Prediction of survival in patients with oesophageal or junctional cancer receiving neoadjuvant chemoradiotherapy and surgery

Shapiro, Joël; Klaveren, David van; Lagarde, Sjoerd M.; Toxopeus, Eelke; Gaast, Ate van der; Hulshof, Maarten C.C.M.; Wijnhoven, Bas P. L.; Henegouwen, Mark I. van Berge; Lanschot, J. Jan B. van

doi:10.1002/bjs.10142

Cited by 30 publications

(54 citation statements)

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“…The absence of an association between lymph node harvest and survival in the NCRS group is consistent with the analysis of patients from the CROSS trial and further non-randomized data, which found that the total number of resected nodes was associated with survival in the surgery-alone group but not in the NCRS group [15, 16]. These results suggest that regional control of esophageal adenocarcinoma is essential and might either be achieved through chemotherapy with radical lymphadenectomy or neoadjuvant chemoradiotherapy with limited lymphadenectomy.…”

Section: Discussionsupporting

confidence: 80%

Multimodality treatment for esophageal adenocarcinoma: multi-center propensity-score matched study

et al. 2017

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BackgroundThe primary aim of this study was to compare survival from neoadjuvant chemoradiotherapy plus surgery (NCRS) versus neoadjuvant chemotherapy plus surgery (NCS) for the treatment of esophageal or junctional adenocarcinoma. The secondary aims were to compare pathological effects, short-term mortality and morbidity, and to evaluate the effect of lymph node harvest upon survival in both treatment groups.MethodsData were collected from 10 European centers from 2001 to 2012. Six hundred and eight patients with stage II or III oesophageal or oesophago-gastric junctional adenocarcinoma were included; 301 in the NCRS group and 307 in the NCS group. Propensity score matching and Cox regression analyses were used to compensate for differences in baseline characteristics.ResultsNCRS resulted in significant pathological benefits with more ypT0 (26.7% versus 5%; P < 0.001), more ypN0 (63.3% versus 32.1%; P < 0.001), and reduced R1/2 resection margins (7.7% versus 21.8%; P < 0.001). Analysis of short-term outcomes showed no statistically significant differences in 30-day or 90-day mortality, but increased incidence of anastomotic leak (23.1% versus 6.8%; P < 0.001) in NCRS patients.There were no statistically significant differences between the groups in 3-year overall survival (57.9% versus 53.4%; Hazard Ratio (HR)= 0.89, 95%C.I. 0.67-1.17, P = 0.391) nor disease-free survival (52.9% versus 48.9%; HR = 0.90, 95%C.I. 0.69-1.18, P = 0.443). The pattern of recurrence was also similar (P = 0.660). There was a higher lymph node harvest in the NCS group (27 versus 14; P < 0.001), which was significantly associated with a lower recurrence rate and improved disease free survival within the NCS group.ConclusionThe survival differences between NCRS and NCS maybe modest, if present at all, for the treatment of locally advanced esophageal or junctional adenocarcinoma. Future large-scale randomized trials must control and monitor indicators of the quality of surgery, as the extent of lymphadenectomy appears to influence prognosis in patients treated with NCS, from this large multi-center European study.

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Section: Discussionsupporting

confidence: 80%

Multimodality treatment for esophageal adenocarcinoma: multi-center propensity-score matched study

et al. 2017

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“…Cardiovascular co‐morbidities, cN, ypT and ypN categories, chyle leakage and pulmonary complications were independent predictors of survival in the present analysis. Shapiro and colleagues developed a prediction model for survival of patients with oesophageal cancer after neoadjuvant chemoradiation, and also found cN, ypT and ypN categories to be strong predictors of survival. In contrast to the present study, conditional survival was not implemented in their final model and postoperative complications were not included in the analyses.…”

Section: Discussionmentioning

confidence: 99%

Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

Hagens

Feenstra

Eshuis

et al. 2020

British Journal of Surgery

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Background Conditional survival accounts for the time already survived after surgery and may be of additional informative value. The aim was to assess conditional survival in patients with oesophageal cancer and to create a nomogram predicting the conditional probability of survival after oesophagectomy. Methods This retrospective study included consecutive patients with oesophageal cancer who received neoadjuvant chemoradiation followed by oesophagectomy between January 2004 and 2019. Conditional survival was defined as the probability of surviving y years after already surviving for x years. The formula used for conditional survival (CS) was: CS(x|y) = S(x + y)/S(x), where S(x) represents overall survival at x years. Cox proportional hazards models were used to evaluate predictors of overall survival. A nomogram was constructed to predict 5‐year survival directly after surgery and given survival for 1, 2, 3 and 4 years after surgery. Results Some 660 patients were included. Median overall survival was 44·4 (95 per cent c.i. 37·0 to 51·8) months. The probability of achieving 5‐year overall survival after resection increased from 45 per cent directly after surgery to 54, 65, 79 and 88 per cent given 1, 2, 3 and 4 years already survived respectively. Cardiac co‐morbidity, cN category, ypT category, ypN category, chyle leakage and pulmonary complications were independent predictors of survival. The nomogram predicted 5‐year survival using these predictors and number of years already survived. Conclusion The probability of achieving 5‐year overall survival after oesophagectomy for cancer increases with each additional year survived. The proposed nomogram predicts survival in patients after oesophagectomy, taking the years already survived into account.

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“…The proposed risk score - based on well-recognized prognostic factors [3, 20, 21, 24, 25, 30] - has reasonable predictive value and may guide clinical decision making. The data indicate that patients with low scores have limited risk of interval metastases, and that in these patients a restaging 18 F-FDG PET/CT may be safely omitted without subjecting the patient to the risks of further diagnostic tests.…”

Section: Discussionmentioning

confidence: 99%

“…Categories were based on previously published cut-off points or estimated by receiver operating characteristic (ROC) curve analysis while maximizing sensitivity and specificity. Clinical factors available before initiation of treatment that have previously been identified as prognostic factors in oesophageal cancer included gender [19], age (dichotomized into <65 and ≥ 65) [20], Histology (adenocarcinoma versus squamous cell carcinoma [3, 20], histologic differentiation grade (good/moderate versus poor) [20, 21], signet ring cell adenocarcinoma [22, 23], EUS-based tumor length (dichotomized into <4.0 cm and ≥ 4.0 cm) [24, 25], nontraversability by EUS [15, 24], tumor location (upper/middle versus distal or gastro-oesophageal junction) [18], clinical T-status (T1b-2 versus T3–4) [19, 20], clinical N status (N0 versus N1–3) [20, 21], maximum lymph node diameter measured on axial CT image (<1.0 cm versus ≥1 cm) [26, 27], and 18 F-FDG avid nodes at baseline PET [15]. The maximum standardized uptake value (SUV max ) of the primary tumor was dichotomized into <9.6 and ≥ 9.6 based on ROC curve analysis.…”

Section: Methodsmentioning

confidence: 99%

Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using 18F-FDG PET/CT

Goense

Ruurda

Carter

et al. 2018

Eur J Nucl Med Mol Imaging

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ObjectiveDuring neoadjuvant chemoradiotherapy for oesophageal cancer, or in the interval prior to surgery, some patients develop systemic metastasis. This study aimed to evaluate the diagnostic performance of 18F-FDG PET/CT for the detection of interval metastasis and to identify predictors of interval metastases in a large cohort of oesophageal cancer patients.MethodsIn total, 783 consecutive patients with potentially resectable oesophageal cancer who underwent chemoradiotherapy and pre- and post-treatment 18F-FDG PET/CT between 2006 and 2015 were analyzed from a prospectively maintained database. Diagnostic accuracy measures were calculated on a per-patient basis using histological verification or clinical follow-up as a reference standard. Multivariable logistic regression analysis was performed to determine pre-treatment predictors of interval metastasis. A prediction score was developed to predict the probability of interval metastasis.ResultsOf 783 patients that underwent 18F-FDG PET/CT restaging, 65 (8.3%) were found to have interval metastasis and 44 (5.6%) were deemed to have false positive lesions. The resulting sensitivity and specificity was 74.7% (95% CI: 64.3–83.4%) and 93.7% (95% CI: 91.6–95.4%), respectively. Multivariable analysis revealed that tumor length, cN status, squamous cell tumor histology, and baseline SUVmax were associated with interval metastasis. Based on these criteria, a prediction score was developed with an optimism adjusted C-index of 0.67 that demonstrated accurate calibration.Conclusions18F-FDG PET/CT restaging detects distant interval metastases in 8.3% of patients after chemoradiotherapy for oesophageal cancer. The provided prediction score may stratify risk of developing interval metastasis, and could be used to prioritize additional restaging modalities for patients most likely to benefit.

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Prediction of survival in patients with oesophageal or junctional cancer receiving neoadjuvant chemoradiotherapy and surgery

Cited by 30 publications

References 54 publications

Multimodality treatment for esophageal adenocarcinoma: multi-center propensity-score matched study

Multimodality treatment for esophageal adenocarcinoma: multi-center propensity-score matched study

Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

Prediction and diagnosis of interval metastasis after neoadjuvant chemoradiotherapy for oesophageal cancer using 18F-FDG PET/CT

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