Factors influencing survival outcome in carcinoma esophagus -patients treated with neoadjuvant chemoradiation followed by esophagectomy - 10 year analysis

Prof.S.Subbiah; Prof.G.Gopu; Dr.P.Muniasamy

Volume : VII, Issue : IV, April - 2018

Factors influencing survival outcome in carcinoma esophagus -patients treated with neoadjuvant chemoradiation followed by esophagectomy - 10 year analysis

Prof. S. Subbiah, Prof. G. Gopu, Dr. P. Muniasamy

Abstract :

To assess tumor response to neoadjuvantchemoradiotherapy in oesophageal carcinoma and to determine whether pathological assessment of tumor regression correlates with overall survival. Total of 65 patients with non metastatic, lower & mid thoracic oesophageal cancer and OG junction cancers (T2, T3/ N0, N1) that were treated with neoadjuvantchemoradiotherapy followed by esophagectomy were included in this study. Patients characteristics age, gender, histological type, grade, Clinical response, method of surgery ,margin status, pathological response of primary tumor and lymph nodes were analyzed . Survival outcome were analysed using SPSS version 17.0.Total number of patients were 65 with mean age of 50.8�10 years. Median follow–up period was 40 months. 21 (35%) patients were less than 50 years. 41(63%) patients were male. Lower and OG junction tumours were 46(70%) patients. Squamous cell carcinoma–50(77%), low grade 38(58%). Complete clinical response noted in 21(32%) patients. Pathological complete response noted in 18(27.7%) patients. Overall survival were 96%,75%,71% & 32% for 1 ,2 ,3 and 5 years respectively. Univariate analysis showed that younger age, low grade tumour and no pathological residue in resected specimen were correlating with good survival outcome. Cox regression multivariate analysis showedthat post treatment pathologic stage was better predictor of survival outcome (HR–37.6 ; 95%C.I 4.22–334.8%) p<0.001 even though age (HR – 3.35; 95%C.I 1.59–7.00)p=0.001 and grade (HR–1.87; 95%CI 0.96–3.65)p=0.065 had statistically significant p value. Conclusion:Most of the patients had residual cancer post neoadjuvantchemoradiotherapy hence esophagectomy is warranted to improve overall survival. Survival outcome depends on pathological residual status.