Adjuvant Therapy for Node-Positive Esophageal Cancer After Induction and Surgery: A Multisite Study

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• The role of adjuvant therapy in esophageal cancer with positive lymph nodes post-neoadjuvant treatment and esophagectomy remains unclear.
• This multicenter study investigates the impact of adjuvant therapy in this specific patient cohort.

Purpose of the Study:

• To assess the benefit of adjuvant therapy for esophageal cancer patients with lymph node positivity after neoadjuvant treatment and esophagectomy.
• To identify factors influencing the administration of adjuvant therapy and its association with survival outcomes.

Main Methods:

• Retrospective cohort study involving 1082 patients from 9 institutions (2000-2014).
• Multilevel random-intercept modeling and Cox proportional hazards modeling were used to analyze treatment administration and survival.
• Kaplan-Meier analyses compared survival between patients who received adjuvant therapy and those who did not.

Main Results:

• 19.3% of patients received adjuvant therapy; administration varied significantly across institutions.
• Factors associated with adjuvant therapy included younger age, higher pathologic stage, and absence of postoperative infection.
• Adjuvant therapy was linked to longer median survival (2.6 vs. 2.3 years) and a 24% reduction in mortality (HR 0.76, P=0.005).

Conclusions:

• Adjuvant therapy is associated with improved overall survival in esophageal cancer patients with node-positive disease after neoadjuvant treatment and esophagectomy.
• Consideration of adjuvant therapy is recommended for eligible patients who can tolerate it, aiming to improve survival outcomes.