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20. EUS-Identified Celiac Adenopathy Remains A Poor Prognostic Factor Despite Preoperative Chemoradiotherapy In Patients With Adenocarcinoma Of The Distal Esophagus
Sukit C Malaisrie, Arlene M Correa, Jaffer A Ajani, Ritsuko R Komaki, Wayne L Hofstetter, David C Rice, Ara A Vaporciyan, Garrett L Walsh, Sandeep Lahoti, Jeffrey H Lee, Bresalier Robert, Jack A Roth, Stephen G Swisher; Houston, TX

Objective: Endoscopic ultrasound (EUS) identified celiac adenopathy ( >1cm, round, hypoechoic, sharp borders) has been associated with poor survival in esophageal cancer patients treated with surgery alone. We evaluated our experience with preoperative chemoradiotherapy (CRT) in patients with adenocarcinoma of the distal esophagus and EUS-identified celiac adenopathy at initial presentation.

Methods: One hundred and eighty seven patients with adenocarcinoma of the distal esophagus were staged with EUS prior to treatment from 1997 to 2004. All patients were treated with concurrent CRT and resection or chemotherapy followed by concurrent CRT and resection. Survival analysis (excluding operative mortality) evaluated multiple pretreatment factors including gender, age, grade, Barrett's mucosa, ASA class, EUS-defined tumor size, depth of invasion, lymph node involvement, size and location.

Results: Multivariable Cox regression analysis showed that EUS-identified celiac adenopathy, cM1a (p=0.04) and depth of tumor invasion, cT (p<0.05) and ASA class (p<0.05) were the only pretreatment factors predictive of survival following CRT and surgery. Median and 3-yr survival were 49 months and 54% in the EUS-identified cN0M0 group (n=96), 45 months and 56% in the EUS-identified cN1M0 group (n=65), and 19 months and 12% in the EUS-identified cM1a group (n=18), (p=0.03). A trend towards increased systemic relapse was noted in the EUS-identified cM1a group (44% vs 22%, p=0.08). The only factor associated with increased survival in the EUS identified-cM1A group (27 vs 15 months, p=0.02) was the addition of induction chemotherapy prior to concurrent CRT and resection.

Conclusions: EUS-identified celiac adenopathy in adenocarcinoma of the distal esophagus remains a poor prognostic factor despite preoperative chemoradiotherapy. These patients should be stratified in future multimodality trials. The investigation of additional induction chemotherapy prior to concurrent chemoradiation may be warranted in this high risk group of patients.

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