Association Between Clinically Staged Node-Negative XXXX and Overall Survival Benefit From Neoadjuvant Chemoradiation.

@entity1 @entity5 @entity420 @entity418
Importance: While neoadjuvant chemoradiation for @entity418 improves oncologic outcomes for a broad group of @entity1 with locally advanced and/or node-positive @entity5 , it is less clear which specific subset of @entity1 derives most benefit in terms of overall survival (OS). Objective: To determine whether neoadjuvant chemoradiation based on @entity420 histology has similar oncologic outcomes for @entity1 treated with surgery alone when stratified by clinical nodal status. Design, Setting, and @entity1 : A retrospective analysis using the American College of Surgeons National @entity5 Database from 1998 to 2006. @entity1 with @entity420 histology and clinical stage T1bN1-N3 or T2-T4aN-/+M0 were divided into 2 treatment groups: (1) neoadjuvant chemoradiation followed by surgery and (2) surgery alone. Subset analysis within each treatment group was performed for clinically node-negative @entity1 (cN-) vs node-positive @entity1 (cN+) in conjunction with pathological nodal status. A propensity score-adjusted analysis, which included @entity1 demographics, comorbidity status, and clinical T stage, was also performed. Main Outcome and Measures: The primary outcome was 3-year OS. Secondary outcomes included margin status, postoperative length of stay, unplanned readmission rate, and 30-day mortality. Results: A total of 1309 @entity1 were identified, of whom 539 received neoadjuvant chemoradiation followed by surgery and 770 received surgery alone. Of the 1309 @entity1 , 41.2% (n   =   539) received neoadjuvant chemoradiation and 47.2% (n   =   618) were cN+. Median follow-up for the entire cohort was 73.3 months (interquartile range, 64.1-93.5 months). The 3-year OS was better for neoadjuvant chemoradiation followed by surgery compared with surgery alone (49% vs 38%, respectively; P   <   .001). Stratifying based on clinical nodal status, the propensity score-adjusted OS was significantly better for cN+ @entity1 who received neoadjuvant chemoradiation (hazard ratio, 0.52; 95% CI, 0.42-0.66; P   <   .001). In contrast, there was no difference in OS for cN- @entity1 based on treatment (hazard ratio, 0.84; 95% CI, 0.65-1.10; P   =   .22). Conclusions and Relevance: @entity1 with cN+ @entity420 benefit significantly from neoadjuvant chemoradiation. However, @entity1 with @entity5 treated with neoadjuvant chemoradiation plus surgery do not derive a significant OS benefit compared with surgery alone. This finding may have significant implications on the use of neoadjuvant chemoradiation in @entity1 with cN- disease.
