Clinical T2N0 Esophageal Cancer: Identifying Pretreatment Characteristics Associated With Pathologic Upstaging and the Potential Role for Induction Therapy

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Clinical T2N0 Esophageal Cancer: Identifying Pretreatment Characteristics Associated With Pathologic Upstaging and the Potential Role for Induction Therapy Pamela Samson, MD, MPHS, Varun Puri, MD, MSCI, Clifford Robinson, MD, Craig Lockhart, MD, Danielle Carpenter, MD, Stephen Broderick, MD, Daniel Kreisel, MD, PhD, A. Sasha Krupnick, MD, G. Alexander Patterson, MD, Bryan Meyers, MD, MPH, Traves Crabtree, MD The Annals of Thoracic Surgery Volume 101, Issue 6, Pages 2102-2111 (June 2016) DOI: 10.1016/j.athoracsur.2016.01.033 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 A CONSORT (consolidated standards of reporting trials) diagram for cT2N0 esophageal cancer patients receiving esophagectomies from 2006-2012 as recorded in the National Cancer Data Base (NCDB). The Annals of Thoracic Surgery 2016 101, 2102-2111DOI: (10.1016/j.athoracsur.2016.01.033) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Receiver-operating characteristics curve for predicting likelihood of pathologic upstaging in cT2N0 esophageal cancer patients receiving upfront esophagectomy. Input variables included tumor grade and presence or absence of lymphovascular invasion (blue line = ROC, green line = reference line indicating no difference). (AUC = area under the curve; CI = confidence interval.) The Annals of Thoracic Surgery 2016 101, 2102-2111DOI: (10.1016/j.athoracsur.2016.01.033) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier survival curve comparing overall survival among cT2N0 esophageal cancer patients who received upfront esophagectomy and were pathologically upstaged, versus induction therapy followed by esophagectomy patients, with any resultant pathologic stage. (Treatment and pathology status: blue line = induction therapy, any pathologic status; green line = surgery first, with upstaged pathology; blue hatch marks = induction therapy, any pathologic stage, censored; green hatch marks = surgery first, with upstaged pathology, censored.) The Annals of Thoracic Surgery 2016 101, 2102-2111DOI: (10.1016/j.athoracsur.2016.01.033) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier curve comparing overall survival among cT2N0 esophageal cancer patients who were pathologically upstaged after upfront esophagectomy but did not receive adjuvant chemotherapy, versus induction therapy patients with any resultant pathologic stage after esophagectomy. In this series, 182 of 326 (55.8%) pathologically upstaged upfront esophagectomy patients did not receive adjuvant chemotherapy. (Treatment and pathologic stage: blue line = induction, any pathologic stage; green line = upfront esophagectomy, no adjuvant chemotherapy; blue hatch marks = induction, any pathologic stage, censored; green hatch marks = upfront esophagectomy, no adjuvant chemotherapy, censored.) The Annals of Thoracic Surgery 2016 101, 2102-2111DOI: (10.1016/j.athoracsur.2016.01.033) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions