2005 Abstracts: ASA Physical Class IV Predicts Decreased Survival in Stage III Esophageal Adenocarcinoma
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ASA Physical Class IV Predicts Decreased Survival in Stage III Esophageal Adenocarcinoma
Daniel Tseng, Oregon Health and Sciences University, Portland, OR
Background: Although esophagectomy for adenocarcinoma (EAC) remains the only opportunity for cure, it may be associated with a high rate of complications and mortality. Balancing procedure-related risk with the potential for cure can be challenging in patients with advanced disease and multiple co-mobidities. We propose that poor risk surgical candidates have a much lower chance for long-term survival in advanced stage disease and palliative therapy should be considered instead.
Hypothesis: In stage III EAC, patients with ASA Physical Class IV (Group A) have a diminished survival compared to ASA Physical Class I-III patients (Group B). Aim: Determine if ASA Physical Class IV patients derive as much survival benefit from esophagectomy as patients with ASA Physical Class I-III when controlling for other patient factors. Methods: All esophagectomy patients between 1994-2004 at Oregon Health and Science University and the Portland Veterans Affairs Medical Center were retrospectively reviewed.213 patients with EAC were identified, 45 with stage III disease, and 11 of whom were classified as ASA Physical Class IV. Results: There were 11 patients in Group A, 34 patients in Group B. Median age for Group A was 66 yrs., and Group B was 62 yrs. (p=0.08).45% of Group A patients and 62% of Group B patients received neoadjuvant therapy (p=0.48). In-hospital mortality occurred in 27% of Group A vs. 6% of Group B (p=0.09). Only 2 out of 11 Group A (18%) survived more than one year. Median survival for Group A (137 days) was significantly less than for Group B (267 days, p=0.03). Kaplan-Meier survival analysis demonstrated significantly decreased survival for Group A compared to Group B (p=0.02). However, possibly due to the small number of patients in our series, age was the only statistically significant factor in a Cox multivariate regression model including ASA, neoadjuvant therapy, sex, and age. ASA Physical Class status was the next most significant factor after age. Conclusions: Older ASA Physical Class IV patients with esophageal adenocarcinoma have poor overall survival when compared with younger, ASA Physical Class I-III patients.
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