Risk factors associated with outcomes following neoadjuvant chemoradiotherapy prior to esophagectomy in patients with adenocarcinoma of the esophagus.

Abstract

186 Background: The study was conducted to evaluate risk factors associated with treatment outcomes following concurrent chemoradiotherapy (CRT) and esophagectomy in patients diagnosed with resectable esophageal cancer. Methods: IRB approval was obtained to evaluate patients with esophageal cancer treated at our center from 2002 to 2017 with neoadjuvant CRT followed by esophagectomy. Patient characteristics pre and post-surgery including age, number of positive lymph nodes, length of time between neoadjuvant therapy and surgery were evaluated. Univariable and multivariable frailty survival analysis were used to evaluate the association between risk factors and treatment outcomes. Results: 74 patients met inclusion criteria of CRT and esophagectomy. Controlling for the number of days between the end of radiotherapy and surgery, the hazard of death for patients who developed metastatic cancer following completion of therapy was 2.08 (95 CI: 1.04 – 4.13) times higher compared to patients who did not develop metastasis (p = .04). Adjusting for metastatic cancer, for every five additional days between the end of radiotherapy and surgery, patients’ hazard of death increased 5% (HR = 1.05, 95 CI: 1.02 – 1.07, p < .001). Controlling for metastatic cancer and the number of positive nodes, for every one-year increase in age, patients’ hazard of recurrence decreased 5% (HR = 0.95, 95 CI: 0.91 – 0.99, p = .04). Adjusting for age and the number of positive nodes, the hazard of recurrence for patients who developed metastatic cancer was 28.57 (95 CI: 6.58-123.97) times higher compared to patients without metastasis (p < .0001). Conclusions: Longer duration between completion of CRT and surgery as well as developing metastatic disease are associated with a significantly higher hazard of death. Additionally, developing metastatic cancer, increase in age, and additional positive lymph nodes are all associated with a significantly higher hazard of recurrence. Optimal timing between neoadjuvant therapy and surgery needs to be evaluated further, as increasing hazard of death following therapy suggests that there may be a role for adjuvant chemotherapy in these patients.