000			02742 am a22002653u 4500
042			_adc
100	1	0	_aRucker, A. Justin _eauthor _9898
700	1	0	_aRaman, Vignesh _eauthor _9899
700	1	0	_aJawitz, Oliver K. _eauthor _9900
700	1	0	_aVoigt, Soraya L. _eauthor _9901
700	1	0	_aHarpole, David H. _eauthor _9902
700	1	0	_aD'Amico, Thomas A. _eauthor _9903
700	1	0	_aTong, Betty C. _eauthor _9904
245	0	0	_aThe Impact of Adjuvant Therapy on Survival Following Esophagectomy for Node-negative Esophageal Adenocarcinoma
260			_c2022-02-01.
500			_a/pmc/articles/PMC7502525/
500			_a/pubmed/32209899
520			_aOBJECTIVE: Determine whether adjuvant chemotherapy is associated with a survival benefit in high risk T2-4a, pathologically node-negative distal esophageal adenocarcinoma. SUMMARY BACKGROUND DATA: There is minimal literature to substantiate the National Comprehensive Cancer Network (NCCN) guidelines recommending adjuvant therapy for patients with distal esophageal adenocarcinoma and no pathologic evidence of nodal disease. METHODS: The National Cancer Database was used to identify adult patients with pT2-4aN0M0 esophageal adenocarcinoma who underwent definitive surgery (2004-2015) and had characteristics considered high risk by the NCCN. Patients were stratified by receipt of adjuvant chemotherapy with or without radiation. The primary outcome was overall survival, which was evaluated using Kaplan-Meier and multivariable Cox Proportional Hazards models. A 1:1 propensity score-matched analysis was also performed to compare survival between the groups. RESULTS: 403 patients met study criteria: 313 (78%) without adjuvant therapy and 90 who received adjuvant chemotherapy with or without radiation (22%). In both unadjusted and multivariable analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit compared to no adjuvant therapy. In a subgroup analysis of 335 patients without high risk features by NCCN criteria, adjuvant chemotherapy was not independently associated with a survival benefit. CONCLUSION: In this analysis, adjuvant chemotherapy with or without radiation was not associated with a significant survival benefit in completely resected, pathologically node-negative distal esophageal adenocarcinoma, independent of presence of high risk characteristics. The risks and benefits of adjuvant therapy should be weighed before offering it to patients with completely resected pT2-4aN0M0 esophageal adenocarcinoma.
540			_a
546			_aen
690			_aArticle
655	7		_aText _2local
786	0		_nAnn Surg
856	4	1	_uhttp://dx.doi.org/10.1097/SLA.0000000000003886 _zConnect to this object online.
999			_c1695 _d1695