Surgery is Associated with Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis.

Published online

Journal Article

BACKGROUND: The National Comprehensive Cancer Network (NCCN) guidelines recommend consideration of surgery for clinical T4a esophageal adenocarcinoma. However, there are limited data on the outcomes of patients with T4a adenocarcinoma treated with surgery vs. definitive chemoradiation. METHODS: The National Cancer Database (NCDB) was used to identify patients from 2010-2015 with clinical T4aN0-3M0 esophageal adenocarcinoma, and grouped by receipt of surgery (with or without perioperative therapy) or definitive, concurrent chemoradiation. Patients receiving incomplete definitive therapy or with missing survival information were excluded. Overall survival (OS) was evaluated with Kaplan-Meier and Cox proportional hazard analyses. RESULTS: Of 182 patients in the study, 85 (47%) underwent esophagectomy and 97 (53%) underwent chemoradiation. In the surgery cohort, 79 patients (93%) received perioperative chemotherapy. Unadjusted and multivariable analyses demonstrated a significant survival benefit associated with surgery compared to definitive chemoradiotherapy (adjusted hazard ratio [HR] 0.32; 95%CI 0.21, 0.50). A 1:1 propensity score-matched analysis of 63 patient pairs also revealed a significant OS benefit with surgery compared to chemoradiotherapy alone (HR 0.26; 95%CI 0.16, 0.43). CONCLUSION: In this national analysis, surgery for cT4a esophageal adenocarcinoma was associated with improved outcomes when compared to definitive chemoradiation. Surgery should be considered for medically fit patients with cT4aN0-3M0 esophageal adenocarcinoma.

Full Text

Duke Authors

Cited Authors

  • Raman, V; Jawitz, OK; Voigt, SL; Farrow, NE; Yang, C-FJ; D'Amico, TA; Harpole, DH

Published Date

  • July 26, 2019

Published In

PubMed ID

  • 31356800

Pubmed Central ID

  • 31356800

Electronic International Standard Serial Number (EISSN)

  • 1552-6259

Digital Object Identifier (DOI)

  • 10.1016/j.athoracsur.2019.05.091


  • eng

Conference Location

  • Netherlands