Adjuvant Therapy after Esophagectomy for Esophageal Cancer: Who Needs It?
Author Information
Author(s): Raja Siva MD, PhD, Rice Thomas W. MD, Lu Min PhD, Semple Marie E. MPH, Toth Andrew J. MS, Blackstone Eugene H. MD, Murthy Sudish C. MD, PhD, Ahmad Usman MD, McNamara Michael MD, Ishwaran Hemant PhD
Primary Institution: Cleveland Clinic
Hypothesis
Most patients with esophageal cancer, particularly those with locally advanced cancer, would benefit from adjuvant therapy after esophagectomy versus esophagectomy alone.
Conclusion
Adjuvant therapy after esophagectomy benefits most patients with node-positive squamous cell carcinoma, but its value in adenocarcinoma is limited to deep cancers and those with substantial nodal burden.
Supporting Evidence
- For adenocarcinoma, adjuvant therapy was beneficial only in pT4NanyM0 and pTanyN3M0 cancers.
- In squamous cell carcinoma, there was a survival benefit for pT3-4N0M0 and pT2-4N1-3M0 cancers.
- Adjuvant therapy had a meaningful survival benefit primarily for patients with node-positive cancer.
Takeaway
This study looked at patients with esophageal cancer to see if getting extra treatment after surgery helps them live longer. It found that some patients do benefit, especially those with certain types of cancer.
Methodology
The study analyzed data from 22,123 patients diagnosed with esophageal cancer from 33 centers worldwide, comparing outcomes for those who received esophagectomy alone versus those who also received adjuvant therapy.
Potential Biases
The data were collected from various institutions, which may introduce variability in treatment approaches and outcomes.
Limitations
The study is based on observational data, which may include variability in treatment practices and lacks specific details on therapy regimens.
Participant Demographics
Patients included those diagnosed with adenocarcinoma and squamous cell carcinoma from 1970 to 2014 across 33 centers on 6 continents.
Digital Object Identifier (DOI)
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