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Adjuvant Therapy for Positive Nodes After Induction Therapy and Resection of Esophageal Cancer
The goal of this study was to detemine whether adjuvant chemotherapy leads to a survival benefit in patients with positive LNs who have undergone induction chemoradiation therapy followed by esophagectomy. This is a retrospective study of 764 patients undergoing esophagectomy at a single institution from 2000-2013. There were 212 patients with postive LNs on the final pathology report and 101 of these had undergone induction chemoradiation therapy. Of those 101, 45 received adjuvant chemotherapy and 56 did not. There was no difference in two-year freedom from recurrence between the two groups, but patients who did not receive adjuvant had earlier recurrence (6.2 versus 9.4 months). For those who received adjuvant therapy, 5-year survival was significantly longer at 41% (versus 25%). When patients who died within the first 90 days were excluded (1 in the adjuvant group and 5 in the no adjuvant group) the 5-year survival was 42% (adjuvant group) versus 27% (no adjuvant group), but was no longer statistically significant. The authors stated that the survival difference between the two groups may be partially due to sicker patients in the no adjuvant group. The 5-year survival for patients with <=3 (+) LNs was 37% versus 17% for those with >=4 (+) LNs. Independent predictors of survival were age, total number of (+) LNs resected, and pathologic T stage.