Outcomes in Pathologic T1n1 Esophageal Adenocarcinoma

Background Some clinical T1N0 (cT1N0) esophageal adenocarcinoma (EAC) patients undergo surgery due to nodal disease risk factors discovered on diagnostic endoscopic resection, including deep submucosal invasion, poor differentiation, and lymphovascular invasion (LVI). Higher risk patients may ultimately be upstaged to pathologic T1N1 (pT1N1) disease. Although few retrospective studies suggest benefits of adjuvant therapy (ADT) for locally advanced EAC, limited literature exists regarding pT1N1 patient outcomes and therapy recommendations. This study aims to describe outcomes and the impact of ADT on survival in this understudied cohort. To our knowledge, this investigation represents the largest number of patients strictly diagnosed with pT1N1 EAC. Methods We identified pT1N1 EAC patients that underwent upfront surgery without neoadjuvant treatment between 2005–2022 at two different centers. Collected data included demographic, clinicopathologic, and treatment-related variables, along with survival outcomes. Patients were stratified based on receipt of ADT (ADT) or observation (OBS) following surgical resection. Survival outcomes were evaluated using the Kaplan–Meier method and multivariable (MV) Cox regression models. Results We identified 41 pT1N1 EAC patients (14 ADT and 27 OBS). Among ADT patients, 11 received chemotherapy and 3 received chemoradiation. Group similarities included male prevalence (ADT, 85.7%, n = 12/14; OBS, 70.4%, 19/27, p = 0.447) and median surgical age (ADT, 64.5 years; OBS, 64 years, p = 0.509). LVI occurred in 5 ADT (35.7%) and 14 OBS (51.8%, p = 0.510) patients. At median follow-up of 40.5 months, ADT and OBS patients had a median overall survival (OS) of 53.9 and 49 months (p = 0.881, Figure), respectively. MV Cox regression revealed no ADT influence on OS, though showed LVI negatively impacting OS (HR = 6.966, 95% CI: 1.497–32.415, P = 0.013). Conclusion Our study failed to find a significant influence of ADT on survival outcomes in pT1N1 EAC patients. Instead, our investigation revealed that LVI portends a negative prognosis in these individuals. Ultimately, this rare subset of EAC remains poorly understood, and our findings add information that is significantly lacking in the literature. Further efforts are needed to elucidate optimal management strategies for pT1N1 EAC patients.