term survival, even after adjusting for confounders with a propensity model. Induction therapy should be considered in all medically appropriate patients with resectable cT2‐3N0 and cT1‐3N+ esophageal cancer, prior to esophagectomy.