In esophageal cancer with positive lymph nodes, adjuvant therapy may help

  • Semenkovich TR & al.
  • Ann Thorac Surg
  • 20 Jun 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • A retrospective study of patients with esophageal cancer and positive lymph nodes (LNs) after neoadjuvant treatment showed better OS associated with adjuvant therapy.

Why this matters

  • Positive LNs after neoadjuvant therapy is an indicator of worse diagnosis, but 2 small studies and a National Cancer Database study examining the effect of adjuvant therapy have returned mixed results.
  • The study uses a larger and more detailed database in an effort to study whether adjuvant therapy improves survival in this population.

Study design

  • Multicenter, retrospective cohort study (n=1082).
  • Funding: None disclosed.

Key results

  • 19.3% of patients had adjuvant therapy. Of those who received adjuvant therapy, 79.9% had adjuvant chemotherapy alone, 14.4% had chemoradiation, and 5.7% had radiation alone.
  • Adjuvant therapy was associated with a longer median postresection Kaplan-Meier survival (2.6 vs 2.3 years). The survival benefit was greatest in the early part of the curves (Wilcoxon P=.02; log-rank P=.06).
  • Cox proportional hazards modeling found an association between adjuvant treatment and mortality (HR, 0.76; P=.005) after adjustment for a range of demographic and clinical factors.

Limitations

  • Retrospective analysis.