Pathological complete response in multimodal treatment of esophageal cancer: a retrospective cohort study.
chemoradiation
chemotherapy
esophageal cancer
esophagogastric junction cancer
multimodal treatment
neoadjuvant treatment
oncologic surgery
pathologic complete response
visceral surgery
Journal
Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
ISSN: 1442-2050
Titre abrégé: Dis Esophagus
Pays: United States
ID NLM: 8809160
Informations de publication
Date de publication:
03 Jul 2023
03 Jul 2023
Historique:
received:
10
08
2022
revised:
09
11
2022
medline:
5
7
2023
pubmed:
27
12
2022
entrez:
26
12
2022
Statut:
ppublish
Résumé
To evaluate pathological complete response (pCR, ypT0ypN0) after neoadjuvant treatment compared with non-complete response (non-CR) in patients with esophageal cancer (EC), and 393 patients were retrospectively analyzed. Survival probability was analyzed in patients with: (i) pCR vs non-CR; (ii) complete response of the primary tumor but persisting lymphatic metastases (non-CR-T0N+) and (iii) pCR and tumor-free lymphnodes exhibiting signs of postneoadjuvant regression vs. no signs of regression. (i) Median overall survival (mOS) was favorable in patients with pCR (pCR: mOS not reached vs. non-CR: 41 months, P < 0.001). Multivariate analysis revealed that grade of regression was not an independent predictor for prolonged survival. Instead, the achieved postneoadjuvant TNM-stage (T-stage: Hazard ratio [HR] ypT3-T4 vs. ypT0-T2: 1.837; N-stage: HR ypN1-N3 vs. ypN0: 2.046; Postneoadjuvant M-stage: HR ypM1 vs. ycM0: 2.709), the residual tumor (R)-classification (HR R1 vs. R0: 4.195) and the histologic subtype of EC (HR ESCC vs. EAC: 1.688) were prognostic factors. Patients with non-CR-T0N+ have a devastating prognosis, similar to those with local non-CR and lymphatic metastases (non-CR-T + N+) (non-CR-T0N+: 22.0 months, non-CR-T + N-: mOS not reached, non-CR-T + N+: 23.0 months; P-values: non-CR-T0N+ vs. non-CR-T + N-: 0.016; non-CR-T0N+ vs. non-CR-T + N+: 0.956; non-CR-T + N- vs. non-CR-T + N+: <0.001). Regressive changes in lymphnodes after neoadjuvant treatment did not influence survival-probability in patients with pCR (mOS not reached in each group; EAC-patients: P = 0.0919; ESCC-patients: P = 0.828). Particularly, the achieved postneoadjuvant ypTNM-stage influences the survival probability of patients with EC. Patients with non-CR-T0N+ have a dismal prognosis, and only true pathological complete response with ypT0ypN0 offers superior survival probabilities.
Identifiants
pubmed: 36572398
pii: 6961032
doi: 10.1093/dote/doac095
pmc: PMC10317005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus.
Références
Lancet Oncol. 2018 Jul;19(7):965-974
pubmed: 29861116
Eur J Cancer. 2012 Dec;48(18):3342-54
pubmed: 22766518
World J Surg. 2016 Feb;40(2):395-401
pubmed: 26630937
Br J Surg. 2010 May;97(5):772-81
pubmed: 20306528
Acta Oncol. 2021 Apr;60(4):497-504
pubmed: 33491513
N Engl J Med. 2019 Jan 10;380(2):152-162
pubmed: 30625052
J Natl Compr Canc Netw. 2019 Jul 1;17(7):855-883
pubmed: 31319389
Hum Pathol. 2019 Feb;84:26-34
pubmed: 30217622
Ann Surg. 2022 Mar 1;275(3):467-476
pubmed: 34191461
Semin Thorac Cardiovasc Surg. 2016 Summer;28(2):549-558
pubmed: 28043475
CA Cancer J Clin. 2017 Jan;67(1):7-30
pubmed: 28055103
CA Cancer J Clin. 2017 Jul 8;67(4):304-317
pubmed: 28556024
N Engl J Med. 2012 May 31;366(22):2074-84
pubmed: 22646630
J Thorac Oncol. 2017 Jan;12(1):36-42
pubmed: 27810391
Ann Surg. 1999 Mar;229(3):303-8
pubmed: 10077040
Eur J Cancer. 2009 Jan;45(2):228-47
pubmed: 19097774
Cancer. 2003 Oct 1;98(7):1521-30
pubmed: 14508841
Eur Urol. 2014 Feb;65(2):350-7
pubmed: 23849998
Ann Transl Med. 2021 Oct;9(20):1516
pubmed: 34790722
J Pathol Clin Res. 2020 Oct;6(4):263-272
pubmed: 32401432
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
PLoS One. 2018 Jan 25;13(1):e0189294
pubmed: 29370182
Cancers (Basel). 2021 Jan 23;13(3):
pubmed: 33561090
J Clin Oncol. 1991 Jan;9(1):191-2
pubmed: 1985169
Ann Surg. 2013 Jul;258(1):1-7
pubmed: 23728278
Dis Esophagus. 2018 Jan 1;31(1):1-9
pubmed: 29087451
Eur J Surg Oncol. 2012 Jul;38(7):555-61
pubmed: 22483704
Ann Oncol. 2013 Aug;24(8):2068-73
pubmed: 23592699
Ann Surg. 2020 Feb;271(2):245-256
pubmed: 31188203
J Clin Oncol. 2020 Aug 10;38(23):2677-2694
pubmed: 32568633
Lancet Oncol. 2010 Sep;11(9):835-44
pubmed: 20692872
J Thorac Dis. 2017 Jul;9(Suppl 8):S843-S850
pubmed: 28815082
Br J Surg. 1998 Nov;85(11):1457-9
pubmed: 9823902
Lancet Oncol. 2016 Dec;17(12):1697-1708
pubmed: 27776843
JAMA Surg. 2016 Nov 16;151(11):e162743
pubmed: 27627765
J Gastrointest Surg. 2020 Feb;24(2):288-298
pubmed: 30809782
Ann Surg Oncol. 2007 Dec;14(12):3412-8
pubmed: 17909917
Ann Surg. 2015 Dec;262(6):972-80
pubmed: 26469952
Lancet. 2019 May 11;393(10184):1948-1957
pubmed: 30982686