title: Geographic distribution of regional metastatic nodes affects the outcome of trimodality-eligible patients with esophageal adenocarcinoma.
abstract: OBJECTIVE
  Malignant nodes in patients with localized esophageal adenocarcinoma (L-EAC) portend a poor prognosis. We assessed the correlation of the distribution of nodes with the outcome of patients undergoing chemoradiation/surgery (trimodality therapy).
  
  
  METHODS
  We studied 209 L-EAC patients who had confirmed or suspicious nodes at baseline staging. All patients received trimodality therapy and were grouped according to the nodal geography: above the diaphragm (AD), below the diaphragm (BD), or above and below the diaphragm (ABD). Survival estimates were calculated using the Kaplan-Meier method, and the outcomes of the groups were assessed by the log-rank test.
  
  
  RESULTS
  Patients were primarily Caucasian (91%) and male (93%), with a baseline stage III L-EAC (89%). The median follow-up was 2.8 years (range, 0.4-11.7). Of the 209 patients, 35% (n = 73) had AD nodes, 20% (n = 41) had BD nodes, and 45% (n = 95) had ABD nodes. ABD patients had a 5-year overall survival rate of 33%, whereas this rate was 55% in AD patients and 60% in BD patients (p = 0.02). Patients with a higher histology grade were also at a higher risk of relapse and had a poor survival (p < 0.01 for both).
  
  
  CONCLUSIONS
  L-EAC patients in the ABD group had the worst outcome after trimodality treatment compared to those in the AD or BD group. Novel strategies are needed for ABD patients.
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Tex., USA.
authors.forename: Hironori
authors.initials: H
authors.lastname: Shiozaki
authors.forename: Rebecca
authors.initials: R
authors.lastname: Slack
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sudo
authors.forename: Elena
authors.initials: E
authors.lastname: Elimova
authors.forename: Roopma
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Hsian-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Heath D
authors.initials: HD
authors.lastname: Skinner
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Brian
authors.initials: B
authors.lastname: Weston
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.forename: Jane E
authors.initials: JE
authors.lastname: Rogers
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis