Abstract Body (Do not enter title and authors here): Limited data indicate an elevated risk of atrial fibrillation (AF) after neoadjuvant chemoradiation in esophageal cancer however the role of AF as an independent predictor of outcomes post-esophagectomy remains under-studied. We sought to the impact of AF on overall outcomes of patients undergoing neoadjuvant chemoradiation and esophagectomy, with or without adjuvant nivolumab.
The global TriNetX database was used to identify patients (based on ICD-10 codes) with esophageal squamous cell carcinoma or adenocarcinoma who received neoadjuvant chemoradiation with carboplatin and paclitaxel and subsequently underwent esophagectomy between 2009 and 2024. Patients who received adjuvant nivolumab were analyzed separately. Patients who developed AF were compared with patients who did not using propensity score matching (PSM) based on age, race, BMI, and multiple comorbidities. Outcomes over a 5-year period were mortality, ischemic stroke, and use of anticoagulation. Odds ratios with 95% confidence intervals were generated with generalized linear mixed modeling and a p value of <0.05 was considered statistically significant.
A total of 1007 patients were identified, of these 186 (18.5%) developed AF after esophagectomy. PSM yielded 94 pairs for patients without adjuvant nivolumab. In this group, mortality was not significantly higher in patients with AF [OR=1.409 (0.793-2.504), p=0.242]. Incidence of stroke was equivalent between patients with and without AF [OR=1 (0.396-2.528), p = 1], despite significantly higher use of anticoagulation in the AF group [OR= 2.004 (1.071-3.749), p<0.028]. PSM for patients receiving adjuvant nivolumab yielded 68 pairs. In this cohort, AF was not associated with a significant difference in mortality [1.86 (0.843, 3.870), p = 0.126]. Incidence of stroke was significantly higher in patients with AF [Risk difference = 0.147 (0.063, 0.231) p = 0.0001], however anticoagulation use was not significantly higher in the AF group [1.944 (0.862, 4.384), p = 0.106].
The current analysis highlights a high incidence of AF after neoadjuvant chemoradiation in esophageal cancer. However, despite rigorous vetting with PSM, we found no difference in mortality associated with AF both among patients who received or did not receive adjuvant nivolumab. Diligent use of anticoagulation is required among patients with AF post-esophagectomy due to an increased risk of stroke. These findings merit confirmation in a large prospective cohort.