4534 Eus staging pre chemo-radiation in esophageal cancer predicts survival.

Abstract

BACKGROUND: Endoscopic ultrasound (EUS) is superior to CT in staging esophageal cancer (EC). Its prognostic value has been shown in a previous study of EC patients treated primarily by surgery. We specifically evaluated the prognostic value of EUS staging for EC patients treated initially by chemo-radiation prior to possible surgery.METHODS:Records from both Vanderbilt University Medical Center and the Veteran's Hospital Nashville were reviewed in 31 patients with esophageal cancer. All had EUS staging prior to recieving chemo-radiation. The EUS was performed by a single examiner using a Pentax 32 UA (n=21 ) and an Olympus UM 20 (n=10). Pathological staging on post surgical specimans was available in 21 cases. Survival data was subsequently analyzed.Nine patients had squamous cell cancer and 22 had adenocarcinoma. Twenty seven patients subsequently underwent esophagectomy. Results: Median follow-up period from date of EUS was 723 days. Kaplan-Meier survival estimates showed that survival was significantly related to overall EUS staging (log rank test: p=0.0055) and independently to EUS T staging (p=0.0001), EUS N staging (p=0.0025)and EUS M (celiac node involovement)staging (p=0.0435). No patients with EUS T stage 1 or 2 died of disease (mean follow-up 1040 days). Of EUS T3 cases 8/14 (57%) died of disease (median survival 448 days)and all stage T4 cases died of disease (median survival 486 days). Only 1/11 (9%)patients staged as N0 by EUS died of disease (mean follow-up 998 days) whereas 14/20 (70%) N1 patients were dead from disease (median survival time 510 days). Conversely, pathological N,T and overall staging did not significantly correlate with survival. Conclusion: EUS staging pre chemo-radiation in EC patients accurately predicts survival and is superior to pathological staging. Patients staged T3,T4 and N1 have a poor prognosis inspite of adjuvent chemo-radiation and better treatment options are needed.