Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS46. Predictive Factors for Survival in Esophageal Cancer Patients withPersistent Lymph Node Metastases Following NeoadjuvantTherapy and SurgeryBrendon M. Stiles, 1 Subroto Paul, 1† Jeffrey L. Port, 1 Paul C. Lee, 1 Paul Christos, 2Nasser K. Altorki 1*1. Division of Thoracic Surgery, New York Presbyterian Hospital, Weill CornellMedical College, New York, NY, USA; 2. Department of Biostatistics andEpidemiology, New York Presbyterian Hospital, Weill Cornell Medical College,New York, NY, USAInvited Discussant: Jeffrey HagenOBJECTIVE: In esophageal cancer (EC) patients, a complete pathologic responsefollowing neoadjuvant therapy is associated with a favorable survival. Less is knownregarding factors predictive of outcome in patients with persistent nodal diseaseafter induction therapy. The purpose of this study is to determine which variablesaffect survival in this patient population.METHODS: We reviewed a prospectively maintained EC database (1989–2008).Patients with positive lymph nodes after preoperative therapy were selected byreview of surgical pathology. Demographic, surgical, and staging data were reviewed.Overall survival (OS) was determined by the Kaplan Meier method. Predictorsof survival were examined univariately using the log-rank test. Factors identified atp < 0.20 by univariate analysis were selected for inclusion in a multivariate cox proportionalhazards regression model.RESULTS: Ninety-six patients (median age 62 yrs; 85% male; 73% adenoCA)with 1 or more positive nodes received preoperative chemotherapy, including 9 whoalso had induction radiation. pT-stage was 0–2 in 25 (26%) and 3 or 4 in 71 (74%)patients. In 28 (30%) patients, nonregional nodal disease was present (M1a). Finalpathologic stages were: IIB in 18 (19%); III in 49 (51%); and IVA in 29 (30%). Postoperatively,44 (46%) patients received additional chemotherapy. OS was 46% at2 years and 30% at 5 years. On univariate analysis, pathologic stage, pathologicT status, and number of positive nodes (range 1–31, median 4) significantlyimpacted OS (Table 1). Patient age, gender, histology, and total lymph nodesresected had no effect on OS. On multivariate analysis, clinical stage (HR 2.43, p = .028),pathologic T status (HR 3.42, p = 0.004) and number of positive nodes (HR 1.047per node, p = 0.029) were significant predictors of OS.CONCLUSION: Long term survival can be achieved in a meaningful proportionof EC patients with persistent nodal disease after neoadjuvant therapy and surgicalresection. Pathological T stage and number of positive nodes resected best predictsurvival. Nonregional nodal disease does not adversely affect outcome. Postoperativechemotherapy appears to confer no additional survival benefit.* AATS Member† Resident Traveling Fellowship 2006180