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Volume 8
Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X
Page 50
JOINT EVENT
Pediatric Gastro 2018
Digestive Diseases 2018
October 22-23, 2018
October 22-23, 2018 Berlin, Germany
3
rd
International Conference on
Digestive and Metabolic Diseases
Pediatric Gastroenterology Hepatology & Nutrition
13
th
International Conference on
&
Adjuvant chemotherapy after neoadjuvant chemoradiation in esophageal cancer: A propensity score
matched analysis
Juan F Ricardo
Florida State University/Sarasota Memorial Hospital, USA
Purpose: Patients with locally advanced esophageal cancer (EC) have poor long-term survival despite improvements in
multi-modality care. Neoadjuvant chemoradiation (NCR) followed by surgical resection remains standard of care. However,
the utilization of adjuvant therapy continues to be debated. Our study reviews the effectiveness of adjuvant therapy after
neoadjuvant therapy in resected EC.
Methods:
Utilizing the National Cancer Database (NCDB) we identified patients with esophageal cancer who underwent NCR
followed by esophagectomy and compared patients who received adjuvant therapy to those who did not. Propensity score
matched (PSM) analysis was performed. Baseline univariate comparisons of patient characteristics were made for continuous
variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson’s Chi-square test was used to
compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method comparing
survival curves with the log-rank test. All statistical tests were two-sided and α (type I) error <0.05 was considered statistically
significant.
Results:
We identified 1,816 patients with EC: adenocarcinoma n=1,664 (91.6%) and squamous cell carcinoma n=134 (7.4%).
There were 1,596 (87.9%) males and 220 (12.1%) females. Location of the tumor was 121 (6.7%) middle, 1,267 (7.0%) lower, and
371 (20.4%) at the gastroesophageal junction. Both the adjuvant therapy group and the no adjuvant group had 908 patients after
PSM with a median age of 60 years (26-83). Univariate analysis revealed age, R0 resection, T-stage, N-stage, grade, <10 lymph
nodes removed and adjuvant therapy were predictors of survival. All patients who received adjuvant therapy revealed greater
median and overall survival, 36.4 months and 34.5% versus 30.9 months and 33.2%, p=0.02. Node negative patients did not
show a significance in survival with adjuvant therapy 57.2 and 55.4 months respectively, p=0.4. However node positive patients
demonstrated improved median and overall survival with adjuvant therapy 31.1 months and 27% respectively compared to
the no adjuvant therapy group 25.7 months and 24.3%, p=0.03. Multivariate analysis revealed LN+, T-stage (p=0.002), R0
resection (p<0.001), and number of lymph nodes removed (p<0.001) were predictors of survival.
Conclusion:
Adjuvant therapy in all EC patients after neoadjuvant therapy does show improved median and overall survival.
Similar to other studies, R0 resection and T-stage continue to influence survival. However, node negative EC patients were
found to have no survival benefit with the addition of adjuvant therapy.
juan-ricardo@smh.comJ Gastrointest Dig Syst 2018, Volume 8
DOI: 10.4172/2161-069X-C7-083