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Surgery Is Associated With Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis.

Publication ,  Journal Article
Raman, V; Jawitz, OK; Voigt, SL; Farrow, NE; Yang, C-FJ; D'Amico, TA; Harpole, DH
Published in: Ann Thorac Surg
December 2019

BACKGROUND: The National Comprehensive Cancer Network guidelines recommend consideration of surgery for clinical T4a esophageal adenocarcinoma. There are limited data on the outcomes of patients with T4a adenocarcinoma treated with surgery vs definitive chemoradiation, however. METHODS: The National Cancer Database 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 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 with definitive chemoradiotherapy (adjusted hazard ratio 0.32; 95% confidence interval 0.21, 0.50). A 1:1 propensity score-matched analysis of 63 patient pairs also revealed a significant overall survival benefit with surgery compared with chemoradiotherapy alone (hazard ratio 0.26; 95% confidence interval 0.16, 0.43). CONCLUSIONS: In this national analysis, surgery for cT4a esophageal adenocarcinoma was associated with improved outcomes when compared with definitive chemoradiation. Surgery should be considered for medically fit patients with cT4aN0-3M0 esophageal adenocarcinoma.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2019

Volume

108

Issue

6

Start / End Page

1633 / 1639

Location

Netherlands

Related Subject Headings

  • United States
  • Survival Rate
  • Retrospective Studies
  • Respiratory System
  • Puerto Rico
  • Prognosis
  • Population Surveillance
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged
 

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Raman, V., Jawitz, O. K., Voigt, S. L., Farrow, N. E., Yang, C.-F., D’Amico, T. A., & Harpole, D. H. (2019). Surgery Is Associated With Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis. Ann Thorac Surg, 108(6), 1633–1639. https://doi.org/10.1016/j.athoracsur.2019.05.091
Raman, Vignesh, Oliver K. Jawitz, Soraya L. Voigt, Norma E. Farrow, Chi-Fu J. Yang, Thomas A. D’Amico, and David H. Harpole. “Surgery Is Associated With Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis.Ann Thorac Surg 108, no. 6 (December 2019): 1633–39. https://doi.org/10.1016/j.athoracsur.2019.05.091.
Raman V, Jawitz OK, Voigt SL, Farrow NE, Yang C-FJ, D’Amico TA, et al. Surgery Is Associated With Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis. Ann Thorac Surg. 2019 Dec;108(6):1633–9.
Raman, Vignesh, et al. “Surgery Is Associated With Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis.Ann Thorac Surg, vol. 108, no. 6, Dec. 2019, pp. 1633–39. Pubmed, doi:10.1016/j.athoracsur.2019.05.091.
Raman V, Jawitz OK, Voigt SL, Farrow NE, Yang C-FJ, D’Amico TA, Harpole DH. Surgery Is Associated With Survival Benefit in T4a Esophageal Adenocarcinoma: A National Analysis. Ann Thorac Surg. 2019 Dec;108(6):1633–1639.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2019

Volume

108

Issue

6

Start / End Page

1633 / 1639

Location

Netherlands

Related Subject Headings

  • United States
  • Survival Rate
  • Retrospective Studies
  • Respiratory System
  • Puerto Rico
  • Prognosis
  • Population Surveillance
  • Neoplasm Staging
  • Neoadjuvant Therapy
  • Middle Aged