High-Risk Features of Esophageal Adenocarcinoma Following Neoadjuvant Chemoradiation: Patients for whom Surgery Should Not Be Delayed.

Document Type

Article

Publication Date

9-2-2022

Publication Title

Annals of surgery

Keywords

washington; swedish; swedish thoracic

Abstract

OBJECTIVE: Clinical predictors of pathological complete response have not reliably identified patients for whom an organ-sparing approach following neoadjuvant chemoradiation be undertaken for esophageal cancer patients. We sought to identify high-risk predictors of residual carcinoma that may preclude patients from a selective surgical approach.

BACKGROUND DATA: Patients treated with neoadjuvant chemoradiation followed by esophagectomy for esophageal adenocarcinoma were identified.

METHODS: Correlation between clinical and pathologic complete responses were examined. Regression models and recursive partitioning were utilized to identify features associated with residual carcinoma. External validation of these high-risk factors was performed on a dataset from an independent institution.

RESULTS: 326 patients were identified, in whom clinical complete response was noted in 104/326 (32%). Pathologic complete response was noted in only 33/104 (32%) of these clinical complete responders. Multivariable analysis identified that the presence of stricture (P=0.011), positive biopsy (P=0.010), and signet ring cell histology (P=0.019) were associated with residual cancer. Recursive partitioning corroborated a 94% probability of residual disease, or greater, for each of these features. The positive predictive value was greater than 90% for these characteristics. A SUVmax>5.4 at the esophageal primary in the absence of esophagitis was also a high-risk factor for residual carcinoma. External validation confirmed these high-risk factors to be implicated in the finding of residual carcinoma.

CONCLUSIONS: Clinical parameters of response are poor predictors of complete pathologic response leading to challenges in selecting candidates for active surveillance. However, we characterize several high-risk features for residual carcinoma which indicate that esophagectomy should not be delayed.

Clinical Institute

Cancer

Clinical Institute

Digestive Health

Department

Oncology

Department

Surgery

Department

Gastroenterology

Link to Full Text

PSJH Full Text

Share

COinS