Adenocarcinoma of the lower esophagus with Barrett’s or without Barrett’s: differences in patients survival after preoperative chemoradiation

Abstract

4524 Background: It is unclear whether the overall survival (OS) of patients with localized esophageal adenocarcinoma (LEA) with Barrett’s (Barrett’s-positive) and those with LEA without Barrett’s (Barrett’s-negative) following preoperative chemoradiation is different. Based on the anticipated differences in biology, we hypothesized that the two groups will have a different OS, if a large cohort is analyzed. Methods: In this retrospective analysis, patients with LEA who had preoperative chemoradiation and surgery were selected. Apart from age, gender, baseline clinical stage, location, class of cytotoxics, post-therapy stage, and OS; LEAs were divided up in the Barrett’s-positive and Barrett’s-negative groups. The Kaplan-Meier and Cox-regression analytic methods were used. Results: We analyzed 362 patients with LEA (137 Barrett’s-positive and 225 Barrett’s-negative). A higher proportion of Barrett’s-positive patients had EUST2 cancers (27%) than those with Barrett’s-negative cancer (17%). More Barrett’s-negative LEAs involved gastroesophageal junction than Barrett’s-positive ones (p=0.001). The OS was significantly shorter for Barrett’s-positive patients than that for Barrett’s-negative patients (32 months vs. 51 months; p=0.04). In a multivariate analysis for OS, Barrett’s-positive LEA (p=0.006), old age (p=0.016), baseline positive nodes (p=0.005), more than 2 positive ypN (p=0.0001), higher ypT (p=0.003), and the use of a taxane (0.04) were the independent prognosticators. Conclusions: This is the largest cohort of patients with LEA to demonstrate that the clinical biology (reflected by the difference in OS) is less favorable for patients with Barrett’s-positive LEA than that for patients with Barrett’s-negative LEA undergoing preoperative chemoradiation. No significant financial relationships to disclose.