title: Induction therapy does not improve survival for clinical stage T2N0 esophageal cancer.
abstract: BACKGROUND
  This study compared survival after initial treatment with esophagectomy as primary therapy to induction therapy followed by esophagectomy for patients with clinical T2N0 (cT2N0) esophageal cancer in the National Cancer Database (NCDB).
  
  
  METHODS
  Predictors of therapy selection for patients with cT2N0 esophageal cancer in the NCDB from 1998 to 2011 were identified with multivariable logistic regression. Survival was evaluated using Kaplan-Meier and Cox proportional hazards methods.
  
  
  RESULTS
  Surgery was used in 42.9% (2057 of 4799) of cT2N0 patients. Of 1599 esophagectomy patients for whom treatment timing was recorded, induction therapy was used in 44.1% (688). Pretreatment staging was proven accurate in only 26.7% of patients (210 of 786) who underwent initial surgery without induction treatment and had complete pathologic data available: 41.6% (n = 327) were upstaged and 31.7% (n = 249) were downstaged. Adjuvant therapy (chemotherapy or radiation therapy) was given to 50.2% of patients treated initially with surgery who were found after resection to have nodal disease. There was no significant difference in long-term survival between strategies of primary surgery and induction therapy followed by surgery (median 41.1 versus 41.9 months, p = 0.51). In multivariable analysis, induction therapy was not independently associated with risk of death (hazard ratio [HR], 1.16, p = 0.32).
  
  
  CONCLUSIONS
  Current clinical staging for early-stage esophageal cancer is highly inaccurate, with only a quarter of surgically resected cT2N0 patients found to have had accurate pretreatment staging. Induction therapy for patients with cT2N0 esophageal cancer in the NCDB is not associated with improved survival.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Speicher
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Hartwig
authors.forename: Mark W
authors.initials: MW
authors.lastname: Onaitis
authors.forename: Thomas A
authors.initials: TA
authors.lastname: D'Amico
authors.forename: Mark F
authors.initials: MF
authors.lastname: Berry
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000473:pathology* / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate