Lymph node status linked to better survival in esophageal cancer

Lymph node status following preoperative neoadjuvant therapy is a more important factor regarding survival rates than tumor status in patients with advanced esophageal cancer, according to research presented at the American Association for Thoracic Surgeons Annual Meeting in San Diego.

Shawn S. Groth, MD, MS, FACS, assistant professor at the Baylor University College of Medicine, and colleagues said their findings could help physicians counsel patients about their prognosis and help direct which patients might benefit from additional chemotherapy before or after surgery, according to a related press release.

“There is a clear benefit associated with esophagectomy as part of a multimodal treatment strategy, along with chemotherapy with or without radiation therapy for patients with locally advanced esophageal adenocarcinoma,” Groth said in the release. “However, there has been little clinical evidence to predict which patients might benefit.”

Groth and colleagues analyzed data from the National Cancer Database on 2,870 patients diagnosed with clinically staged, locally advanced esophageal adenocarcinoma between 2006 and 2012. The patients received either neoadjuvant chemotherapy or chemoradiation therapy followed by esophagectomy with negative margins.

Overall, 17.3% of patients achieved complete response, and 34.5% had a partial response.

The researchers found that neoadjuvant chemotherapy correlated with lower primary tumor response compared with neoadjuvant chemoradiation (21.3% vs. 33.9%; P < .001), and lower nodal response rates (32.7% vs. 55.9%; P < .001).

Regarding patients treated with chemoradiation, investigators found an association with a lower risk for death in both primary (HR = 0.71; 95% CI, 0.63–0.79) and nodal response (HR = 0.6; 95% CI, 0.54–0.67). However, they found that in patients who had primary but no nodal response, the survival benefit of the primary tumor response was mitigated (HR =0. 88; 95% CI, 0.69–1.11). In patients with a nodal but no primary response, the benefit was maintained (HR = 0.66; 95% CI, 0.58–0.76).

The researchers noted that the data suggest the need to optimize neoadjuvant procedures to ensure more complete nodal response rates.

“Given the aggressive nature of esophageal cancer, our inability to predict which patients will respond to neoadjuvant therapy, and the morbidity associated with surgical resection which currently limits the number of patients who are able to receive adjuvant treatment, certain patients with locally advanced esophageal adenocarcinoma may also benefit from this ‘total upfront’ approach prior to esophagectomy,” Groth said in the press release. – by Alex Young

Reference:

Groth SS, et al. Abstract 114. Presented at: Interdisciplinary Autoimmune Summit; April 28-May 1, 2018; San Diego, Calif.

Disclosures:

Healio Gastroenterology and Liver Disease could not confirm the authors’ relevant financial disclosures at the time of reporting.