4529 Eus t staging of esophageal cancer and outcome after neoadjuvant chemoradiotherapy.

Abstract

Aim: As the use of neoadjuvant chemoradiotherapy for esophageal cancer becomes more widespread, the role of EUS T staging may evolve. We sought to compare the survival of patients with various EUS T staged esophageal cancers in the setting of this new treatment modality. Methods: This is a retrospective observational study of 73 patients with biopsy proven adenocarcinoma or squamous cell carcinoma of the esophagus who underwent preoperative EUS staging at our institution between January 1993 and March 1999. All patients were considered surgical candidates prior to referral for EUS. No patients had distant metastases as determined by computed tomography. Survival time was calculated as the time to death from the time of EUS staging. We only considered all-cause mortality. Median survival was calculated by the Kaplan-Meier method. Univariate analysis of possible confounders was performed using the logrank test and multivariate analysis was done with a cox proportional hazards model. The study was approved by our Institutional Review Board. Results: Ten patients with T1N0M0 or T1N1M0 disease by EUS staging underwent surgical resection without receiving neodjuvant chemoradiotherapy. All ten T1 cases were alive at the end of the study. Of the remaining 63 patients there were 6 T2, 49 T3, and 8 T4 cancers. All 63 patients underwent neoadjuvant chemoradiotherapy (including a cisplatin and fluorouracil-based chemotherapy regimen) followed by a surgical resection. There were no early post-operative deaths (i.e. < 30 days). There were 29 deaths by November 30, 1999: 1 T2, 24 T3, and 4 T4. The median survival for patients with T3 and T4 cancers was identical (4.6 years). Age <65 was the only variable significantly associated with improved survival. Non-significant variables included type of cancer, location in the esophagus, gender, celiac node involvement, and inability to pass a standard gastroscope through the tumor. In the multivariate analysis, T4 stage was not associated with decreased survival (RR for death 1.1, 95% CI 0.374-3.254). Conclusion: As the use of neoadjuvant chemoradiotherapy becomes more widespread, and as surgical techniques improve, endosonographers should be aware that patients with T4 lesions may have similar outcomes as those with T3 lesions. Therefore, patients with T4 lesions should be considered for multimodality therapy.