Improved outcomes in the management of esophageal cancer with the addition of surgical resection to chemoradiation therapy

Shaun McKenzie, Brian Mailey, Avo Artinyan, Michelle Metchikian, Stephen Shibata, Kemp Kernstine, Joseph Kim

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background: For patients with locally advanced esophageal cancer, prospective randomized clinical trials have reported no added value of surgical resection to chemoradiation alone. Using a large regional cancer registry, our objective was to determine whether curative-intent esophageal resection provided a survival advantage in the multimodality management of esophageal cancer. Materials and Methods: Using the Los Angeles County Cancer Surveillance Program (CSP), we identified all patients with local and regional (i.e., AJCC Stages I-III) esophageal cancer during the years 1988-2006. Clinical and pathologic data included patient demographics, tumor information, indication for surgery, lymph node status, and timing of therapy. Overall survival was assessed by the Kaplan-Meier method, and multivariate Cox-regression analysis was performed. Results: From CSP, 2233 patients with esophageal cancer were identified. Median survival (MS) of the entire cohort was 13.1 months. We stratified this cohort into patients who received chemoradiation alone (n = 645) and patients who received trimodality therapy (n = 286) (i.e., chemoradiation and surgery). Patients had significantly improved survival with trimodality therapy compared with chemoradiation alone (MS 25.2 vs. 12.3 months, respectively; P < 0.001). The survival advantage with trimodality therapy was observed for patients with squamous cell carcinoma (MS 24.5 vs. 12.8 months, respectively; P < 0.001) and adenocarcinoma (MS 25.9 vs. 10.6 months, respectively; P < 0.001). By multivariate analysis, trimodality therapy was a significant prognostic factor for improved survival in patients with esophageal cancer (hazard ratio [HR] 0.66, 95% confidence interval [95% CI]: 0.56-0.77, P < 0.001). Conclusions: Our data indicate that surgical resection remains an important component of the multimodality management of esophageal cancer.

Original languageEnglish (US)
Pages (from-to)551-558
Number of pages8
JournalAnnals of Surgical Oncology
Volume18
Issue number2
DOIs
StatePublished - Feb 2011

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Esophageal Neoplasms
Survival
Therapeutics
Neoplasms
Los Angeles
Registries
Squamous Cell Carcinoma
Adenocarcinoma
Multivariate Analysis
Randomized Controlled Trials
Lymph Nodes
Regression Analysis
Demography
Confidence Intervals

ASJC Scopus subject areas

  • Surgery
  • Oncology

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Improved outcomes in the management of esophageal cancer with the addition of surgical resection to chemoradiation therapy. / McKenzie, Shaun; Mailey, Brian; Artinyan, Avo; Metchikian, Michelle; Shibata, Stephen; Kernstine, Kemp; Kim, Joseph.

In: Annals of Surgical Oncology, Vol. 18, No. 2, 02.2011, p. 551-558.

Research output: Contribution to journalArticle

McKenzie, Shaun ; Mailey, Brian ; Artinyan, Avo ; Metchikian, Michelle ; Shibata, Stephen ; Kernstine, Kemp ; Kim, Joseph. / Improved outcomes in the management of esophageal cancer with the addition of surgical resection to chemoradiation therapy. In: Annals of Surgical Oncology. 2011 ; Vol. 18, No. 2. pp. 551-558.
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abstract = "Background: For patients with locally advanced esophageal cancer, prospective randomized clinical trials have reported no added value of surgical resection to chemoradiation alone. Using a large regional cancer registry, our objective was to determine whether curative-intent esophageal resection provided a survival advantage in the multimodality management of esophageal cancer. Materials and Methods: Using the Los Angeles County Cancer Surveillance Program (CSP), we identified all patients with local and regional (i.e., AJCC Stages I-III) esophageal cancer during the years 1988-2006. Clinical and pathologic data included patient demographics, tumor information, indication for surgery, lymph node status, and timing of therapy. Overall survival was assessed by the Kaplan-Meier method, and multivariate Cox-regression analysis was performed. Results: From CSP, 2233 patients with esophageal cancer were identified. Median survival (MS) of the entire cohort was 13.1 months. We stratified this cohort into patients who received chemoradiation alone (n = 645) and patients who received trimodality therapy (n = 286) (i.e., chemoradiation and surgery). Patients had significantly improved survival with trimodality therapy compared with chemoradiation alone (MS 25.2 vs. 12.3 months, respectively; P < 0.001). The survival advantage with trimodality therapy was observed for patients with squamous cell carcinoma (MS 24.5 vs. 12.8 months, respectively; P < 0.001) and adenocarcinoma (MS 25.9 vs. 10.6 months, respectively; P < 0.001). By multivariate analysis, trimodality therapy was a significant prognostic factor for improved survival in patients with esophageal cancer (hazard ratio [HR] 0.66, 95{\%} confidence interval [95{\%} CI]: 0.56-0.77, P < 0.001). Conclusions: Our data indicate that surgical resection remains an important component of the multimodality management of esophageal cancer.",
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