Outcomes of neoadjvuant chemotherapy versus chemoradiation for esophageal adenocarcinoma: A National Cancer Database analysis.

416 Background: While neoadjuvant chemoradiation (NCRT) has been the acceptable standard of care for esophageal adenocarcinoma (EAC), there has been a paradigm shift from recent trials have shown that neoadjuvant chemotherapy (NAC) is either equivalent or superior to NCRT. We sought to examine the outcomes of NAC versus NCRT in esophageal cancer from the National Cancer Database (NCDB). Methods: Utilizing the NCDB, we identified esophagectomy patients with EAC who underwent multiagent NCT versus multiagent NCRT. Overall Survival (OS) was analyzed with the Kaplan-Meier method and multivariate analysis (MVA) was performed to identify predictors of OS. Propensity score matching (PSM) was used to correct for baseline differences between groups. Results: After PSM, we identified 1007 patients in each group. Groups were equally balanced in age, gender, T/N stage, grade, and facility volume. There was improved lymphadenectomy and higher use of adjuvant therapy in NCT patients. There were significant improvements in R0 resection and pathologic response associated with NCRT patients. There was a significant improvement in OS in NCT versus NCRT. The median and 5-year OS was 42.7 months and 42% in NCT patients versus 34.2 months and 35% in NCRT patients (p = 0.001). For pathologic complete responders, median and 5-year OS was 101 months and 64% in NCT patients versus 71.2 months and 53% in NCRT patients (p = 0.04). On MVA, improved mortality was associated with female gender, pathologic N0, >10 nodes removed, pathologic partial or complete response, R0, well/moderate grade, NCT, adjuvant chemotherapy, and higher facility volume. There was also no survival benefit to adjuvant chemoradiation. Conclusions: Despite higher R0 and pathologic response associated with NCRT, NCT was superior to NCRT for OS in EAC patients. NCRT needs to be re-examined in its role as a treatment recommendation for operable EAC patients. Multivariate analysis for overall survival. Variable HR 95% CI P value Age 1.01 1.00 – 1.02 0.004 SexMaleFemale Reference0.79 0.64 – 0.98 0.03 Charlson Deyo score01 Reference1.05 0.91 – 1.21 0.54 Pathologic N-stageN0N+ Reference1.82 1.58 – 2.10 <0.001 LN removed<10>10 Reference0.81 0.68 – 0.97 0.02 ResponseNonePartialComplete Reference0.810.61 0.69 – 0.940.50 – 0.75 0.008<0.001 Margin statusR0R1 Reference1.24 1.01 – 1.52 0.04 GradeWell/moderatePoor Reference1.35 1.18 – 1.54 <0.001 Preop radiationYesNo Reference0.77 0.67 – 0.88 <0.001 Adjuvant therapyNoneChemotherapyChemoradiation Reference0.770.83 0.65 – 0.920.64 – 1.08 0.0040.17 Facility volumeLow (≤10/year)Medium (11-19/year)High (≥20/year) Reference0.860.78 0.72 – 1.030.67 – 0.90 0.10<0.001