Thomas W. Rice, MD, Deepak Khuntia, MD, Lisa A. Rybicki, MS, David J

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Brain Metastases From Esophageal Cancer: A Phenomenon of Adjuvant Therapy? Thomas W. Rice, MD, Deepak Khuntia, MD, Lisa A. Rybicki, MS, David J. Adelstein, MD, Michael A. Vogelbaum, MD, PhD, David P. Mason, MD, Sudish C. Murthy, MD, PhD, Eugene H. Blackstone, MD The Annals of Thoracic Surgery Volume 82, Issue 6, Pages 2042-2049.e2 (December 2006) DOI: 10.1016/j.athoracsur.2006.06.089 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Brain metastases after esophagectomy for esophageal cancer. (A) Hazard function (instantaneous risk) for brain metastases after surgery alone or adjuvant therapy. Solid lines are parametric estimate, and dashed lines are 68% confidence limits. (B) Prevalence of brain metastases after surgery alone or adjuvant therapy. Each step represents an occurrence, and short vertical lines are patients remaining alive (censored); vertical bars represent ±1 standard error. (C) Hazard functions for brain metastases as in (A), but with adjuvant therapy group broken down according to adjuvant therapy administered preoperatively only, postoperatively only, or both. (D) Prevalence of brain metastases in adjuvant therapy groups. Format is as in (B). The Annals of Thoracic Surgery 2006 82, 2042-2049.e2DOI: (10.1016/j.athoracsur.2006.06.089) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Occurrence of brain metastases after surgery alone according to number of locoregional lymph nodes positive for cancer. Each step represents an occurrence, and short vertical lines are patients remaining alive (censored); vertical bars represent ±1 standard error. The Annals of Thoracic Surgery 2006 82, 2042-2049.e2DOI: (10.1016/j.athoracsur.2006.06.089) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Occurrence of brain metastases in propensity-matched groups (in this illustration, matched on patient, pathologic tumor, and surgical factors). For comparison, unmatched patients are also shown. Each step represents an occurrence, and short vertical lines are patients remaining alive (censored); vertical bars represent ±1 standard error. The Annals of Thoracic Surgery 2006 82, 2042-2049.e2DOI: (10.1016/j.athoracsur.2006.06.089) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Survival after occurrence of brain metastases following surgery alone or adjuvant therapy (p = 0.1). Each step represents an occurrence, and short vertical lines are patients remaining alive (censored); vertical bars represent ±1 standard error. The Annals of Thoracic Surgery 2006 82, 2042-2049.e2DOI: (10.1016/j.athoracsur.2006.06.089) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Survival after either surgery alone or adjuvant therapy (p < 0.001). Each step represents an occurrence, and short vertical lines are patients remaining alive (censored); vertical bars represent ±1 standard error. (A) Unadjusted survival. (B) Propensity-matched survival comparison (p = 0.04), based on clinical TNM. The Annals of Thoracic Surgery 2006 82, 2042-2049.e2DOI: (10.1016/j.athoracsur.2006.06.089) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Occurrence of brain metastases in patients undergoing surgery alone versus adjuvant therapy, stratified by pathologic nodal status. Each step represents an occurrence, and short vertical lines are patients remaining alive (censored); vertical bars represent ± 1 standard error. The Annals of Thoracic Surgery 2006 82, 2042-2049.e2DOI: (10.1016/j.athoracsur.2006.06.089) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions