title: Improved long-term survival after esophagectomy for esophageal cancer: influence of epidemiologic shift and neoadjuvant therapy.
abstract: BACKGROUND
  The study was done to determine long-term outcomes of surgically treated esophageal cancer and to identify trends in epidemiology, oncological therapy, and oncological prognosis over the last two decades.
  
  
  METHODS
  Overall survival in 304 patients undergoing esophagectomy was analyzed. Fifty-three percent had squamous cell carcinoma and 46 % had adenocarcinoma (AC). A total of 161 patients received neoadjuvant chemoradiation, 38 received neoadjuvant chemotherapy, and 105 were treated with surgery alone.
  
  
  RESULTS
  Median survival (MS) increased significantly from 18.0 months (1988-1994) to 26.6 months (1995-2001) and to 59.3 months (2002-2011; p < 0.001). The proportion of AC (22 vs 35 vs 65 %; p < 0.001) and the proportion of patients treated with neoadjuvant therapy (neoT; 15.9 vs 85.3 vs 77.8 %; p < 0.001) increased during the treatment period. After neoT, a beneficial outcome with a MS of 45.6 vs. 20.4 months (p = 0.003) was found. Lymph node ratio [LNR; relative risk (RR), 5.4; p < 0.001], response to neoT (RR, 1.6; p < 0.004), and histological subtype (RR, 1.7; p < 0.003) were identified as independent parameters of survival.
  
  
  CONCLUSIONS
  Since 1988, the outcome of surgically resected esophageal cancer strongly improved. Besides tumorbiological factors like histological type and LNR, the outcome is also affected by the increasing use of neoT towards favorable survival rates.
authors: Department of Surgery, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
authors: Frank
authors: F
authors: Makowiec
authors: Peter
authors: P
authors: Baier
authors: Birte
authors: B
authors: Kulemann
authors: Goran
authors: G
authors: Marjanovic
authors: Peter
authors: P
authors: Bronsert
authors: Katja
authors: K
authors: Zirlik
authors: Michael
authors: M
authors: Henke
authors: Ulrich Theodor
authors: UT
authors: Hopt
authors: Jens
authors: J
authors: Hoeppner
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
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