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Purpose Patients with esophageal carcinoma (EC) who are treated with definitive chemoradiotherapy (bimodality therapy [BMT]) experience frequent relapses. In a large cohort, we assessed the timing, frequency, and types of relapses during an aggressive surveillance program and the value of the salvage strategies. Patients and Methods Patients with EC (N = 276) who received BMT were analyzed. Patients who had surgery within 6 months of chemoradiotherapy were excluded to reduce bias. We focused on local relapse (LR) and distant metastases (DM) and the salvage treatment of patients with LR only. Standard statistical methods were applied. Results The median follow-up time was 54.3 months (95% CI, 48.4 to 62.4). First relapses included LR only in 23.2% (n = 64), DM with or without LR in 43.5% (n = 120), and no relapses in 33.3% (n = 92) of patients. Final relapses included no relapses in 33.3%, LR only in 14.5%, DM only in 15.9%, and DM plus LR in 36.2% of patients. Ninety-one percent of LRs occurred within 2 years and 98% occurred within 3 years of BMT. Twenty-three (36%) of 64 patients with LR only underwent salvage surgery, and their median overall survival was 58.6 months (95% CI, 28.8 to not reached) compared with those patients with LR only who were unable to undergo surgery (9.5 months; 95% CI, 7.8 to 13.3). Conclusion Unlike in patients undergoing trimodality therapy, for whom surveillance/salvage treatment plays a lesser role, 1 in the BMT population, approximately 8% of all patients (or 36% of patients with LR only) with LRs occurring more than 6 months after chemoradiotherapy can undergo salvage treatment, and their survival is excellent. Our data support vigilant surveillance, at least in the first 24 months after chemotherapy, in these patients.

4029Background: Older patients with localized gastric adenocarcinoma (LGAC) have substantial postoperative morbidity and mortality; however, postoperative outcomes of these patients who receive pre...

132 Background: Older patients with localized gastric adenocarcinoma (LGAC) suffer from substantial postoperative morbidity and mortality; however, postoperative outcomes in older patients who have received preoperative chemotherapy and/or chemoradiation have not been reported. Our study examined the impact of age and other covariates on baseline, surgical and postoperative characteristics and explored potential predictors of postoperative outcomes. Methods: Patients with LGAC who were treated with chemotherapy (n = 36; 18%) and/or chemoradiation (n = 167; 82%) followed by surgery (n = 203) were grouped in 2 categories by age: 1) ≥ 65 years old (n = 70) and 2) < 65 years old (n = 133). The short-term outcomes included postoperative morbidity and mortality, and the long-term outcomes overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age group and ii) by a number of other covariates. Descriptive statistics and survival analyses were utilized. Results: The 90-daypostoperative morbidity rate was similar in older and younger patients(61 vs 58%; p = 0.6549). The 90-day mortality rate did not differ statistically between the two groups (3 vs 0%; p = 0.1178). Although major Clavien grade III/IV complications after surgery were more common in older patients, this difference did not reach statistical significance (17 vs 12%; p = 0.3919). The long-term outcomes in terms of OS and PFS were also similar (p = 0.8629 and p = 0.558 respectively). The effect of patient age and ECOG PS on outcomes was not significant. Instead, other factors, such as Charlson comorbidity index (p = 0.0114), length of hospital stay (p = 0.0009), median operative time (p = 0.006) and presence of diabetes (p = 0.0282) were strong predictors of postoperative complications. Conclusions: Our data demonstrate that older patients with LGAC who received preoperative therapy had similar outcomes with younger patients but were more likely to demonstrate higher morbidity, although the differences were not statistically significant. Comorbidity indices provided more information than age in identifying postoperative short and long-term outcomes.

4067 Background: Patients with LGAC, when treated with preoperative therapy, have heterogeneous and unpredictable outcomes. Currently, there are no clinical variables or biomarkers that can predict...

4064 Background: Accurate clinical staging is essential for making immediate treatment decisions. The role of endoscopic ultrasound (EUS) and fine needle aspiration (FNA) in altering treatment has been debated in patients diagnosed with cStage II or III EC. The purpose of this study was to assess the yield of EUS-FNA for paratracheal and subcarinal lymph nodes in distal ECs. Methods: We analyzed278 EC patients who had baseline EUS-FNA between 2010 and 2014. A subgroup of 85 patients with Seiwert’s type I or II EC had FNAs of the paratracheal or subcarinal nodes (far away from the primary EC) were carefully reviewed. The accuracy of EUS, PET, EUS+PET, and FNA were compared using FNA as the gold standard. A McNemar’s test was used to determine whether EUS+PET or FNA performed differently in identifying positive nodes. Results: In the subgroup of 85 patients, FNA was positive for malignancy in 27 (32%) leading to modifications of the radiation field in upper thorax. Moreover, EUS, PET, and EUS+PET had an acc...

41 Background: Laparoscopic staging of patients with GC can disclose peritoneal metastases. Although this finding is associated with a poor prognosis, some patients achieve a long-term survival. In an attempt to provide explanation we compared the overall survival (OS) of patients with GC peritoneal metastases from two settings: cytology positive only (Cy+) and grossly positive (Gross+). Methods: 146 GC patients with peritoneal metastases were identified between 2000 and 2014. Cox-model regression was used for overall survival (OS) analyses. Results: Patient/treatment characteristics were as follows: males (66%), good ECOG scores (0-1; 89%), metastases confirmed by a diagnostic laparoscopy (84%), poorly differentiated histology(92%), received chemotherapy (89%), received chemoradiation (22%), and received surgery (10%). The median follow-up time for all patients was 12.9 months and median OS was 15 months. Patients with Gross+ were at higher risk of death compared to Cy+ patients (50% vs. 83%1-year OS, respectively). Only diagnostic laparoscopy and metastasis type (Gross+ vs. Cy+) were significant in both univariate and multivariate OS models. With both factors in the same model, patients with Gross+ were more than twice as likely to die when compared to those with Cy+ (HR=2.23; p=0.001) while patients having a diagnostic laparoscopy were half as likely to die (HR=0.52; p=0.01). Conclusions: The one-year OS of patients with Cy+ peritoneal metastases is significantly longer than those with Gross+ findings. As such, novel strategies for Cy+ patients may further prolong their survival. From U. T. M. D. Anderson Cancer Center (UTMDACC), Houston, Texas, USA. (Supported in part by UTMDACC, and CA 138671 and CA172741 from the NCI).

21 Background: The goal of surveillance after local therapy (trimodality or bimodality) is to salvage patients with actionable LRF, however, the benefits of current surveillance strategies are not well documented. We report on a large cohort of LEC patients with actionable LRF. Methods: Between 2000 and 2013, 127 patients with actionable LRF were assessed. Histologic/cytologic confirmation of LRF was the gold standard. All surveillance tools (imaging and endoscopy) were assessed. Results: The majority of the patients were men (89%), had adenocarcinoma (79%), had their LRF identified through surveillance (85%) and most had no new symptoms (72%). For the 41 LRFs after trimodality, the sensitivity of PET/CT alone was 93% but the specificity was 67%. In trimodality patients with a positive PET/CT for LRF, only 44% had LRF confirmed by endoscopy and 56% LRFs confirm by additional testing (e.g., FNA, etc). Alternatively, in bimodality patients, endoscopy confirmed LRF in 81% (n=85; 1 patient not evaluable). Trimodality patients were at higher risk of subsequent (e.g., distant) relapse after LRF was documented than were bimodality patients (p=0.03); 78% of the relapses were distant. In bimodality patients, 99% of relapses (LRF and/or distant) occurred within 36 months of therapy while in trimodality patients, 90% of relapses occurred within 36 months of surgery. Conclusions: Our data suggest that PET/CT is more likely to detect LRFs than endoscopy in trimodality patients. However, in bimodality patients, endoscopy is more valuable than PET/CT for documenting LRFs. At least 3 years of surveillance are needed for all LEC patients. However, even after the salvage, distant relapses are common. From U. T. M. D. Anderson Cancer Center (UTMDACC), Houston, Texas, USA. (Supported in part by UTMDACC, and CA 138671 and CA172741 from the NCI).

97 Background: Patients with localized gastric cancer (LGC), when treated with preoperative therapy, tend to have heterogeneous and unpredictable outcomes. Currently, no clinical variables or biomarkers can predict response. Methods: We analyzed 107 LGC patients who were treated with chemoradiation followed by surgery (trimodality therapy; TMT). Tumors were grouped into poorly (G3) or moderately (G2) differentiated and signet ring cell (SRC) or non-SRC histology. Association was made with pathologic complete response (pathCR) or < pathCR. Descriptive statistics and survival analyses were utilized. Results: The majority of the patients were male (60%), had clinical stage III cancer (51%), and received chemotherapy before chemoradiation (94%). All had adenocarcinoma and most had G3 (78%) and SRC histology (58%). PathCR was noted in 18% of patients with G3 and 33% of patients with G2 (p=0.125). Overall survival (OS) was significantly shorter for G3 patients compared to G2 patients (p=0.045). Patients with SRC histology had a lower rate of pathCR than those with non-SRC (8% vs 40%, p

4084 Background: In patients with trimodality-eligible EAC, the presence of malignant nodes at baseline portends a poor prognosis. It is difficult to quantify the number of positive lymph nodes usi...

e15088 Background: The neutrophil-lymphocyte ratio (NLR) is related to inflammatory status and/or cellular immunity status of patients with some cancers. We hypothesize that preoperative NLR is ass...

4075 Background: Despite many investigations, the median survival of MGC patients remains well below 12 months. The purpose of this analysis was to assess if the onset (instant or delayed) of syste...

4053 Background: For patients with LGCA, adjunctive therapies improve the 5-year survival rates by ≈10% over surgery alone. We studied preoperative oxaliplatin/5-FU-based chemotherapy followed by c...

89 Background: For localized E-EGJ cancer patients, chemoradiation followed by surgery (trimodality therapy [TMT]) or definitive chemoradiation (bimodality therapy [BMT]) are considered the standard of care. However, ˜30-40 % of patients with localized E-EGJ cancer develop DM. We hypothesized that a clinical parameters’ model can be established to predict DM. Methods: We analyzed E-EGJ cancer patients who completed TMT or BMT from our prospectively maintained database. Logistic regression models were used for analysis. Overall survival (OS) was estimated by the Kaplan-Meier method. We used the AJCC 6th edition. Results: Between 2002 and 2013, 356 TMT patients and 273 BMT patients were analyzed. 33% (119/356) of TMT patients and 40% (109/273) of BMT developed DM as a first relapse. The median OS from DM were 10.2 months (95% CI: 7.8-12.7) for TMT patients and 7.8 months (95% CI: 5.7-9.9) for BMT patients. In a logistic regression analysis for all patients, the following parameters were associated with a significantly increased risk of DM: age (odds ratio [OR]: 0.97 [95% CI: 0.96-0.99]), initial standardized uptake value (iSUV) of PET (OR: 1.02 [95% CI: 1.00-1.04]), Stage III/IVa (vs. I/II) (OR: 2.43 [95% CI 1.65-3.57]) and male (vs. female) (OR 3.99 [95% CI: 1.89-8.42]). For TMT patients, baseline T3/T4 (vs. T1/T2) (OR 2.75 [95%CI 1.10-6.86]), baseline N1 (vs. N0) (OR: 1.69 [95% CI: 1.03-2.77]), and poorly differentiated cancer (vs. well/moderately differentiated) (OR 1.78 [95% CI: 1.13-2.82]) were significantly associated with DM. Conclusions: Our data suggest that younger men with Stage III/IVa cancer and high iSUV are at risk for DM irrespective of local therapy (TMT or BMT). A nomogram to predict DM will be developed with a larger cohort. Supported by UT M. D. Anderson Cancer Center Multidisciplinary Research Grants, CA138671, CA172741, CA129926 from NCI (JAA) and Generous Donors.

18 Background: For the purpose of understanding clinical behavior of EC, imaging and biomarkers have not been correlated. We attempted to correlate iSUV with a variety of biomarkers (NF-kB, SHH, ALDH1, ABCB1, survivin, and BCRP) including pre-treatment nuclear Gli-1 LIs in patients with EC who had undergone TMT. Methods: 128 patients were analyzed. The iSUV and pre-treatment nuclear Gli-1 LIs were assessed among others. Post-treatment residual cancer status in the resected specimen was also correlated (P0=0% residual cells, P1=1-50% residual cells, and P2=>50% residual cells) with iSUV and nuclear Gli-1 LIs. The Kruskal-Wallis test was performed to find correlations between (1) iSUV and P status; and (2) between nuclear Gli-1 LIs and P status. Results: The Pearson’s correlation coefficient between iSUV and nuclear Gli-1 LIs was 0.21 (p = 0.02). Pre-treatment nuclear Gli-1 LIs were strongly associated with the P status (p

105 Background: For localized E-EGJ cancer patients, the preferred therapy is chemoradiation (CRT) followed by surgery (TMT). Definitive CRT (BMT) has been also established for the patients who do not qualify for surgery. Distribution and timing of distant metastasis has not been described. Methods: Between 2002 and 2013, 629 patients with localized E-EGJ cancer who underwent TMT or BMT were reviewed the distribution and timing of DM over time. Overall survival (OS) was estimated by the Kaplan-Meier method. Results: The median follow-up time was 37.2 months (interquartile range: 17.8-65.0) among patients with data that were censored. Among 356 patients with TMT, 33% (119) developed DM as their first relapse. Among 273 patients with BMT, 40% (109) developed DM. Following TMT and BMT, 91% and 96% of DM were diagnosed within 2 years of treatment, respectively. The 7 most common anatomic sites of DM were: lung (20% of DM for TMT and 17% of DM for BMT), distant lymph node (13% and 20%), liver (14% and 11%), peritoneum (10% and 13%), bone (6% and 11%), brain (8% and 8%) and pleura (7% and 5%). The median OS from DM were 10.2 months (95% CI: 7.8-12.7) for TMT patients and 7.8 months (95% CI: 5.7-9.9) for BMT patients. The median OS of patients with pleura metastasis was the shortest (1.5 months [95% CI: 1.0-2.1] for TMT and 3.5 months [95% CI: 3.3-3.6]) for BMT. Conclusions: After TMT and BMT, 33% and 40% of patients had DM and most DM occurred within 2 years (91% and 96%). Common sites of DM sites are lung, distant lymph node and liver. The risk factors associated with DM need to be elucidated. Supported by UT M. D. Anderson Cancer Center Multidisciplinary Research G rants, CA138671, CA172741, CA129926 from NCI (JAA) and Generous Donors. [Table: see text]