Pretreatment Primary Tumor Stage is a Risk Factor for Recurrence in Patients with Esophageal Squamous Cell Carcinoma Who Achieve Pathological Complete Response After Neoadjuvant Chemoradiotherapy.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
17
05
2020
accepted:
14
09
2020
pubmed:
21
10
2020
medline:
18
5
2021
entrez:
20
10
2020
Statut:
ppublish
Résumé
Although pathological complete response (pCR) after multimodal treatment for esophageal cancer is associated to the best prognosis, recurrence may occur in 20-40% of cases. The present study investigated the recurrence pattern and predictive factors of recurrence after pCR in patients with esophageal cancer. In this study, 427 patients received preoperative treatment for either esophageal squamous cell carcinoma (SCC) or adenocarcinoma at Verona University Hospital between 2000 and 2018. Of these, 145 patients (34%) achieved a pCR. Long-term prognosis, recurrence pattern, and risk factors for relapse in pCR patients were analysed. During a median follow-up of 52 months, 37 relapses (25.5%) occurred, mostly at distant level (n = 28). Nearly all locoregional relapses (8/9) were detected in SCC cases. The 5-year overall survival and cancer-related survival were 71.7% (95% confidence interval [CI] 62.6-78.9%) and 77.5% (95% CI 68.5-84.2%) respectively. Male sex, higher body mass index, and cT4 were significant risk factors for recurrence at univariate analysis. The multivariate analysis confirmed the role of cT4 as predictor of recurrence only in SCCs. Esophageal cancer recurs in about one-fourth of pCR cases. A fair number of local recurrences occurs in SCCs, but the main problem is the systemic disease control. According to our analysis, SCCs patients with cT4 stage have an increased risk to recur, so they should be managed differently by a personalized approach in terms of adjuvant treatment and follow-up.
Sections du résumé
BACKGROUND
BACKGROUND
Although pathological complete response (pCR) after multimodal treatment for esophageal cancer is associated to the best prognosis, recurrence may occur in 20-40% of cases. The present study investigated the recurrence pattern and predictive factors of recurrence after pCR in patients with esophageal cancer.
METHODS
METHODS
In this study, 427 patients received preoperative treatment for either esophageal squamous cell carcinoma (SCC) or adenocarcinoma at Verona University Hospital between 2000 and 2018. Of these, 145 patients (34%) achieved a pCR. Long-term prognosis, recurrence pattern, and risk factors for relapse in pCR patients were analysed.
RESULTS
RESULTS
During a median follow-up of 52 months, 37 relapses (25.5%) occurred, mostly at distant level (n = 28). Nearly all locoregional relapses (8/9) were detected in SCC cases. The 5-year overall survival and cancer-related survival were 71.7% (95% confidence interval [CI] 62.6-78.9%) and 77.5% (95% CI 68.5-84.2%) respectively. Male sex, higher body mass index, and cT4 were significant risk factors for recurrence at univariate analysis. The multivariate analysis confirmed the role of cT4 as predictor of recurrence only in SCCs.
CONCLUSIONS
CONCLUSIONS
Esophageal cancer recurs in about one-fourth of pCR cases. A fair number of local recurrences occurs in SCCs, but the main problem is the systemic disease control. According to our analysis, SCCs patients with cT4 stage have an increased risk to recur, so they should be managed differently by a personalized approach in terms of adjuvant treatment and follow-up.
Identifiants
pubmed: 33078313
doi: 10.1245/s10434-020-09219-6
pii: 10.1245/s10434-020-09219-6
pmc: PMC8119402
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3034-3043Références
van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Eng J Med. 2012;366(22):2074–84.
doi: 10.1056/NEJMoa1112088
Liu B, Bo Y, Wang K, et al. Concurrent neoadjuvant chemoradiotherapy could improve survival outcomes for patients with esophageal cancer: a meta-analysis based on randomized trials. Oncotarget. 2017;8:20410–7.
doi: 10.18632/oncotarget.14669
Xi M, Yang Y, Zhang L, et al. Multi-institutional analysis of recurrence and survival after neoadjuvant chemoradiotherapy of esophageal cancer: impact of histology on recurrence patterns and outcomes. Ann Surg. 2019;269(4):663–70.
doi: 10.1097/SLA.0000000000002670
Tomasello G, Petrelli F, Ghidini M, et al. Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: a meta-analysis of 17 published studies. Eur J Surg Oncol. 2017;43(9):1607–16.
doi: 10.1016/j.ejso.2017.03.001
van Hagen P, Wijnhoven BP, Nafteux P, et al. Recurrence pattern in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer. Br J Surg. 2013;100:267–73.
doi: 10.1002/bjs.8968
Vallböhmer D, Hölscher AH, DeMeester S, et al. A multicenter study of survival after neoadjuvant radiotherapy/chemotherapy and esophagectomy for ypT0N0M0R0 esophageal cancer. Ann Surg 2010, 252(5):744–9.
doi: 10.1097/SLA.0b013e3181fb8dde
Rizk NP, Venkatraman E, Bains MS, et al. American joint committee on cancer staging system does not accurately predict survival in patients receinving multimodality therapy for oesophageal adenocarcinoma. J Clin Oncol 2007, 25:507–12.
doi: 10.1200/JCO.2006.08.0101
Xi M, Hallemeier CL, Merrell KW, et al. Recurrence risk stratification after preoperative chemoradiation of esophageal adenocarcinoma. Ann Surg 2018, 268:289–95.
doi: 10.1097/SLA.0000000000002352
Verlato G, Zanoni A, Tomezzoli A, et al. Response to induction therapy in oesophageal and cardia carcinoma using Mandard tumor regression grade or size of residual foci. Br J Surg. 2010;97(5):719–25.
doi: 10.1002/bjs.6949
Jipping KM, Hulshoff JB, van Amerongen EA, Bright TI, Watson DI, Plukker JTM. Influence of tumor response and treatment schedule on the distribution of tumor recurrence in esophageal cancer patients treated with neoadjuvant chemoradiotherapy. J Surg Oncol. 2017;116(8):1096–102.
doi: 10.1002/jso.24786
Rice TW, Patil DT, Blackstone EH. 8th edition AJCC/UICC staging of cancers og the esophagus and esophagogastric junction: application to clinical practice. Ann Cardiothotac Surg. 2017;6(2):119–30.
doi: 10.21037/acs.2017.03.14
Pasini F, de Manzoni G, Pedrazzani C, et al. High pathological response rate in locally advanced esophageal cancer after neoadjuvant combined modality therapy: dose finding of a weekly chemotherapy schedule with protracted venous infusion of 5-fluorouracil and dose escalation of cisplatin, docetaxel and concurrent radiotherapy. Ann Oncol. 2005;16(7):1133–9.
doi: 10.1093/annonc/mdi207
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
doi: 10.1097/01.sla.0000133083.54934.ae
Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer. 1994;73(11):2680–6.
pubmed: 8194005
Chao YK, Chan SC, Liu YH, et al. Pretreatment T3-4 stage is an adverse prognostic factor in patients with esophageal squamous cell carcinoma who achieve pathological complete response following preoperative chemoradiotherapy. Ann Surg. 2009;249:392–6.
doi: 10.1097/SLA.0b013e3181949e9f
Barbetta A, Sihag S, Nobel T, et al. Patterns and risk of recurrence in patients with esophageal cancer with a pathologic complete response after chemoradiotherapy followed by surgery. J Thorac Cardiovasc Surg. 2019;157(3):1249–59.
doi: 10.1016/j.jtcvs.2018.09.136
Steffen T, Dietrich D, Schnider A, et al. Recurrence Patterns and long-term results after induction chemotherapy, chemoradiotherapy and curative surgery in patients with locally advanced esophageal cancer. Ann Surg. 2019;269(1):83–7.
doi: 10.1097/SLA.0000000000002435
Sugawara K, Yamashita H, Seto Y. Optimal postoperative surveillance strategy in patients undergoing neoadjuvant chemoradiotherapy followed by surgery for esophageal carcinoma. J Thorac Dis. 2019;11(15):S1874–6.
doi: 10.21037/jtd.2019.08.89
Dossa F, Acuna SA, Rickles AS, et al. Association between adjuvant chemotherapy and overall survival in patients with rectal cancer and pathological complete response after neoadjuvant chemotherapy and resection. JAMA Oncol. 2018;4(7):930–7.
doi: 10.1001/jamaoncol.2017.5597
Lightdale CJ, Kulkarni KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol. 2005;23:4483–9.
doi: 10.1200/JCO.2005.20.644
Markar SR, Gronnier C, Pasquer A, et al. Role of neoadjuvant in clinical T2N0M0 oesophageal cancer: results from a retrospective multi-center European study. Eur J Cancer. 2016;56:59–68.
doi: 10.1016/j.ejca.2015.11.024
Lu SL, Hsu FM, Tsai CL, et al. Improved prognosis with induction chemotherapy in pathological complete responders after trimodality treatment for esophageal squamous cancer cell carcinoma: hypotesis generating for adjuvant treatment. Eur J Surg Oncol. 2019;45:1498–504.
doi: 10.1016/j.ejso.2019.03.020
Luc G, Gronnier C, Lebreton G, et al. Predictive factors of recurrence in patients with pathological complete response after esophagectomy following neoadjuvant chemoradiotherapy for esophageal cancer: a multicenter study. Ann Surg Oncol. 2015;22:S1357–64.
doi: 10.1245/s10434-015-4619-8
Egyud M, Tejani M, Pennathur A, et a. Detection of circulating tumor DNA in plasma: a potential biomarker for esophageal adenocarcinoma. Ann Thorac Surg. 2019;108:343–9.