• Marisa Sewell, Nicolas Toumbacaris, Kay See Tan, Nadia Bahadur, John Philip, Neil J Shah, Andrew Niederhausern, Tavarez MartinezCarlosCClinical & Translational Research Informatics, Memorial Sloan Kettering Cancer Center, New York, NY., Haiyu Zheng, Thomas Boerner, Yelena Y Janjigian, Steve B Maron, Matthew J Bott, Katherine D Gray, Bernard J Park, Smita Sihag, David R Jones, Geoffrey Y Ku, Abraham J Wu, and Daniela Molena.
• Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 22.

ObjectiveWe sought to determine whether aggressive local treatment provides a benefit in patients with stage IV esophageal adenocarcinoma and to determine factors associated with survival.MethodsPatients with clinical stage IV esophageal adenocarcinoma at diagnosis who underwent esophagectomy from 2010 to 2023 were identified from our prospectively maintained database. Clinicopathologic and demographic characteristics were compared among patients by stage. Overall survival was estimated using the Kaplan-Meier approach.ResultsIn total, 66 patients met the inclusion criteria. Of these, 30 (45%) had stage IVA disease, and 36 (55%) had stage IVB disease. Of the 36 patients with stage IVB disease, 26 had oligometastatic disease, and 10 had disseminated disease. All patients with stage IVA disease received standard neoadjuvant therapy followed by curative-intent surgery; 26 of these patients (87%) received chemoradiation. Patients with oligometastatic stage IVB disease underwent systemic therapy with the goal of surgical resection. Patients with disseminated stage IVB disease underwent palliative chemotherapy, which led to improvement in disease burden and performance of esophagectomy. Median time from the start of therapy to surgery was shorter for patients with stage IVA disease than patients with stage IVB disease (P < .001). Three-year progression-free survival was lower for patients with stage IVA disease (40% vs 56%), as was 3-year overall survival (57% vs 85%). Adjusted overall survival, from the start of therapy to most recent follow-up, was higher for patients with stage IVB disease.ConclusionsAggressive local treatment may provide a benefit for highly selected patients with advanced or metastatic esophageal adenocarcinoma.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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