title: Endoscopic ultrasonography-identified celiac adenopathy remains a poor prognostic factor despite preoperative chemoradiotherapy in esophageal adenocarcinoma.
abstract: OBJECTIVE
  We reviewed our experience with preoperative chemoradiotherapy in patients with adenocarcinoma of the distal esophagus and pretreatment endoscopic ultrasonography-identified celiac adenopathy.
  
  
  METHODS
  One hundred eighty-six patients with adenocarcinoma of the distal esophagus were staged with endoscopic ultrasonography before treatment from 1997 through 2004. All patients were treated with concurrent chemoradiotherapy (CRT group) and surgical intervention or induction chemotherapy followed by concurrent chemoradiotherapy (C-->CRT group) and surgical intervention. Survival analysis (excluding operative mortality) evaluated various pretreatment factors.
  
  
  RESULTS
  Multivariable Cox regression analysis showed that pretreatment endoscopic ultrasonography-identified celiac adenopathy was a significant predictor of decreased long-term survival (P = .03). Median and 3-year survivals were 49 months and 54% in the endoscopic ultrasonography-identified cN0 M0 group (n = 65), 45 months and 56% in the endoscopic ultrasonography-identified cN1 M0 group (n = 96), and 19 months and 12% in the endoscopic ultrasonography-identified celiac adenopathy (cM1a) group (n = 18; P = .03). Increased systemic relapse was noted in the endoscopic ultrasonography-identified cM1a group (44% vs 22%, P = .07). The only factor associated with increased survival in the endoscopic ultrasonography-identified cM1a group (27 vs 15 months, P = .02) was the addition of induction chemotherapy before concurrent chemoradiotherapy and surgical intervention.
  
  
  CONCLUSIONS
  Endoscopic ultrasonography-identified celiac adenopathy in patients with adenocarcinoma of the distal esophagus conveys a poor prognosis despite preoperative chemoradiotherapy. These patients should be stratified in future multimodality trials. The investigation of induction chemotherapy before concurrent chemoradiotherapy might be warranted in this high-risk group of patients.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Tex 77030, USA.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Ritsuko R
authors.initials: RR
authors.lastname: Komaki
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
authors.forename: Alexandria
authors.initials: A
authors.lastname: Phan
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: Sandeep
authors.initials: S
authors.lastname: Lahoti
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Robert
authors.initials: R
authors.lastname: Bresalier
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
mesh_terms: D000005:Abdomen; D000230:Adenocarcinoma / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis