Abstract | BACKGROUND: METHODS: The 2004 to 2015 National Cancer Database was used to identify patients with cT1-4aN1-3M0 (stage II-IVA) esophageal adenocarcinoma who underwent esophagectomy. Patients were stratified by receipt of NCR. A multivariable logistic regression was performed to examine factors associated with NCR, and survival between the 2 groups was compared using a multivariable Cox model. RESULTS: Of 8076 patients meeting the study criteria, 1616 (20%) did not receive NCR and 6460 (80%) did. In a multivariable regression, factors associated with receipt of NCR were a later year of diagnosis, treatment in a high-volume center, and clinical stage III disease. Factors associated with nonreceipt of NCR were increasing age, comorbidities, and treatment in a Middle Atlantic, South Central, or Pacific state. Receipt of trimodality therapy was associated with improved survival compared with other or no perioperative therapies (adjusted hazard ratio, 0.80; 95% confidence interval, 0.74-0.87). CONCLUSIONS: Numerous personal-, demographic-, and treatment center-related factors account for variability in NCR for clinically node-positive esophageal adenocarcinoma, although neoadjuvant therapy was associated with a survival benefit. Further efforts are needed to identify reasons for these differences and design interventions to provide more equitable care for patients with esophageal cancer.
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Authors | Vignesh Raman, Oliver K Jawitz, Soraya L Voigt, Kristen E Rhodin, Anthony W Kim, Betty C Tong, Thomas A D'Amico, David H Harpole |
Journal | The Annals of thoracic surgery
(Ann Thorac Surg)
Vol. 110
Issue 6
Pg. 1832-1839
(12 2020)
ISSN: 1552-6259 [Electronic] Netherlands |
PMID | 32622794
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Copyright | Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Topics |
- Adenocarcinoma
(mortality, pathology, therapy)
- Aged
- Chemoradiotherapy
- Esophageal Neoplasms
(mortality, pathology, therapy)
- Esophagectomy
- Female
- Humans
- Logistic Models
- Male
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Staging
- Patient Selection
- Practice Patterns, Physicians'
- Proportional Hazards Models
- Retrospective Studies
- Survival Rate
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