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A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma.
Zahoor, Haris; Luketich, James D; Levy, Ryan M; Awais, Omar; Winger, Daniel G; Gibson, Michael K; Nason, Katie S.
Afiliação
  • Zahoor H; Department of Medicine, University of Pittsburgh, Pittsburgh, Pa.
  • Luketich JD; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
  • Levy RM; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
  • Awais O; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa.
  • Winger DG; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pa.
  • Gibson MK; Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
  • Nason KS; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa. Electronic address: nasonks@upmc.edu.
J Thorac Cardiovasc Surg ; 149(2): 538-47, 2015 Feb.
Article em En | MEDLINE | ID: mdl-25454907
OBJECTIVES: Prognosis for patients with locally advanced esophagogastric adenocarcinoma (EAC) is poor with surgery alone, and adjuvant therapy after open esophagectomy is frequently not tolerated. After minimally invasive esophagectomy (MIE); however, earlier return to normal function may render patients better able to receive adjuvant therapy. We examined whether primary MIE followed by adjuvant chemotherapy influenced survival compared with propensity-matched patients treated with neoadjuvant therapy. METHODS: Patients with stage II or higher EAC treated with MIE (N = 375) were identified. Using 30 pretreatment covariates, propensity for assignment to either neoadjuvant followed by MIE (n = 183; 54%) or MIE as primary therapy (n = 156; 46%) was calculated, generating 97 closely matched pairs. Hazard ratios were adjusted for age, sex, body mass index, smoking, comorbidity, and final pathologic stage. RESULTS: In propensity-matched pairs, adjusted hazard ratio for death did not differ significantly for primary MIE compared with neoadjuvant (hazard ratio, 0.83; 95% confidence interval, 0.60-1.16). Recurrence patterns were similar between groups and 65% of patients with IIb or greater pathologic stage received adjuvant therapy. Clinical staging was inaccurate in 37 out of 105 patients (35%) who underwent primary MIE (n = 18 upstaged and n = 19 downstaged). CONCLUSIONS: Primary MIE followed by adjuvant chemotherapy guided by pathologic findings did not negatively influence survival and allowed for accurate staging compared with clinical staging. Our data suggest that primary MIE in patients with resectable EAC may be a reasonable approach, improving stage-based prognostication and potentially minimizing overtreatment in patients with early stage disease through accurate stage assignments. A randomized controlled trial testing this hypothesis is needed.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Neoplasias Esofágicas / Adenocarcinoma / Esofagectomia Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Thorac Cardiovasc Surg Ano de publicação: 2015 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Gástricas / Neoplasias Esofágicas / Adenocarcinoma / Esofagectomia Tipo de estudo: Clinical_trials / Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: J Thorac Cardiovasc Surg Ano de publicação: 2015 Tipo de documento: Article País de publicação: Estados Unidos