Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer. Issue 8 (1st December 2015)

• 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: 2015-12-01
• 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.