Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study
Objective:. Based on current practice guidelines, we hypothesized that most patients with esophageal cancer, particularly those with locally advanced cancer, would benefit from adjuvant therapy after esophagectomy versus esophagectomy alone. We sought to obtain a granular estimate of patient-level r...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-12-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000497 |
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| author | Siva Raja, MD, PhD Thomas W. Rice, MD Min Lu, PhD Marie E. Semple, MPH Andrew J. Toth, MS Eugene H. Blackstone, MD Sudish C. Murthy, MD, PhD Usman Ahmad, MD Michael McNamara, MD Hemant Ishwaran, PhD for the Worldwide Esophageal Cancer Collaboration Investigators |
| author_facet | Siva Raja, MD, PhD Thomas W. Rice, MD Min Lu, PhD Marie E. Semple, MPH Andrew J. Toth, MS Eugene H. Blackstone, MD Sudish C. Murthy, MD, PhD Usman Ahmad, MD Michael McNamara, MD Hemant Ishwaran, PhD for the Worldwide Esophageal Cancer Collaboration Investigators |
| author_sort | Siva Raja, MD, PhD |
| collection | DOAJ |
| description | Objective:. Based on current practice guidelines, we hypothesized that most patients with esophageal cancer, particularly those with locally advanced cancer, would benefit from adjuvant therapy after esophagectomy versus esophagectomy alone. We sought to obtain a granular estimate of patient-level risk-adjusted survival for each therapeutic option by cancer histopathology and stage.
Background:. Although esophagectomy alone is now an uncommon therapy for treating locally advanced esophageal cancer, the value of adjuvant therapy after esophagectomy is unknown.
Methods:. From 1970 to 2014, 22,123 consecutive patients from 33 centers on 6 continents (Worldwide Esophageal Cancer Collaboration) were diagnosed with biopsy-proven adenocarcinoma (n = 7526) or squamous cell carcinoma (n = 5625), of whom 10,873 received esophagectomy alone and 2278 additional adjuvant therapy. Random forests for survival and virtual-twin analyses were performed for all-cause mortality.
Results:. For adenocarcinoma, adjuvant therapy was beneficial only in pT4NanyM0 cancers (6–8 month survival benefit) and in pTanyN3M0 cancers (4–8 month benefit); a survival decrement was observed in pT1-3N0M0 cancers, with no effect on TanyN1-2M0 cancers. In squamous cell carcinoma, there was a 4 to 21 month survival benefit for pT3-4N0M0 cancers and a 4 to 15 month survival benefit for pT2-4N1-3M0 cancers.
Conclusions:. Adjuvant therapy after esophagectomy appears to benefit most patients with node-positive squamous cell carcinoma, but for adenocarcinoma, its value is limited to deep cancers and to those with substantial nodal burden. Future studies of the role of adjuvant therapies should treat these 2 cancers differently, with guidelines reflecting the histopathologic-appropriate survival value of adjuvant therapy. |
| format | Article |
| id | doaj-art-e00617b92b5148a883b2c6fd1f92a84c |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-e00617b92b5148a883b2c6fd1f92a84c2025-01-24T09:18:58ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-12-0154e49710.1097/AS9.0000000000000497202412000-00009Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational StudySiva Raja, MD, PhD0Thomas W. Rice, MD1Min Lu, PhD2Marie E. Semple, MPH3Andrew J. Toth, MS4Eugene H. Blackstone, MD5Sudish C. Murthy, MD, PhD6Usman Ahmad, MD7Michael McNamara, MD8Hemant Ishwaran, PhD9for the Worldwide Esophageal Cancer Collaboration InvestigatorsFrom the * Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OHFrom the * Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH† Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, FL‡ Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH‡ Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OHFrom the * Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OHFrom the * Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OHFrom the * Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH§ Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.† Division of Biostatistics, Department of Public Health Sciences, University of Miami, Miami, FLObjective:. Based on current practice guidelines, we hypothesized that most patients with esophageal cancer, particularly those with locally advanced cancer, would benefit from adjuvant therapy after esophagectomy versus esophagectomy alone. We sought to obtain a granular estimate of patient-level risk-adjusted survival for each therapeutic option by cancer histopathology and stage. Background:. Although esophagectomy alone is now an uncommon therapy for treating locally advanced esophageal cancer, the value of adjuvant therapy after esophagectomy is unknown. Methods:. From 1970 to 2014, 22,123 consecutive patients from 33 centers on 6 continents (Worldwide Esophageal Cancer Collaboration) were diagnosed with biopsy-proven adenocarcinoma (n = 7526) or squamous cell carcinoma (n = 5625), of whom 10,873 received esophagectomy alone and 2278 additional adjuvant therapy. Random forests for survival and virtual-twin analyses were performed for all-cause mortality. Results:. For adenocarcinoma, adjuvant therapy was beneficial only in pT4NanyM0 cancers (6–8 month survival benefit) and in pTanyN3M0 cancers (4–8 month benefit); a survival decrement was observed in pT1-3N0M0 cancers, with no effect on TanyN1-2M0 cancers. In squamous cell carcinoma, there was a 4 to 21 month survival benefit for pT3-4N0M0 cancers and a 4 to 15 month survival benefit for pT2-4N1-3M0 cancers. Conclusions:. Adjuvant therapy after esophagectomy appears to benefit most patients with node-positive squamous cell carcinoma, but for adenocarcinoma, its value is limited to deep cancers and to those with substantial nodal burden. Future studies of the role of adjuvant therapies should treat these 2 cancers differently, with guidelines reflecting the histopathologic-appropriate survival value of adjuvant therapy.http://journals.lww.com/10.1097/AS9.0000000000000497 |
| spellingShingle | Siva Raja, MD, PhD Thomas W. Rice, MD Min Lu, PhD Marie E. Semple, MPH Andrew J. Toth, MS Eugene H. Blackstone, MD Sudish C. Murthy, MD, PhD Usman Ahmad, MD Michael McNamara, MD Hemant Ishwaran, PhD for the Worldwide Esophageal Cancer Collaboration Investigators Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study Annals of Surgery Open |
| title | Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study |
| title_full | Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study |
| title_fullStr | Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study |
| title_full_unstemmed | Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study |
| title_short | Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?: Multi-institution Worldwide Observational Study |
| title_sort | adjuvant therapy after esophagectomy for esophageal cancer who needs it multi institution worldwide observational study |
| url | http://journals.lww.com/10.1097/AS9.0000000000000497 |
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