Effect of neoadjuvant chemoradiotherapy on pathologic stage and survival in patients with locally advanced esophageal cancer

Abstract

4032 Background: The strongest predictor of survival in patients with locally advanced esophageal cancer treated with primary surgical resection is stage. This study aimed to determine if surgical stage after pre-operative chemoradiotherapy predicted a similar survival pattern. Methods: Patients (n=42) received cisplatin, 5-FU and radiotherapy (RT) followed by esophagectomy. Pre- and post-treatment stages were compared to determine effect of treatment on pathologic stage and to evaluate the relationship between stage and survival compared to surgery only treated patients. Results: Characteristics included: age (range 35 to 75 years); gender (38 male; 9 female); histology (30 adeno; 12 squamous cell); and Barrett's (n=14). Pre-treatment stages were: stage IIA (n=9), stage IIB (n=3), stage III (n=21) and stage IV (n=9). Four patients did not have pathologic staging (2 progressive disease; 1 refused; 1 unknown). Treatment led to downstaging (DS, n= 29); no change (NC, n=6); and progression (PD, n=6). Post-treatment stage was: stage 0 (n=12); stage I (n=2); stage IIA (n=13); stage III (n=3); and stage IV (n=6). Of the 42 patients, 3 did not have surgery and 2 are lost to follow-up. Status of the remaining 37 patients is alive (n=10) and dead (n=27). Median survival is 4 years with minimum follow up of surviving patients of 5.5 years. All patients with NC or PD died. Of the 29 DS patients, 10 are alive, 17 are dead and 2 are censored. Median survivals for each pathologic stage were: stage 0 (7 yrs), stage I (not reached), stage IIA (1.9 yrs), stage IIB (1 yr), stage III (2.2 yrs) and stage IV (0.8 yr). Higher pathological stage correlated with worse survival (HR 1.56; 95% CI 1.16–2.1). The distribution of survivors by pathologic stage was: stage 0 (n=5), stage I (n=2), stage IIA (n=2), stage IIB (n=1), stage III (n=0) and stage IV (n=0). Conclusions: Pre-operative chemoradiotherapy for resectable esophageal cancer seems to impact the natural history of disease. Most patients achieved DS, lower pathologic stage correlated with better survival, and survival stratified by pathologic stage was similar to historical controls treated with primary surgery. No significant financial relationships to disclose.