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Nodal Response to Pre-Op Tx Tied to Survival in Esophageal Cancer

WEDNESDAY, May 2, 2018 -- For patients with locally advanced esophageal cancer, the status of lymph nodes following preoperative neoadjuvant chemotherapy or chemoradiation therapy determines survival, according to a study presented at the annual meeting of the American Association for Thoracic Surgery, held from April 28 to May 1 in San Diego.

Shawn S. Groth, M.D., from the Baylor College of Medicine in Houston, and colleagues conducted a retrospective study of patients aged 18 to 80 years in the National Cancer Database with clinically staged, locally advanced esophageal adenocarcinoma who underwent a margin-negative esophagectomy following neoadjuvant chemotherapy or chemoradiation.

Of the 2,870 patients in the study, 17.3 and 34.5 percent, respectively, had a complete and partial response. The researchers observed correlations for both primary tumor response and nodal response with lower risk of death (hazard ratios, 0.71 [95 percent confidence interval, 0.63 to 0.79] and 0.60 [95 percent confidence interval, 0.54 to 0.67], respectively). The survival benefit of the primary tumor response was mitigated among patients who had a primary tumor response but no nodal response (hazard ratio, 0.88; 95 percent confidence interval, 0.69 to 1.11); in contrast, the survival benefit of nodal response was maintained among patients with a nodal response but not primary tumor response (hazard ratio, 0.66; 95 percent confidence interval, 0.58 to 0.76).

"Certain patients with locally advanced esophageal adenocarcinoma may also benefit from this 'total upfront' approach prior to esophagectomy," Groth said in a statement.

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Posted: May 2018