Gastrointestinal Cancer

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SU_8_2082 - Pathologic Tumor Response to Neoadjuvant Chemoradiation Predicts Survival in Esophageal Cancer

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

Pathologic Tumor Response to Neoadjuvant Chemoradiation Predicts Survival in Esophageal Cancer
A. Moeller1,2, M. M. Qureshi1,2, S. X. Yan2, M. A. Dyer1,2, K. Suzuki1,3, M. Charlot1,4, P. Everett1,4, V. Litle1,3, M. T. Truong1,2, and K. S. Mak1,2; 1Boston University School of Medicine, Boston, MA, 2Department of Radiation Oncology, Boston Medical Center, Boston, MA, 3Department of Surgery, Boston Medical Center, Boston, MA, 4Department of Medicine, Boston Medical Center, Boston, MA

Purpose/Objective(s): Neoadjuvant chemoradiation (CRT) and esophagectomy are established treatments in the management of non-metastatic esophageal cancer. The aim of this study was to determine if pathologic tumor response to neoadjuvant CRT was associated with improved survival in esophageal cancer using a national database.

Materials/Methods: Using the National Cancer Database (NCDB), we identified patients with non-metastatic esophageal cancer, diagnosed between 2004-2013, who received neoadjuvant CRT and surgery. Comparing pretreatment clinical and posttreatment pathologic staging, patients were divided into four groups: 1) pathologic complete response (pCR) if the pathologic stage was ypT0N0; 2) “downstaged” if ypT and ypN stage both decreased, or one decreased and the other remained unchanged; 3) “no change” if cTN matched ypTN; 4) “upstaged” if either ypT or ypN increased relative to their respective clinical stage. Overall survival (OS) for each group was estimated using Kaplan-Meier analysis. Univariate and multivariate Cox regression models were used to identify factors with significant impact on survival.

Results: A total of 6,106 patients with esophageal cancer matching study criteria were identified. There were 1,239 patients (20.3%) with pCR, while 2,459 patients (40.3%) were downstaged, 1,337 patients (21.9%) had no change in stage, and 1,071 patients (17.5%) were upstaged. Median survival was 61.2 months with pCR, 40.3 months if downstaged, 27.6 months if no change in stage, and 23.9 months if upstaged (p<0.0001). Time to surgery, gender, race, Charlson-Deyo score, year of diagnosis, tumor grade, histology, site, clinical T and N stage, facility type, surgical margin status, treatment at >1 facility, regional dose, and radiation modality were identified as predictors of pathologic tumor response. On multivariate analysis (MVA) adjusting for these factors, pCR was associated with improved OS compared to the other groups (all p<0.0001; Table). Additionally, on MVA, downstaged patients had improved OS compared to patients with no change or upstaging, and patients with no change had improved OS compared to those with upstaging (all p<0.0001; Table).
Reference Group: pCR Reference Group: Downstage Reference Group: No Change
N Events Hazard Ratio [95% CI] p Hazard Ratio [95% CI] p Hazard Ratio [95% CI] p
pCR 821 336 Ref 0.77 [0.68-0.87] <0.0001 0.55 [0.48-0.62] <0.0001
Downstage 1,816 977 1.30 [1.14-1.47] <0.0001 Ref 0.71 [0.64-0.79] <0.0001
No Change 953 624 1.82 [1.59-2.08] <0.0001 1.40 [1.26-1.56] <0.0001 Ref
Upstage 805 541 2.31 [2.00-2.67] <0.0001 1.78 [1.59-2.00] <0.0001 1.27 [1.13-1.44] <0.0001

Conclusion: In this large database study, pathologic tumor response to neoadjuvant CRT was strongly associated with survival for patients with non-metastatic esophageal cancer. Notably, there was a significant stepwise decline in survival with tumor response, in descending order of pCR, downstaged tumor, no change in stage, and upstaged tumor.

Author Disclosure: A. Moeller: None. M.M. Qureshi: None. S.X. Yan: Employee; Boston Medical Center. M.A. Dyer: None. V. Litle: None. M. Truong: Travel Expenses; American Board Radiology. K.S. Mak: Employee; Brigham and Women's Hospital. Honoraria; Int'l Consortium for Health Outcomes Measurement.

Alexander Moeller, BS

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