American Surgical Association Home American Surgical Association Annual Meeting
Search Meeting Site Only
Annual Meeting Home
Program
Past & Future Meetings

 

 

Back to Annual Meeting Abstracts


Long-term Survival and Recurrence Rates Following Trimodality Therapy of Esophageal Adenocarcinoma - The Influence of Histologic Tumor Viability
Ashleigh M. Francis*, Boris Sepesi*, Arlene M. Correa*, Reza J. Mehran*, David C. Rice*, Jack A. Roth, Ara A. Vaporciyan, Garrett L. Walsh*, Stephen G. Swisher, Wayne L. Hofstetter*
M.D. Anderson Cancer Center, Houston, TX

OBJECTIVES: Current AJCC 7th esophageal carcinoma staging system does not account for the treatment effect of preoperative chemoradiotherapy (CRT). The extent of histologic tumor viability (HTV) post CRT has been correlated with patient outcome. Our aim was to evaluate long-term survival and recurrence rates based on response to neoadjuvant therapy for esophageal adenocarcinoma.
METHODS: Medical records of 1402 esophagectomy patients (1981-2011) were reviewed; 788 patients underwent preoperative CRT. Histologic tumor viability was assessed in 602 patients and classified as 0-10%, 11-50%, >50%. Survival was estimated using Kaplan-Meier method at potential median follow-up 67 months. Univariate and multivariate analyses identified variables associated with survival.
RESULTS: Multivariate analysis identified HTV>50% (p<0.001, HR 2.5), and positive nodal status (p<0.001, HR 1.8), but not pathologic T-status (p=0.781, HR 1.2) to be independently associated with survival. Actuarial 5 and 10-year survival was 51% and 42% (HTV 0-10%), 46% and 34% (HTV 11-50%), and 16% for both (HTV>50%). The best 5-year survival 56% was achieved in N0 patients with HTV 0-10% (p=0.05, HR 1.0), contrary to 6% observed in node-positive patients with HTV>50% (p<0.001, HR 2.5). Patients with HTV>50% demonstrated significantly (p=0.01, OR 2.2) increased distant recurrence (51%, N=25/49) compared to HTV<50% (32%, N=179/553).
CONCLUSIONS: Long-term outcomes of trimodality therapy of
esophageal carcinoma are best predicted utilizing histologic tumor viability; HTV may be a practical secondary endpoint predicting efficacy of therapy.


Back to Annual Meeting Abstracts

 



© 2019 American Surgical Association. All Rights Reserved. Privacy Policy.