M. Di Corpo1, F. Schlottmann1, P. D. Strassle2, C. Gaber2, M. G. Patti1,2 1University Of North Carolina At Chapel Hill,Department Of Surgery,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Department Of Medicine,Chapel Hill, NC, USA
Introduction: The rise in incidence of esophageal adenocarcinoma in the United States over the last decade has been well documented; however, data on trends in use of different therapies and their impact on long-term survival are lacking. We aimed to: a) assess the national trends in the use of different treatment modalities; and b) compare survival outcomes among the different treatment strategies.
Methods: A retrospective, population-based analysis was performed using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program registry for the period 2004-2014. Adult patients (>18 years old) diagnosed with esophageal adenocarcinoma were eligible for inclusion. Treatments of interest included chemoradiation, esophagectomy, and chemoradiation plus esophagectomy. The yearly incidence of each treatment strategy was calculated using Poisson regression. A weighted Cox regression model was used to assess the overall effect of each treatment on mortality. Inverse-probability of treatment weights were used to account for potential confounding by year of diagnosis, sex, age, race/ethnicity, tumor grade, and derived AJCC TNM value.
Results: A total of 10,755 patients were included. The median follow-up time was 15 months (interquartile range 7 – 33). During the study period, the percentage of esophagectomy alone significantly decreased from 14.6% to 4.8% (p<0.0001), the percentage of chemoradiation alone significantly decreased from 25.45% to 28.5% (p=0.08), and the percentage of chemoradiation plus esophagectomy significantly increased from 13.7% to 19.8% (p<0.0001). The 60-month survival rate was 13.0% for chemoradiation only, 33.0% for esophagectomy only, and 36.3% for chemoradiation plus esophagectomy (figure). After accounting for patient and cancer characteristics, both esophagectomy (hazard ratio [HR] 0.62, 95% CI 0.55, 0.70, p<0.0001) and chemoradiation plus esophagectomy (HR 0.45, 95% CI 0.41, 0.48, p<0.0001) had significantly lower rates of mortality compared to chemoradiation only.
Conclusion: The use of esophagectomy alone has decreased, and both the use of chemoradiation plus esophagectomy and chemoradiation alone have increased for patients with esophageal adenocarcinoma. Considering the better survival outcomes achieved with surgical resection, the use of chemoradiation alone should be discouraged in surgically fit patients.
