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J Thorac Cardiovasc Surg 2010;139:387-394
© 2010 The American Association for Thoracic Surgery

General Thoracic Surgery

Predictors of survival in patients with persistent nodal metastases after preoperative chemotherapy for esophageal cancer

^a Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY
^b Department of Biostatistics and Epidemiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY

Read at the Eighty-ninth Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, May 9–13, 2009.

Received for publication May 18, 2009; revisions received September 3, 2009; accepted for publication October 1, 2009.

^_* Address for reprints: Nasser K. Altorki, MD, Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Suite M404, New York Presbyterian–Weill Cornell Medical Center, 525 East 68th St, New York, NY10021. (Email: nkaltork{at}med.cornell.edu).

Objective: In patients with esophageal cancer, a complete pathologic response after preoperative therapy is universally regarded as a favorable prognostic factor. However, less is known about factors predictive of outcome in patients with persistent nodal disease. The purpose of this study is to determine which variables affect survival in this patient population.

Methods: We reviewed a prospectively maintained esophageal cancer database. Patients with positive lymph nodes after preoperative therapy and surgery were selected. Predictors of survival were examined univariately using the log–rank test. Factors identified at P < .20 by univariate analysis were selected for inclusion in a multivariate model.

Results: Ninety-six patients with 1 or more positive nodes received preoperative therapy. Pathologic T classification was 0 to 2 in 25 (26%) patients and 3 to 4 in 71 (74%) patients. In 29 (30%) patients, nonregional nodal disease was present (M1). Final pathologic stages were IIB in 18 (19%), III in 49 (51%), and IV in 29 (30%). Postoperatively, 44 (46%) patients received additional chemotherapy. On univariate analysis, pathologic stage, pathologic T classification, and number of positive nodes significantly affected overall survival. On multivariate analysis, clinical stage (hazard ratio [HR], 2.25; P = .05), pathologic T classification (HR, 3.06; P = .006), and number of positive nodes (HR 1.03 per node, P = .09) were significant predictors of overall survival.

Conclusion: Long-term survival can be achieved in patients with esophageal cancer who have persistent nodal disease after neoadjuvant therapy and surgical resection. Clinical stage, pathologic T classification, and number of positive nodes best predict survival. Nonregional nodal disease does not adversely affect outcome. Postoperative chemotherapy conferred no additional survival benefit in this patient population.