Abstract
92 Background: The use of adjuvant chemotherapy (AC) after neoadjuvant Chemoradiotherapy (NCR) and surgery for esophageal cancer is controversial. The purpose of this study is determine if AC is associated with an overall survival (OS) benefit after NCR. Methods: The National Cancer Database was queried to identify esophageal cancer patients who underwent NCR and surgery between 2006 and 2013 and stratified by treatment with AC. Propensity score matching was utilized against age, pathologic tumor and nodal stage, histology, and margin status. Kaplan-Meier and log-rank analysis was used to determine OS benefit. Univariate (UVA) and multivariate (MVA) was performed with Cox proportional hazard ratio analysis. Results: We identified 1816 patients. AC was associated with improved OS. The median and 3-year OS for AC versus none was 36.4 months and 50% versus 30.9 months and 45%, respectively, (p = 0.02), however, the benefit was restricted to node positive (N+) patients. The median and 3-year OS for AC versus none in N+ patients was 31 months and 44% versus 26 months and 36%, respectively, (p = 0.03). UVA revealed that AC only benefitted patients with N+, R0 resection, and adenocarcinoma. UVA revealed that age, pathologic T3-4, N+, high grade, and R1 resection were associated with increased mortality, while removal of > 10 nodes and AC was associated with decreased mortality. MVA revealed that age, pathologic T3-4, N+, high grade, and R1 resection were associated with increased mortality, while removal of > 10 nodes was associated with decreased mortality. MVA revealed that AC was not prognostic for OS in all patients nor in N+ patients. Conclusions: This is the largest analysis on the use of AC after NCR and surgery for esophageal cancer. While there is an OS benefit favoring AC, the benefit is restricted to N+ patients. However, no benefit to AC was seen on MVA. Clinical trials are needed to address the role of AC after NCR in esophageal cancer.
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