Impact of squamous histology on the response to treatment and long-term outcomes of patients with distal esophageal cancer.
135 Background: Squamous cell carcinoma (SCC) has been traditionally linked to a better response to treatment and overall survival when compared to adenocarcinoma (AC) of the esophagus. Recent advances in staging, neoadjuvant therapy (NAT) and increasing surgical management of patients with EC have led to improved overall survival of these patients. The aim of this study is to analyze the impact of squamous histology on treatment response and long term outcomes in patients with distal EC. Methods: A retrospective review of patients who underwent esophagectomy for EC at a single institution over a 16 year period (1999-2015) was performed. Pre-operative clinical parameters, stage as well as oncologic management were compared between SCC and AC of the distal esophagus and the difference in response to treatment and overall survival were analyzed using descriptive statistics. Results: Esophagectomy was performed on 945 patients with EC of which 839 patients (89%) had distal EC. The mean age of this group was 63 years and majority were male (87%). Histology was SCC for 78 patients (9.4%) and AC for 747 patients (90.6%). Pretreatment clinical stage was similar between groups (p = 0.16). NAT administration was similar between groups (p = 0.13). Although SCC patients had higher rate of complete response (54% v/s 36%, p = 0.01) we found no difference in the overall survival after surgery (33 months for SCC v/s 40 months for AC, p = 0.72) irrespective of whether they received NAT (p = 0.95) or not (p = 0.55). Conclusions: Squamous cell histology had a favorable impact on the rate of pathologic response for patients with distal EC; however, this improvement did not alter their overall survival. This could provide an insight into the decreasing significance of the histology in the management and expectations from treatment of EC while emphasizing the continuing need for multimodality therapy to assure good outcomes on these patients.