Clinical parameters model for predicting pathologic complete response following preoperative chemoradiation in patients with esophageal cancer

Ajani, Jaffer A.; Correa, Arlene M.; Hofstetter, Wayne L.; Rice, David C.; Blum, Mariela A.; Suzuki, Akihiro; Takenaka, Takashi; Welsh, James W.; Lin, Steven H.; Lee, J. H.; Bhutani, Manoop S.; Ross, William A.; Maru, Dipen M.; Macapinlac, Homer A.; Erasmus, Jeremy J.; Komaki, Ritsuko; Mehran, Reza J.; Vaporciyan, Ara A.; Swisher, Stephen G.

doi:10.1093/annonc/mds210

Cited by 73 publications

(71 citation statements)

References 28 publications

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“…In concordance with the literature, this data demonstrate that female gender and SCCs are the strongest pre-treatment predictive factors for pCR (10,14,(26)(27)(28). However the number of females with SCC is too small in this cohort to confirm this with a significant better OS outcome.…”

Section: Discussionsupporting

confidence: 89%

“…Several studies have shown that pCR is independently associated with survival, both the 5-year OS and disease free survival (6,8,9). In literature, squamous cell carcinoma (SCC) and female gender are identified as predictive factors for pCR (8,(10)(11)(12)(13)(14), there is however limited knowledge on factors that can be used to predict which patients will achieve a pathologic non response (pNR). The effect of nCRT in patients with a pNR remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Non responders to neoadjuvant chemoradiation for esophageal cancer: why better prediction is necessary

Bakker¹,

Smit²,

Bruynzeel³

et al. 2017

J. Thorac. Dis.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Non responders to neoadjuvant chemoradiation for esophageal cancer: why better prediction is necessary

Bakker¹,

Smit²,

Bruynzeel³

et al. 2017

J. Thorac. Dis.

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“…13,14 Identification of a molecular or histologic marker that is that predicts pCR following CRT would provide useful adjunctive clinical information, although others have attempted to predict clinical surrogates for benefit from CRT. 22 It is worth noting that based on our model, even patients with a heavy residual disease burden demonstrated on pathology after CRT received a survival benefit from their trimodality treatment when compared with patients with comparable pathologic stage undergoing isolated esophagectomy. We predict that a typical patient with ypT4N3 disease received an estimated 9-month median survival benefit from their CRT, irrespective of their clinical stage of disease.…”

Section: Recent Randomized and Appropriately Powered Clinical Data Comentioning

confidence: 86%

Nomogram for predicting the benefit of neoadjuvant chemoradiotherapy for patients with esophageal cancer: A SEER‐Medicare analysis

Eil

Diggs

Wang

et al. 2013

Cancer

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BACKGROUND:The survival impact of neoadjuvant chemoradiotherapy (CRT) on esophageal cancer remains difficult to establish for specific patients. The aim of the current study was to create a Web-based prediction tool providing individualized survival projections based on tumor and treatment data. METHODS: Patients diagnosed with esophageal cancer between 1997 and 2005 were selected from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The covariates analyzed were sex, T and N classification, histology, total number of lymph nodes examined, and treatment with esophagectomy or CRT followed by esophagectomy. After propensity score weighting, a log-logistic regression model for overall survival was selected based on the Akaike information criterion. RESULTS: A total of 824 patients with esophageal cancer who were treated with esophagectomy or trimodal therapy met the selection criteria. On multivariate analysis, age, sex, T and N classification, number of lymph nodes examined, treatment, and histology were found to be significantly associated with overall survival and were included in the regression analysis. Preoperative staging data and final surgical margin status were not available within the SEER-Medicare data set and therefore were not included. The model predicted that patients with T4 or lymph node disease benefitted from CRT. The internally validated concordance index was 0.72. CONCLUSIONS: The SEER-Medicare database of patients with esophageal cancer can be used to produce a survival prediction tool that: 1) serves as a counseling and decision aid to patients and 2) assists in risk modeling. Patients with T4 or lymph node disease appeared to benefit from CRT. This nomogram may underestimate the benefit of CRT due to its variable downstaging effect on pathologic stage. It is available at skynet.ohsu.edu/nomograms. Cancer 2014;120:492-9.

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“…13,14 Approximately 5 to 6 weeks after the completion of chemoradiotherapy, the patients underwent preoperative restaging. All patients completed esophagectomy.…”

Section: Therapymentioning

confidence: 99%

Locoregional Failure Rate After Preoperative Chemoradiation of Esophageal Adenocarcinoma and the Outcomes of Salvage Strategies

Sudo

Takenaka

Correa

et al. 2013

JCO

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A B S T R A C T PurposeThe primary purpose of surveillance of patients with esophageal adenocarcinoma (EAC) and/or esophagogastric junction adenocarcinoma after local therapy (eg, chemoradiotherapy followed by surgery or trimodality therapy [TMT]) is to implement a potentially beneficial salvage therapy to overcome possible morbidity/mortality caused by locoregional failure (LRF). However, the benefits of surveillance are not well understood. We report on LRFs and salvage strategies in a large cohort. Patients and MethodsBetween 2000 and 2010, 518 patients with EAC who completed TMT were analyzed for the frequency of LRF over time and salvage therapy outcomes. Standard statistical techniques were used. ResultsFor 518 patients, the median follow-up time was 29.3 months (range, 1 to 149 months). Distant metastases (with or without LRF) occurred in 188 patients (36%), and LRF only occurred in 27 patients (5%). Eleven of 27 patients had lumen-only LRF. Most LRFs (89%) occurred within 36 months of surgery. Twelve patients had salvage chemoradiotherapy, but only five survived more than 2 years. Four patients needed salvage surgery, and three who survived more than 2 years developed distant metastases. The median overall survival of 27 patients with LRF was 17 months, and 10 patients (37%) survived more than 2 years. Thus, only 2% of all 518 patients benefited from surveillance/salvage strategies. ConclusionOur surveillance strategy, which is representative of many others currently being used, raises doubts about its effectiveness and benefits (along with concerns regarding types and times of studies and costs implications) to patients with EAC who have LRF only after TMT. Fortunately, LRFs are rare after TMT, but the salvage strategies are not highly beneficial. Our data can help develop an evidence-based surveillance strategy.

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Clinical parameters model for predicting pathologic complete response following preoperative chemoradiation in patients with esophageal cancer

Abstract: Our data suggest that the logistic regression model can predict pathCR with a high probability. This clinical model could complement others (biomarkers) to predict pathCR.

Cited by 73 publications

References 28 publications

Non responders to neoadjuvant chemoradiation for esophageal cancer: why better prediction is necessary

Non responders to neoadjuvant chemoradiation for esophageal cancer: why better prediction is necessary

Nomogram for predicting the benefit of neoadjuvant chemoradiotherapy for patients with esophageal cancer: A SEER‐Medicare analysis

Locoregional Failure Rate After Preoperative Chemoradiation of Esophageal Adenocarcinoma and the Outcomes of Salvage Strategies

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