Active Surveillance Versus Immediate Surgery in Clinically Complete Responders After Neoadjuvant Chemoradiotherapy for Esophageal Cancer

Wilk, Berend J van der; Noordman, Bo Jan; Neijenhuis, Lisanne K A; Nieboer, Daan; Nieuwenhuijzen, Grard A. P.; Sosef, Meindert N.; Henegouwen, Mark I. van Berge; Lagarde, Sjoerd M.; Spaander, Manon C.W.; Valkema, Roelf; Biermann, Katharina; Wijnhoven, Bas P. L.; Gaast, Ate van der; Lanschot, J. Jan B. van; Doukas, Michael; Nikkessen, Suzan; Luyer, Misha; Schoon, Erik J.; Roef, Mark J.; Lijnschoten, Ineke van; Oostenbrug, Liekele E.; Riedl, Robert G.; Gisbertz, Suzanne S.; Krishnadath, Kausilia K.; Bennink, Roel J.; Meijer, Sybren L.

doi:10.1097/sla.0000000000003636

Cited by 40 publications

(13 citation statements)

References 34 publications

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“…Many studies have demonstrated that pCR is associated with a longer disease-free survival (DFS) and overall survival (OS) duration [7,8]. In view of the substantial postoperative morbidity and the decrease of quality of life associated with esophagectomy, active surveillance approach could be implemented and improve outcomes in patients with pCR after neoadjuvant therapy [9]. Therefore, how to select patients achieving pCR after neoadjuvant immunochemotherapy is a major unmet need in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

The role of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant PD-1 blockade in combination with chemotherapy for resectable esophageal squamous cell carcinoma

Wang

Yang

Zhou

et al. 2022

Eur J Nucl Med Mol Imaging

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Purpose Accurate assessment of residual disease of tumor and lymph nodes after neoadjuvant immunochemotherapy is crucial in the active surveillance for patients with pathological complete response (pCR) and the optimal extent of lymphadenectomy for patients with non-pCR. This post-hoc analysis aimed to evaluate the performance of 18 F-FDG PET/CT to predict the pathological response to neoadjuvant immunochemotherapy for esophageal squamous cell carcinoma (ESCC).Methods Fifty-eight resectable ESCC patients, received two cycles of camrelizumab in combination with chemotherapy were enrolled in the nal analysis. The 18 F-FDG PET/CT scans were acquired at baseline (scan-1) and after immunochemotherapy but prior to surgery (scan-2). Maximum standardized uptake value (SUV max ), mean standardized uptake value (SUV mean ), tumor-to-blood pool SUV max ratio (SUV TBR ), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were evaluated for their association with the pathological response to immunochemotherapy.Results Nineteen patients (32.8%, 19/58) had pCR and thirty-nine patients (67.2%, 39/58) had non-pCR after two doses of camrelizumab and chemotherapy. At scan-2, the SUV max , SUV mean , SUV TBR , TLG and MTV were signi cantly lower in pCR than that in non-pCR patients. Decrease in TLG and MTV between scan-2 and scan-1 of the same patient were signi cantly higher in the pCR than in the non-pCR group. In the receiver operating characteristic curve analysis, SUV max , SUV mean , SUV TBR , TLG and MTV in scan-2 showed excellent predictive value for the pCR of primary tumors. Furthermore, SUV max in scan-2 were higher in positive lymph nodes than that in negative ones, suggesting a high negative predictive ability (98.6%) with a cut-off value at 1.4. ConclusionThe parameters of 18 F-FDG PET/CT have the excellent performance for predicting pCR after the combined neoadjuvant immunochemotherapy in resectable ESCC.

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Section: Introductionmentioning

confidence: 99%

The role of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant PD-1 blockade in combination with chemotherapy for resectable esophageal squamous cell carcinoma

Wang

Yang

Zhou

et al. 2022

Eur J Nucl Med Mol Imaging

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“…Van der Wilk et al reported that patients with esophageal cancer who achieved a clinical complete response after neoCRT and underwent active surveillance had a survival outcome comparable to immediate surgery after neoCRT. The 3-year OS was 77% vs. 55% (p = 0.104) and the 3-year PFS was 60% v. 54% (p = 0.871) in the active surveillance and immediate surgery groups, respectively 27 . Taketa et al described similar findings.…”

Section: Discussionmentioning

confidence: 93%

Good prediction of treatment responses to neoadjuvant chemoradiotherapy for esophageal cancer based on preoperative inflammatory status and tumor glucose metabolism

Lin

Yeh

et al. 2021

Sci Rep

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To develop a tool for predicting pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (neoCRT) in patients with esophageal cancer by combining inflammatory status and tumor glucose metabolic activity. This study included 127 patients with locally advanced esophageal cancer who had received neoCRT followed by esophagectomy from 2007 to 2016. We collected their neutrophil–lymphocyte ratio (NLR) and standardized uptake value (SUV) obtained from fluorodeoxyglucose positron emission tomography (PET/CT) before and after neoCRT. Univariate and multivariate logistic regression analyses were performed to identify potential predictive factors for pCR. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of predictors were calculated. Between pCR and non-pCR groups, there were no statistically significant differences in patient characteristics, such as sex, age, site, and clinical T/N stage. Multivariate analyses identified four independent predictors for pCR, including pre-OP NLR < 5.4 [OR 11.179; 95% CI 8.385–13.495; p = 0.003], NLR change (ΔNLR) < 3 [OR 4.891; 95% CI 2.274–9.180; p = 0.005], changes in SUV (ΔSUV) > 7.2 [OR 3.033; 95% CI 1.354–6.791; p = 0.007], and SUV changes ratio (ΔSUV ratio) > 58% [OR 3.585; 95% CI 1.576–8.152; p = 0.002]. ΔNLR had the highest accuracy and NPV (84.3% and 90.3%, respectively). Combined factors of ΔNLR < 3 and ΔSUV ratio > 58% had the best PPV for pCR (84.8%). Inflammatory status (ΔNLR) and tumor glucose metabolic activity (ΔSUV ratio), when considered together, constitute a promising low-invasive tool with high efficacy for prediction of treatment response before surgery.

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“…Ultimately, 9 articles, comprising 749 patients, were deemed eligible for inclusion in our study. Among these articles, most came from Asia [3 from Korea ( 8 , 13 , 14 ); 1 from Taiwan/China ( 11 ), and 1 from Turkey ( 15 )], and 4 came from the West (1 each from Italy ( 10 ), the Netherlands ( 16 ), France ( 17 ), and Ireland ( 18 )]. In total, 333 and 416 patients were categorized into the nCRT and nCRT + S groups, respectively.…”

Section: Resultsmentioning

confidence: 99%

Comparison of clinical outcomes of conservative treatment and surgery for esophageal cancer patients who achieve a clinical complete response following neoadjuvant chemoradiotherapy: a systematic review and meta-analysis

Sun¹,

Zheng²,

Xu³

et al. 2022

Ann Transl Med

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Background: Although the clinical complete response (cCR) for esophageal cancer patients after neoadjuvant chemoradiotherapy (nCRT) may be related to the good survival prognosis, the choice of conservative and surgical treatments is still controversial. This study sought to compare the clinical outcomes of these two treatments.Methods: A systematic search was conducted according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses of the PubMed, Embase, and Cochrane Library databases to retrieve articles published between January 1, 2010 and March 31, 2022 on the efficacy of conservative treatment or surgery in esophageal cancer patients who had achieved a cCR after nCRT The predominant endpoints were overall survival (OS), disease-free-survival (DFS), local recurrence, and distant metastasis.Odds ratios (ORs) were generated for the dichotomous variants by meta-analysis. The software implemented was Stata 16.0 MP. This research was prospectively registered under PROSPERO (registration number: CRD42022332143).Results: Ultimately, eight retrospective cohort studies and one randomized controlled trial, comprising 749 patients (nCRT group: 333 and nCRT + surgery group: 416), were included in the meta-analysis after two researchers independently assessed the risk of bias for all included studies. The 2-year OS [OR =1.239, 95% confidence interval (CI): 0.891 to 1.723] and 5-year OS (OR =1.369, 95% CI: 0.963 to 1.947) were comparable between the nCRT group and nCRT plus surgery (nCRT + S) group. Patients in the nCRT + S group had significantly longer DFS (2 and 5 years, OR ranging from 0.303 to 0.357) and lower local recurrence rate (OR =0.179, 95% CI: 0.104 to 0.291) than those in the nCRT group. However, the distant metastasis rate was similar between the nCRT group and the nCRT + S group.Conclusions: Esophageal cancer patients who achieved a cCR after nCRT and received an esophagectomy had better DFS and lower local recurrence than those who received conservative treatment; however, this DFS advantage did not lead to a significant difference in OS. Salvage surgery may be a feasible option for resectable patients who have local recurrence after achieving cCR.

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Active Surveillance Versus Immediate Surgery in Clinically Complete Responders After Neoadjuvant Chemoradiotherapy for Esophageal Cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 40 publications

References 34 publications

The role of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant PD-1 blockade in combination with chemotherapy for resectable esophageal squamous cell carcinoma

The role of 18F-FDG PET/CT in predicting the pathological response to neoadjuvant PD-1 blockade in combination with chemotherapy for resectable esophageal squamous cell carcinoma

Good prediction of treatment responses to neoadjuvant chemoradiotherapy for esophageal cancer based on preoperative inflammatory status and tumor glucose metabolism

Comparison of clinical outcomes of conservative treatment and surgery for esophageal cancer patients who achieve a clinical complete response following neoadjuvant chemoradiotherapy: a systematic review and meta-analysis

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