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Pathologic Nodal Status Predicts Disease-Free Survival After Neoadjuvant Chemoradiation for Gastroesophageal Junction Carcinoma

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Abstract

Background

The incidence of carcinoma of the gastroesophageal junction (GEJ) is rapidly increasing, and the prognosis remains poor. We examined outcomes in patients who received neoadjuvant chemoradiation for GEJ tumors to identify factors that predict disease-free (DFS) and overall (OS) survival.

Methods

A retrospective analysis was performed of 101 consecutive patients who received chemoradiation and surgery for GEJ carcinoma between 1992 and 2001.

Results

The median DFS and OS of all patients were 16 and 25 months, respectively. Twenty-eight patients with a complete histological response (T0N0) experienced greater DFS compared with all others (P = .02). Node-negative patients, regardless of T stage, experienced improved median DFS (24 months) compared with N1 patients (9 months; P = .01). Preoperative stage, age, tumor location, or Barrett’s esophagus did not independently predict OS by univariate analysis. Multivariate analysis demonstrated that only posttreatment nodal status (P = .03)—not the degree of primary tumor response—predicted DFS.

Conclusions

The nodal status of patients with GEJ tumors after neoadjuvant therapy is predictive of DFS after resection. The poor outcome in node-positive patients supports postneoadjuvant therapy nodal staging, because surgical aggressiveness should be tempered by the realization that cure is unlikely and median survival is short.

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References

  1. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr. Rising incidence of adenocarcinoma of the esophagus, gastric cardia. JAMA 1991;265:1287–9

    Article  CAS  PubMed  Google Scholar 

  2. Pera M, Cameron AJ, Trastek VF, Carpenter HA, Zinsmeister AR. Increasing incidence of adenocarcinoma of the esophagus, esophagogastric junction. Gastroenterology 1993;104:510–3

    CAS  PubMed  Google Scholar 

  3. Wright CD, Mathisen DJ, Wain JC, et al. Evolution of treatment strategies for adenocarcinoma of the esophagus and gastroesophageal junction. Ann Thorac Surg 1994;58:1574–8

    CAS  PubMed  Google Scholar 

  4. Lund O, Hasenkam JM, Aagaard MT, Kimose HH. Time-related changes in characteristics of prognostic significance in carcinomas of the oesophagus and cardia. Br J Surg 1989;76:1301–7

    CAS  PubMed  Google Scholar 

  5. Papachristou D, Fortner JG. Adenocarcinoma of the gastric cardia: the choice of gastrectomy. Ann Surg 1980;192:58–64

    CAS  PubMed  Google Scholar 

  6. Urba S, Orringer MB, Turrisi A, Iannetoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001;19:305–13

    CAS  PubMed  Google Scholar 

  7. Kelson D, Ginsburg R, Pajak TF, et al. Chemotherapy followed by surgery compared to surgery alone for localized esophageal cancer. N Engl J Med 1998;339:1979–84

    Google Scholar 

  8. Walsh T, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy TPJ. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med 1996;335:462–7

    CAS  PubMed  Google Scholar 

  9. Nygaard K, Hagen S, Hansen HS, et al. Pre-operative radiotherapy prolongs survival in operable esophageal carcinoma: a randomized, multicenter study of pre-operative radiotherapy and chemotherapy. The second Scandinavian trial in esophageal cancer. World J Surg 1992;16:1104–9

    Article  CAS  PubMed  Google Scholar 

  10. Law S, Fok M, Chow S, Chu KM, Wong J. Preoperative chemotherapy versus surgical therapy alone for squamous cell carcinoma of the esophagus: a prospective randomized trial. J Thorac Cardiovasc Surg 1997;114:210–7

    CAS  PubMed  Google Scholar 

  11. Wolfe WG, Burton GV, Seigler HF, Crocker IR, Vaughn AL. Early results with combined modality therapy for carcinoma of the esophagus. Ann Surg 1987;205:563–71

    CAS  PubMed  Google Scholar 

  12. Wolfe WG, Vaughn AL, Seigler HF, Hathorn JW, Leopold KA, Duhaylongsod FG. Survival of patients with carcinoma of the esophagus treated with combined-modality therapy. J Thorac Cardiovasc Surg 1993;105:749–55

    CAS  PubMed  Google Scholar 

  13. Siewert JR, Stein HJ. Carcinoma of the cardia: carcinoma of the gastroesophageal junction—classification, pathology, and extent of resection. Dis Esoph 1996;9:173–82

    Google Scholar 

  14. Steup WH, De Leyn P, Deneffe G, Van Raemdonck D, Coosemans W, Lerut T. Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification. J Thorac Cardiovasc Surg 1996;111:85–94

    CAS  PubMed  Google Scholar 

  15. Wijnhoven BP, Siersema PD, Hop WC, van Dekken H, Tilanus HW. Adenocarcinomas of the distal oesophagus and gastric cardia are one clinical entity. Rotterdam Oesophageal Tumour Study Group. Br J Surg 1999;86:529–35

    Article  CAS  PubMed  Google Scholar 

  16. American Joint Committee on Cancer. Manual for Staging of Cancer. 5th ed. Philadelphia: JB Lippincott, 1997

  17. Kalish RJ, Clancy PE, Orringer MB, Appelman HD. Clinical, epidemiologic, and morphologic comparison between adenocarcinomas arising in Barrett’s esophageal mucosa and in the gastric cardia. Gastroenterology 1984;86:461–7

    CAS  PubMed  Google Scholar 

  18. Mendes de Almeida JC, Chaves P, Pereira AD, Altorki NK. Is Barrett’s esophagus the precursor of most adenocarcinomas of the esophagus and cardia? A biochemical study. Ann Surg 1997;226:725–35

    Google Scholar 

  19. Korst RJ, Rusch VW, Venkatraman E, et al. Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg 1998;115:660–9

    CAS  PubMed  Google Scholar 

  20. Entwsitle J, Goldberg M. Multimodality therapy for resectable cancer of the esophagus. Ann Thorac Surg 2002;73:1009–15

    Google Scholar 

  21. Evans DB, Rich TA, Byrd DR, et al. Preoperative chemoradiation and pancreatoduodenectomy for adenocarcinoma of the pancreas. Arch Surg 1992;127:1335–9

    CAS  PubMed  Google Scholar 

  22. Hoffman JP, Weese JL, Solin LJ, et al. A pilot study of preoperative chemoradiation for patients with localized adenocarcinoma of the pancreas. Am J Surg 1995;169:71–7

    Article  CAS  PubMed  Google Scholar 

  23. Higgins GA, Humphrey EW, Dwight RW, Roswit B, Lee LE Jr, Keehn RJ. Preoperative radiation and surgery for cancer of the rectum. Veterans Administration Surgical Oncology Group Trial II. Cancer 1986;58:352–9

    CAS  PubMed  Google Scholar 

  24. Swanson SJ, Batirel HF, Bueno R, et al. Transthoracic esophagectomy with radical mediastinal and abdominal lymph node dissection and cervical esophagogastrostomy for esophageal carcinoma. Ann Thorac Surg 2001;72:1918–24

    Article  CAS  PubMed  Google Scholar 

  25. Alexander EP, Lipman T, Harmon J, Wadleigh R. Aggressive multimodality therapy for stage III esophageal cancer: a phase I/II study. Ann Thorac Surg 2000;69:363–8

    Article  CAS  PubMed  Google Scholar 

  26. Couper GW, McAteer D, Wallis F, et al. Detection of response to chemotherapy using positron emission tomography in patients with oesophageal and gastric cancer. Br J Surg 1998;85:1403–6

    Article  CAS  PubMed  Google Scholar 

  27. Aloia TA, Harpole DH Jr, Reed CE, et al. Tumor marker expression is predictive of survival in patients with esophageal cancer. Ann Thorac Surg 2001;72:859–66

    Article  CAS  PubMed  Google Scholar 

  28. Duhaylongsod FG, Gottfried MR, Iglehart JD, Vaughn AL, Wolfe WG. The significance of c-erb B-2 and p53 immunoreactivity in patients with adenocarcinoma of the esophagus. Ann Surg 1995;221:677–83

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Departments of Surgery, Duke University Medical Center, Box 3118, Durham, North Carolina, 27710

    Jeffrey G. Gaca MD, Rebecca P. Petersen MD, MSc, David H. Harpole Jr. MD, Thomas A. D’Amico MD, Theodore N. Pappas MD, Hilliard F. Seigler MD, Walter G. Wolfe MD & Douglas S. Tyler MD

  2. Departments of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina, 27710

    Bercedis L. Peterson PhD

Authors
  1. Jeffrey G. Gaca MD
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  2. Rebecca P. Petersen MD, MSc
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  3. Bercedis L. Peterson PhD
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  4. David H. Harpole Jr. MD
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  5. Thomas A. D’Amico MD
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  6. Theodore N. Pappas MD
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  7. Hilliard F. Seigler MD
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  8. Walter G. Wolfe MD
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  9. Douglas S. Tyler MD
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Corresponding author

Correspondence to Douglas S. Tyler MD.

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Gaca, J.G., Petersen, R.P., Peterson, B.L. et al. Pathologic Nodal Status Predicts Disease-Free Survival After Neoadjuvant Chemoradiation for Gastroesophageal Junction Carcinoma. Ann Surg Oncol 13, 340–346 (2006). https://doi.org/10.1245/ASO.2006.02.023

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  • DOI: https://doi.org/10.1245/ASO.2006.02.023

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