05. Results Patient and tumor characteristics We analyzed 106 patients with esophageal cancer that underwent NAC followed by esophagectomy from September 1996 to May 2011. Patient characteristics as well as tumor histology and staging are presented in Table 1. The vast majority of patients in this study were male (n=88, 83%) and the median age was 61 (range, 31-86) years at Inhibitors,research,lifescience,medical the time of diagnosis. The predominant histology was adenocarcinoma (n=92, 87%) while 13% were squamous cell carcinoma (n=14). Prior to treatment, nearly two-thirds of patients presented with stage III disease (n=66, 62%), with stage IIIA being the

most frequent presenting stage (n=51, 48%), while one-third had stage II (n=33, 31%) and 7% had stage I (n=7) disease. Median follow up was 6.7 (range, 2.6-17.5) years. Table 1 Patient characteristics, histology, and staging Pathologic response

and post-operative staging Following NAC Inhibitors,research,lifescience,medical and esophagectomy, a pCR with no evidence of disease histologically was achieved in 31 patients (29%) of the cohort. Moreover, the majority of patients had an R0 resection with negative margins microscopically (n=98, 92.5%). Grossly, 14 patients (13.2%) had an R1 resection with confirmed positive margins in 8 patients (7.5%). Expectedly, post-operative pathologic staging determined that 62 patients (59%) were downstaged following NAC while 9 patients (8%) were upstaged and 34 patients Inhibitors,research,lifescience,medical (32%) remained at the same stage (Table 1). Survival analysis The median OS was 31.2 months (range, 2 months -17 years) for all patients in this cohort (Figure 1). When analyzed by histologic subtype, there was a trend toward Inhibitors,research,lifescience,medical increased OS in patients with squamous cell carcinoma vs. adenocarcinoma (53 vs. 29 months, respectively; P=0.06, Figure 2). Interestingly there was a similar extent of downstaging between squamous cell carcinomas and adenocarcinomas (50% vs. 51.9%, respectively). Inhibitors,research,lifescience,medical However 35.7% (n=5 of 14) of squamous cell carcinomas had a pCR compared to only 24.5% (n=23 of 92) of adenocarcinomas. Moreover, there were a greater proportion of patients who had squamous cell carcinoma with stage

III disease compared to those in the adenocarcinoma group (78.6% vs. 51.9%, respectively). Figure 1 SKI 606 Overall survival Thalidomide for the 106 patients in our cohort. Figure 2 Overall survival (OS) by histological subtype in all 106 patients in our cohort (P=0.06). Importantly, there was also a trend toward increased OS for downstaged patients following NAC and esophagectomy (P=0.08, Figure 3).The OS for downstaged patients was 40 months, upstaged patients was 20.6 months, and 27 months for those who remained at the same stage. Patients that had no evidence of disease on histological exam at surgery (pCR) had a median OS of 52 months. Figure 3 Overall survival as a function of post-operative tumor stage compared to initial stage following NAC and esophagectomy (P=0.08, n=106). NAC, neoadjuvant chemoradiotherapy.