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Open Access 01-06-2018 | Gastrointestinal Oncology

Preoperative Nomogram to Risk Stratify Patients for the Benefit of Trimodality Therapy in Esophageal Adenocarcinoma

Authors: Lucas Goense, MD, Peter S. N. van Rossum, MD, PhD, Mian Xi, MD, Dipen M. Maru, MD, PhD, Brett W. Carter, MD, Gert J. Meijer, MsC, PhD, Linus Ho, MD, PhD, Richard van Hillegersberg, MD, PhD, Wayne L. Hofstetter, MD, PhD, Steven H. Lin, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2018

Abstract

Purpose

To develop a nomogram that estimates 1-year recurrence-free survival (RFS) after trimodality therapy for esophageal adenocarcinoma and to assess the overall survival (OS) benefit of esophagectomy after chemoradiotherapy (CRT) on the basis of 1-year recurrence risk.

Methods

In total, 568 consecutive patients with potentially resectable esophageal adenocarcinoma who underwent CRT were included for analysis, including 373 patients who underwent esophagectomy after CRT (trimodality therapy), and 195 who did not undergo surgery (bimodality therapy). A nomogram for 1-year RFS was created using a Cox regression model. The upper tertile of the nomogram score was used to stratify patients in low-risk and high-risk groups for 1-year recurrence. The 5-year OS was compared between trimodality and bimodality therapy in low-risk and high-risk patients after propensity score matching, respectively.

Results

Median follow-up for the entire cohort was 62 months. The 5-year OS in the trimodality and bimodality treatment groups was 56.3% (95% confidence interval [CI] 47.9–64.7) and 36.9% (95% CI 31.4–42.4), respectively. The final nomogram for the prediction of 1-year RFS included male gender, poor histologic grade, signet ring cell adenocarcinoma, cN1, cN2-3, and baseline SUV_max, with accurate calibration and reasonable discrimination (C-statistic: 0.66). Trimodality therapy was associated with improved 5-year OS in low-risk patients (p = 0.003), whereas it showed no significant survival benefit in high-risk patients (p = 0.302).

Conclusions

The proposed nomogram estimates early recurrence risk. The addition of surgery to CRT provides a clear OS benefit in low-risk patients. The OS benefit of surgery in high-risk patients is less pronounced.

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Title: Preoperative Nomogram to Risk Stratify Patients for the Benefit of Trimodality Therapy in Esophageal Adenocarcinoma
Authors: Lucas Goense, MD
Peter S. N. van Rossum, MD, PhD
Mian Xi, MD
Dipen M. Maru, MD, PhD
Brett W. Carter, MD
Gert J. Meijer, MsC, PhD
Linus Ho, MD, PhD
Richard van Hillegersberg, MD, PhD
Wayne L. Hofstetter, MD, PhD
Steven H. Lin, MD, PhD
Publication date: 01-06-2018
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 6/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-018-6435-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Preoperative Nomogram to Risk Stratify Patients for the Benefit of Trimodality Therapy in Esophageal Adenocarcinoma

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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