The effect of histologic grade on neoadjuvant treatment outcomes in esophageal cancer.
chemoradiation
esophageal cancer
esophagectomy
histologic grade
neoadjuvant therapy
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Sep 2022
Sep 2022
Historique:
revised:
05
04
2022
received:
31
12
2021
accepted:
05
05
2022
pubmed:
18
5
2022
medline:
2
8
2022
entrez:
17
5
2022
Statut:
ppublish
Résumé
The gold standard for locoregional esophageal cancer (LEC) treatment includes preoperative chemoradiation and surgical resection, with possible perioperative or adjuvant systemic therapy. With few data associating histologic grade and prognosis in LEC patients receiving neoadjuvant chemoradiation followed by resection, we seek to evaluate this association. Our institutional esophagectomy database between 1999 and 2019 was queried, selecting esophageal adenocarcinoma patients who completed neoadjuvant therapy (NAT), followed by esophagectomy. Propensity-score matching of low- and high-histologic grade groups was performed to assess survival metrics using initial clinical grade (cG) and final pathologic grade (pG). We performed a multivariable logistic regression to study predictors of pathologic complete response as a secondary objective. A total of 518 patients met the inclusion criteria. Kaplan-Meier analysis of the matched dataset showed no difference in initial or 5-year recurrence-free survival or overall survival (OS) between cG1 and cG2 versus cG3 based on original grade. When matched according to pG, cG1-2 had improved median survival parameters compared to cG3, with 5-year OS for cG1-2 of 45% versus 27% (p = 0.001). Higher pG, pathologic N stage, and poor response to NAT are predictors of poor survival. Patients with post-NAT pG1-2 demonstrated improved survival. Integrating histologic grade into postneoadjuvant staging may be warranted.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
The gold standard for locoregional esophageal cancer (LEC) treatment includes preoperative chemoradiation and surgical resection, with possible perioperative or adjuvant systemic therapy. With few data associating histologic grade and prognosis in LEC patients receiving neoadjuvant chemoradiation followed by resection, we seek to evaluate this association.
METHODS
METHODS
Our institutional esophagectomy database between 1999 and 2019 was queried, selecting esophageal adenocarcinoma patients who completed neoadjuvant therapy (NAT), followed by esophagectomy. Propensity-score matching of low- and high-histologic grade groups was performed to assess survival metrics using initial clinical grade (cG) and final pathologic grade (pG). We performed a multivariable logistic regression to study predictors of pathologic complete response as a secondary objective.
RESULTS
RESULTS
A total of 518 patients met the inclusion criteria. Kaplan-Meier analysis of the matched dataset showed no difference in initial or 5-year recurrence-free survival or overall survival (OS) between cG1 and cG2 versus cG3 based on original grade. When matched according to pG, cG1-2 had improved median survival parameters compared to cG3, with 5-year OS for cG1-2 of 45% versus 27% (p = 0.001). Higher pG, pathologic N stage, and poor response to NAT are predictors of poor survival.
CONCLUSION
CONCLUSIONS
Patients with post-NAT pG1-2 demonstrated improved survival. Integrating histologic grade into postneoadjuvant staging may be warranted.
Identifiants
pubmed: 35578777
doi: 10.1002/jso.26921
pmc: PMC9339510
mid: NIHMS1808155
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
465-478Subventions
Organisme : NCI NIH HHS
ID : P30 CA076292
Pays : United States
Organisme : H. Lee Moffitt Cancer Center & Research Institute NCI Cancer Center Support Grant
ID : P30-CA076292
Informations de copyright
© 2022 Wiley Periodicals LLC.
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