Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma

Jeffrey G. Gaca, Rebecca P. Petersen, Bercedis L. Peterson, David H. Harpole, Thomas A. D'Amico, Theodore N. Pappas, Hilliard F. Seigler, Walter G. Wolfe, Douglas S. Tyler

Research output: Contribution to journalArticle

40 Scopus citations

Abstract

Background: The incidence of carcinoma of the gastroesophageal junction (GEJ) is rapidly increasing, and the prognosis remains poor. We examined outcomes in patients who received neoadjuvant chemoradiation for GEJ tumors to identify factors that predict disease-free (DFS) and overall (OS) survival. Methods: A retrospective analysis was performed of 101 consecutive patients who received chemoradiation and surgery for GEJ carcinoma between 1992 and 2001. Results: The median DFS and OS of all patients were 16 and 25 months, respectively. Twenty-eight patients with a complete histological response (T0N0) experienced greater DFS compared with all others (P = .02). Node-negative patients, regardless of T stage, experienced improved median DFS (24 months) compared with N1 patients (9 months; P = .01). Preoperative stage, age, tumor location, or Barrett's esophagus did not independently predict OS by univariate analysis. Multivariate analysis demonstrated that only posttreatment nodal status (P = .03) - not the degree of primary tumor response - predicted DFS. Conclusions: The nodal status of patients with GEJ tumors after neoadjuvant therapy is predictive of DFS after resection. The poor outcome in node-positive patients supports postneoadjuvant therapy nodal staging, because surgical aggressiveness should be tempered by the realization that cure is unlikely and median survival is short.

Original languageEnglish (US)
Pages (from-to)340-346
Number of pages7
JournalAnnals of surgical oncology
Volume13
Issue number3
DOIs
StatePublished - Mar 1 2006
Externally publishedYes

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Keywords

  • Carcinoma
  • Chemotherapy
  • Gastroesophageal junction
  • Radiation

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Gaca, J. G., Petersen, R. P., Peterson, B. L., Harpole, D. H., D'Amico, T. A., Pappas, T. N., Seigler, H. F., Wolfe, W. G., & Tyler, D. S. (2006). Pathologic nodal status predicts disease-free survival after neoadjuvant chemoradiation for gastroesophageal junction carcinoma. Annals of surgical oncology, 13(3), 340-346. https://doi.org/10.1245/ASO.2006.02.023