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Immediate Surgery and Not Preoperative Chemotherapy Improves Recurrence-Free Interval in Patients With cT2 Esophageal Cancer
Erwin Rieder*1, Reza Asari1, Matthias Paireder1, Matthias Preuser2, Peter Birner3, Sebastian F. Schoppmann1
1Surgery, Medical University of Vienna, Vienna, Austria; 2Oncology, Medical University of Vienna, Vienna, Austria; 3Pathology, Medical University of Vienna, Vienna, Austria
BACKGROUND
Preoperative treatment is a generally accepted standard in patients with advanced, resectable esophageal cancer. However, there is an ongoing discussion concerning the benefit of preoperative treatment in the small subgroup of patients clinically staged T2, including a significant lack of staging accuracy in these patients. The aim of this study was to assess the impact of preoperative chemotherapy on the recurrence-free interval (RFI) and overall survival (OS) in patients with clinical stage T2 esophageal carcinoma.
METHODS
A prospectively collected database was analyzed to identify patients resected for cT2 esophageal cancer with (NCT) or without (S) preoperative chemotherapy. Clinical staging accuracy of computer tomography, endosonography and/or 18-FDG-positron emission computed tomography was analyzed. The Kaplan-Meier method and a Cox proportional-hazards model were used to estimate survival and treatment effects.
RESULTS
In total, 87 patients (40% squamous cell carcinoma and 60% adenocarcinomas, respectively) clinically staged T2 were included into this analysis. Forty-four (51%) of patients had been treated with NCT and 43 (49%) with surgery only.
RFI was significantly improved in patients with immediate surgical resection compared to those that had received preoperative chemotherapy (5-year cumulative recurrence rate 54% versus 29%, HR 1.95; 95% CI 1.03-3.682, log rank 0.037). Overall survival of cT2 patients did not differ between the two groups (log rank 0.374). Subgroup analysis found S superior to NCT solely in pN0 patients (log rank 0.008, HR 4.85; 95% CI 1.35-17.46), but not in patients with pN+ (log rank 0.964).
Overall 42% were found to be understaged (UICC 7th edition) which was not correlated to neoadjuvant treatment (43.2 % vs. 40.5%) or staging modality.
CONCLUSIONS
Compared to preoperative chemotherapy followed by surgical resection, immediate surgery appears to improve recurrence free interval in patients with cT2 esophageal cancer without lymphnode metastasis at pathological analysis (pN0).
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