Researchers predicted that the ratio of positive lymph nodes to total evaluated lymph nodes (LNR) as a predictor of cancer burden in esophageal adenocarcinoma may be used to select patients who would benefit the most from AC. For a study, they sought to determine if there was an LNR threshold at which AC confers a survival advantage in the population. Patients who received upfront, full excision of pT1-4N1–3M0 esophageal adenocarcinoma were searched in the National Cancer Database from 2004 to 2015. Multivariable Cox proportional hazards models with an interaction term between LNR and AC were used to investigate overall survival’s primary outcome. A total of 1,733 participants were involved in the study, with 811 (47%) not receiving AC and 922 (53%) receiving it. The median LNR (interquartile range 9–40) was 20%. The interaction term between LNR and AC receipt was significant (P=0.01) in a multivariable Cox model. Beyond an LNR of roughly 10%–12%, the interaction plot revealed that AC was related to better survival. In a sensitivity analysis, AC was not linked with increased survival in patients with LNR 12% (hazard ratio 1.02; 95% CI 0.72–1.44), but it was associated with improved survival in patients with LNR 12% (hazard ratio 0.65; 95% CI 0.50–0.79). AC was related to enhanced survival for LNR of more than or equal to 12% in the trial of individuals with upfront, full resection of node-positive esophageal adenocarcinoma. LNR could be used as a supplement to multidisciplinary decision-making about adjuvant medicines in the patient population.
