Recurrence Patterns and Long-term Results After Induction Chemotherapy, Chemoradiotherapy, and Curative Surgery in Patients With Locally Advanced Esophageal Cancer

Steffen, Thomas; Dietrich, Daniel; Schnider, Annelies; Kettelhack, Christoph; Huber, Olivier; Marti, Walter R.; Furrer, Markus; Gloor, Beat; Schiesser, Marc; Thierstein, Sandra; Brauchli, Peter; Ruhstaller, Thomas

doi:10.1097/sla.0000000000002435

Cited by 37 publications

(32 citation statements)

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“…Through tumor downsizing and downstaging, nCRT improves locoregional control and overall survival rates compared to surgery alone [2][3][4]. The degree of tumor regression in response to nCRT is directly related to long-term survival, with pathologic complete response (pCR) resulting in the most favorable long-term prognosis [4,5]. A pCR, defined as the absence of viable tumor cells at the site of the primary tumor after nCRT, is observed in around 16-29% of the patients after nCRT [2,6,7].…”

Section: Introductionmentioning

confidence: 99%

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

et al. 2019

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Objective This study was conducted in order to determine the optimal timing of diffusion-weighted magnetic resonance imaging (DW-MRI) for prediction of pathologic complete response (pCR) to neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. Methods Patients with esophageal adenocarcinoma or squamous cell carcinoma who planned to undergo nCRT followed by surgery were enrolled in this prospective study. Patients underwent six DW-MRI scans: one baseline scan before the start of nCRT and weekly scans during 5 weeks of nCRT. Relative changes in mean apparent diffusion coefficient (ADC) values between the baseline scans and the scans during nCRT (ΔADC(%)) were compared between pathologic complete responders (pCR) and non-pCR (tumor regression grades 2-5). The discriminative ability of ΔADC(%) was determined based on the c-statistic. Results A total of 24 patients with 142 DW-MRI scans were included. pCR was observed in seven patients (29%). ΔADC(%) from baseline to week 2 was significantly higher in patients with pCR versus non-pCR (median [IQR], 36% [30%, 41%] for pCR versus 16% [14%, 29%] for non-pCR, p = 0.004). The ΔADC(%) of the second week in combination with histology resulted in the highest c-statistic for the prediction of pCR versus non-pCR (0.87). The c-statistic of this model increased to 0.97 after additional exclusion of patients with a small tumor volume (< 7 mL, n = 3) and tumor histology of the resection specimen other than adenocarcinoma or squamous cell carcinoma (n = 1). Conclusion The relative change in tumor ADC (ΔADC(%)) during the first 2 weeks of nCRT is the most predictive for pathologic complete response to nCRT in esophageal cancer patients. Key Points • DW-MRI during the second week of neoadjuvant chemoradiotherapy is most predictive for pathologic complete response in esophageal cancer. • A model including ΔADC week 2 was able to discriminate between pathologic complete responders and non-pathologic complete responders in 87%. • Improvements in future MRI studies for esophageal cancer may be obtained by incorporating motion management techniques.

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Section: Introductionmentioning

confidence: 99%

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

et al. 2019

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“…Patients with residual tumor cells after neoadjuvant therapy primarily experience relapse within the first two postoperative years; however, there have been reports of patients with complete remission who experienced late relapses four years after surgery. After curative surgery in a trimodality, the histological type and response to neoadjuvant therapy predicted different prognoses . The CROSS trial demonstrated median overall survival (OS) of 49.4 months in the nCRT + surgery group compared to 24 months in the surgery alone cohort ( P = 0.003) .…”

Section: Introductionmentioning

confidence: 99%

“…After curative surgery in a trimodality, the histological type and response to neoadjuvant therapy predicted different prognoses. 8 The CROSS trial demonstrated median overall survival (OS) of 49.4 months in the nCRT + surgery group compared to 24 months in the surgery alone cohort (P = 0.003). 9,10 The five-year survival rates were 47% and 34%, respectively, and 29% of patients reached a pathological complete response (pCR).…”

Section: Introductionmentioning

confidence: 99%

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

et al. 2018

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BackgroundAlthough a clinical complete response (cCR) after chemoradiotherapy (CRT) could lead to a better prognosis, the choice of a following strategy, such as surgical or non‐surgical approach, remains controversial.MethodsAll articles relevant to a comparison of surgical and non‐surgical treatment (including further definitive chemoradiotherapy or active surveillance) for esophageal carcinoma patients with a cCR after CRT were retrieved for meta‐analysis. The final date for data retrieval was 30 June 2018.ResultsFour retrospective studies including 648 patients met the inclusion criteria: 620 with squamous cell carcinoma and 28 with adenocarcinoma. The CRT + surgery group had an advantage over the non‐surgery group in regard to two‐year disease‐free survival (DFS); however, the two groups showed similar results in five‐year DFS. The CRT + surgery group had an advantage over the non‐surgery group in two‐year overall survival (OS); nevertheless, the two groups showed similar results in five‐year OS.ConclusionsBased on the available evidence, the addition of surgery to thoracic locally advanced esophageal carcinoma patients with a cCR after neoadjuvant CRT provided no advantage to long‐term survival. As an exception, the two‐year DFS and OS could be improved. This research conclusion might be more suitable to patients with squamous cell carcinoma.

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“…Over the decades, esophagectomy with lymph node (LN) dissection has remained the most effective treatment modality for patients with early-stage ESCC (6,7). Adequate lymph nodes harvested, esophagectomy might increase postoperative morbidity and mortality which is probably unsuitable for patients with suspected T1N0M0 disease (8)(9)(10).…”

Section: Bcakgroundmentioning

confidence: 99%

Development and Validation of a Gene-panel-based Nomogram for Prediction of Lymph Node Metastasis in Esophageal Squamous Cell Carcinoma

Chen

Wang

et al. 2020

Preprint

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Background: Esophageal squamous cell carcinoma (ESCC) is one of the main histological subtypes of esophageal cancer. This study aimed to develop a gene-panel-based nomogram for identification of lymph node metastasis (LNM) in ESCC patients.Methods: RNA sequencing profiles of ESCC patients were obtained from the Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA) database. A bioinformatic approach was employed to investigate differentially expressed genes (DEGs) between ESCC patients with LNM and those without. A 4-DEGs panel was eventually identified and integrated with clinical characteristics to construct a nomogram for predicting LNM. Predictive performance of the nomogram was further evaluated by calibration curves and concordance index (C-index). Results: A total of 179 ESCC patients with 32059 genes from the GEO dataset were included. Among these genes, 3524 DEGs were correlated with lymph node involvement. Meanwhile, TCGA dataset containing 93 ESCC patients was obtained, in which 82 DEGs were selected out of 18416 genes. Among the 11 communal DEGs, four genes were identified to be (ALG3, CPOX, LMLN, PSMD2) associated with LNM. A nomogram was established by integrating the four-gene panel and three clinical characteristics including T stage, G stage and tumor location. The nomogram exhibited good performance with C-indices of 0.710 and 0.693 in the GEO and TCGA datasets, respectively. Conclusion: Our novel 4-gene-based nomogram displayed its value in prediction of LNM in ESCC patients, which may be helpful in determining treatment approach for early-stage ESCC patients.

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Recurrence Patterns and Long-term Results After Induction Chemotherapy, Chemoradiotherapy, and Curative Surgery in Patients With Locally Advanced Esophageal Cancer

Abstract: After curative surgery in a multimodal setting, the histological type and the response to neoadjuvant therapy predicted the time frame of relapse; this knowledge may influence further follow-up guidelines for esophageal carcinoma.

Cited by 37 publications

References 12 publications

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

Optimal timing for prediction of pathologic complete response to neoadjuvant chemoradiotherapy with diffusion-weighted MRI in patients with esophageal cancer

Clinical complete response after chemoradiotherapy for carcinoma of thoracic esophagus: Is esophagectomy always necessary? A systematic review and meta‐analysis

Development and Validation of a Gene-panel-based Nomogram for Prediction of Lymph Node Metastasis in Esophageal Squamous Cell Carcinoma

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