title: Predictors of survival in patients with persistent nodal metastases after preoperative chemotherapy for esophageal cancer.
abstract: OBJECTIVE
  In patients with esophageal cancer, a complete pathologic response after preoperative therapy is universally regarded as a favorable prognostic factor. However, less is known about factors predictive of outcome in patients with persistent nodal disease. The purpose of this study is to determine which variables affect survival in this patient population.
  
  
  METHODS
  We reviewed a prospectively maintained esophageal cancer database. Patients with positive lymph nodes after preoperative therapy and surgery were selected. Predictors of survival were examined univariately using the log-rank test. Factors identified at P < .20 by univariate analysis were selected for inclusion in a multivariate model.
  
  
  RESULTS
  Ninety-six patients with 1 or more positive nodes received preoperative therapy. Pathologic T classification was 0 to 2 in 25 (26%) patients and 3 to 4 in 71 (74%) patients. In 29 (30%) patients, nonregional nodal disease was present (M1). Final pathologic stages were IIB in 18 (19%), III in 49 (51%), and IV in 29 (30%). Postoperatively, 44 (46%) patients received additional chemotherapy. On univariate analysis, pathologic stage, pathologic T classification, and number of positive nodes significantly affected overall survival. On multivariate analysis, clinical stage (hazard ratio [HR], 2.25; P = .05), pathologic T classification (HR, 3.06; P = .006), and number of positive nodes (HR 1.03 per node, P = .09) were significant predictors of overall survival.
  
  
  CONCLUSIONS
  Long-term survival can be achieved in patients with esophageal cancer who have persistent nodal disease after neoadjuvant therapy and surgical resection. Clinical stage, pathologic T classification, and number of positive nodes best predict survival. Nonregional nodal disease does not adversely affect outcome. Postoperative chemotherapy conferred no additional survival benefit in this patient population.
authors.affiliation: Division of Thoracic Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10021, USA.
authors.forename: Brendon M
authors.initials: BM
authors.lastname: Stiles
authors.forename: Paul
authors.initials: P
authors.lastname: Christos
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Port
authors.forename: Paul C
authors.initials: PC
authors.lastname: Lee
authors.forename: Subroto
authors.initials: S
authors.lastname: Paul
authors.forename: James
authors.initials: J
authors.lastname: Saunders
authors.forename: Nasser K
authors.initials: NK
authors.lastname: Altorki
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult