The role of surgery and postoperative chemoradiation therapy in patients with lymph node positive esophageal carcinoma

BACKGROUND. Patients who have undergone resection for lymph node positive e sophageal carcinoma are at high risk of disease recurrence and early death. The role of postoperative adjuvant therapy in this population needs to be determined. METHODS. A retrospective review of all patients with resected esophageal ca rcinoma between 1991 and 1997 was performed. Lymph node positive (N1) patie nts who received concurrent or sequential postoperative radiotherapy (50 gr ays) and chemotherapy (cisplatin, 5-fluorouracil with or without epirubicin ) were compared with N1 patients who underwent surgery alone. The disease f ree and overall survival rates were calculated using the Kaplan-Meier metho d, and groups were compared with the log-rank test. Prognostic variables we re entered into a Cox regression model controlling for age, weight loss, T status, Eastern Cooperative Oncology Group (ECOG) score, and treatment rece ived. RESULTS. A total of 165 patients were reviewed: Twenty-eight N1 patients un derwent surgery alone (S group), and 38 N1 patients underwent surgery and r eceived postoperative chemoradiation therapy (CRT group). Preoperative risk factors, tumor characteristics, ECOG scores, and lengths of hospital stay were similar. The disease free survival rates were similar (S group, 10.6 m onths; CRT group, 10.2 months), although the S group had more local disease recurrences (S group, 35%; CRT group, 13%; P = 0.09). The overall survival rate according to the Kapian-Meier analysis showed a significant survival advantage with postoperative CRT radiation (log-rank test; P = 0.001). The median overall survival for the CRT group was 47.5 months, which was signif icantly longer than that of the S group (14.1 months). The ECOG score, T st atus, and treatment received all were found to influence survival significa ntly on univariate analysis. In the multivariate model, postoperative CRT w as a predictor of survival (P = 0.007; risk ratio for mortality, 0.35; 95% confidence interval, 0.16-0.76) and was correlated with a significantly dec reased risk of death in patients with lymph node positive, resected esophag eal carcinoma. CONCLUSIONS. Postoperative CRT appears to prolong survival in patients with lymph node positive, resected esophageal carcinoma. (C) 2001 American Canc er Society.