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Wayne L. Hofstetter
David C. Rice
Ara A. Vaporciyan
Garrett L. Walsh
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Jack A. Roth
Stephen G. Swisher
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Right arrow Esophagus - cancer

J Thorac Cardiovasc Surg 2006;131:65-72
© 2006 The American Association for Thoracic Surgery

General Thoracic Surgery

Endoscopic ultrasonography-identified celiac adenopathy remains a poor prognostic factor despite preoperative chemoradiotherapy in esophageal adenocarcinoma

S. Chris Malaisrie, MD a , e , Wayne L. Hofstetter, MD a , Arlene M. Correa, PhD a , Jaffer A. Ajani, MD b , Ritsuko R. Komaki, MD c , Zhongxing Liao, MD c , Alexandria Phan b , David C. Rice, MD a , Ara A. Vaporciyan, MD a , Garrett L. Walsh, MD a , Sandeep Lahoti, MD d , Jeffrey H. Lee, MD d , Robert Bresalier, MD d , Jack A. Roth, MD a , Stephen G. Swisher, MD a , *

a Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Tex.
b Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex.
c Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex.
d Department of Gastrointestinal Medicine and Nutrition, The University of Texas M.D. Anderson Cancer Center, Houston, Tex.
e Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Tex.

Read at the Eighty-fifth Annual Meeting of The American Association for Thoracic Surgery, San Francisco, Calif, April 10-13, 2005.

Received for publication April 4, 2005; revisions received August 19, 2005; accepted for publication August 30, 2005.

* Address for reprints: Stephen G. Swisher, MD, Professor of Surgery, The University of Texas M.D. Anderson Cancer Center, Department of Thoracic and Cardiovascular Surgery, Deputy Chairperson, Academic Affairs, 1515 Holcombe Blvd, Box 445, Houston, TX 77030. (Email: sswisher{at}mdanderson.org).

OBJECTIVE: We reviewed our experience with preoperative chemoradiotherapy in patients with adenocarcinoma of the distal esophagus and pretreatment endoscopic ultrasonography-identified celiac adenopathy.

METHODS: One hundred eighty-six patients with adenocarcinoma of the distal esophagus were staged with endoscopic ultrasonography before treatment from 1997 through 2004. All patients were treated with concurrent chemoradiotherapy (CRT group) and surgical intervention or induction chemotherapy followed by concurrent chemoradiotherapy (C->CRT group) and surgical intervention. Survival analysis (excluding operative mortality) evaluated various pretreatment factors.

RESULTS: Multivariable Cox regression analysis showed that pretreatment endoscopic ultrasonography-identified celiac adenopathy was a significant predictor of decreased long-term survival (P = .03). Median and 3-year survivals were 49 months and 54% in the endoscopic ultrasonography-identified cN0 M0 group (n = 65), 45 months and 56% in the endoscopic ultrasonography-identified cN1 M0 group (n = 96), and 19 months and 12% in the endoscopic ultrasonography-identified celiac adenopathy (cM1a) group (n = 18; P = .03). Increased systemic relapse was noted in the endoscopic ultrasonography-identified cM1a group (44% vs 22%, P = .07). The only factor associated with increased survival in the endoscopic ultrasonography-identified cM1a group (27 vs 15 months, P = .02) was the addition of induction chemotherapy before concurrent chemoradiotherapy and surgical intervention.

CONCLUSIONS: Endoscopic ultrasonography-identified celiac adenopathy in patients with adenocarcinoma of the distal esophagus conveys a poor prognosis despite preoperative chemoradiotherapy. These patients should be stratified in future multimodality trials. The investigation of induction chemotherapy before concurrent chemoradiotherapy might be warranted in this high-risk group of patients.

Abbreviations and Acronyms cM1a = celiac adenopathy; EUS = endoscopic ultrasonography




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