Remnant lymph node metastases after neoadjuvant therapy and surgery in patients with pathologic T0 esophageal carcinoma impact on prognosis

Lv, Hongwei; Li, Yin; Zhou, Mengting; Jiwei, Cheng; Xing, Wei

doi:10.1097/md.0000000000007342

Cited by 7 publications

(10 citation statements)

References 22 publications

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“…2), indicating the need for potential useful biomarkers to select patients better with improved treatment options taking into account the differences in histological types. [31][32][33] This study also showed that we need more innovative and protocol-based information of both pretreatment imaging and examination of the pathological specimens. Promising is the image quantification with radiomics as a potential future tool in predicting nCRT response after EC treatment.…”

Section: Discussionmentioning

confidence: 73%

“…DFS was also related with residues in the anatomical layer in TRG 1-5 (n ¼ 143) specimens, including muscularis mucosae, submucosa, muscularis propria, and adventitia (median DFS: 16-29 months; P ¼ 0.028). Among the TRG 2-3 group (n ¼ 118), the median DFS was 26 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) months. Patients with macroscopic residual tumor had a significantly worse DFS compared to patients with microscopic tumor alone (16 vs 33 months; P¼ 0.022) (Fig.…”

Section: Outcomementioning

confidence: 99%

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Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields

et al. 2020

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Objective:Neoadjuvant chemoradiotherapy followed by surgery establishes a considerable pathologic complete response (pCR) in EC. The aim was to determine site of residual tumor and its prognostic impact.Summary Background Data:High rates of residual tumor in the adventitial region even inside the radiation fields will influence current decision-making.Methods:We evaluated resection specimens with marked target fields from 151 consecutive EC patients treated with carboplatin/paclitaxel and 41.4Gy between 2009 and 2018.Results:In radically resected (R0) specimens 19.8% (27/136) had a pCR (ypT0N0) and 14% nearly no response (tumor regression grade: tumor regression grade 4–5). Residual tumor commonly extended in or restricted to the adventitia (43.1%; 47/109), whereas 7.3% was in the mucosa (ypT1a), 16.5% in the submucosa (ypT1b) and 6.4% only in lymph nodes (ypT0N+). Macroscopic residues in R0-specimens of partial responders (tumor regression grade 2-3: N = 90) were found in- and outside the gross tumor volume (GTV) in 33.3% and 8.9%, and only microscopic in- and outside the clinical target volume in 58.9% and 1.1%, respectively. Residual nodal disease was observed proximally and distally to the clinical target volume in 2 and 5 patients, respectively. Disease Free Survival decreased significantly if macroscopic tumor was outside the GTV and in ypT2-4aN+.Conclusions:After neoadjuvant chemoradiotherapy, pCR and ypT1aN0 were seen in a limited number of R0 resected specimens (19.8% and 7.3%, respectively), whereas 6.4% had only nodal disease (yT0N+). Disease Free Survival decreased significantly if macroscopic residue was outside the GTV and in responders with only nodal disease. Therefore, we should be cautious in applying wait and see strategies.

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Section: Discussionmentioning

confidence: 73%

Section: Outcomementioning

confidence: 99%

Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields

et al. 2020

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“…16 Another critical problem is that the current TRG systems do not consider the ypN status. ypN status has been reported to be the major determinant of prognosis, 11,12 and a pCR is technically ypT0N0. 17 However, current TRG systems do not distinguish ypT0N0 and ypT0N+, which have been proven to have different prognoses in Lv et al's report 12 and also in our study (Figure 1).…”

Section: T a B L E 2 Baseline Characteristics Of The Study Patientsmentioning

confidence: 99%

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

et al. 2022

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“…Additionally, the TRG was evaluated by centre-specific pathologists and only evaluated the regression grade of the primary tumour and not of the lymph nodes. As a consequence, persistent disease only at the nodal level was possible [32][33][34]. Since the lack of adequate TRG systems for nodes after preoperative treatment and the relatively low percentage of patients in our study with an ypT0Nþ, the current study focussed on the primary tumour.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose and pathological response in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery: a multi-institutional analysis

et al. 2019

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Purpose: To explore whether a higher neoadjuvant radiation dose increases the probability of a pathological complete response (pCR) or pathological major response (pMR) response in oesophageal cancer patients. Material and methods: Between 2000 and 2017, 1048 patients from four institutions were stratified according to prescribed neoadjuvant radiation doses of 36.0 Gy (13.3%), 40.0 Gy (7.4%), 41.4 Gy (20.1%), 45.0 Gy (25.5%) or 50.4 Gy (33.7%) in 1.8-2.0 Gy fractions. Endpoints were pCR (tumour regression grade (TRG) 1) and pMR (TRG 1 þ 2). Multivariable binary (TRG 1 þ 2 vs. TRG > 2) and ordinal (TRG 1 vs. TRG 2 vs. TRG > 2) logistic regression analyses were performed, with subgroup analyses according to histology (squamous cell carcinoma (SCC) vs. adenocarcinoma (AC)). Variables entered in the regression model along with neoadjuvant radiation dose were clinical tumour stage (cT), histology, chemotherapy regimen, induction chemotherapy and time from neoadjuvant chemoradiation to surgery. Results: A pCR was observed in 312 patients (29.8%); in 22.7% patients with AC and in 49.6% patients with SCC. No radiation dose-response relation was observed for pCR (OR ¼ 1.01, 95% CI: 0.98-1.05 for AC and OR ¼ 1.03, 95% CI: 0.96-1.10 for SCC). A pMR was observed in 597 patients (57.0%); in 53.4% patients with AC and in 67.2% patients with SCC. A higher radiation dose increased the probability of achieving pMR (OR ¼ 1.04, 95% CI: 1.02-1.05). Factors reducing this probability were advanced cT stage (reference ¼ cT1-2; cT3: OR ¼ 0.54, 95% CI: 0.37-0.80; cT4: OR ¼ 0.45, 95% CI: 0.24-0.84), AC histology (reference ¼ SCC; OR ¼ 0.62, 95% CI: 0.44-0.88), the use of non-platinum based chemotherapy in SCC patients (OR ¼ 0.30, 95% CI: 0.10-0.91) and platinum based chemotherapy without induction chemotherapy in patients with AC (OR ¼ 0.56, 95% CI: 0.42-0.76). The radiation dose-response relation was confirmed in a subgroup analysis of histologic subtypes (OR ¼ 1.02, 95% CI: 1.01-1.04 for AC and OR ¼ 1.05, 95% CI: 1.02-1.08 for SCC). Conclusions: Neoadjuvant radiation dose impacts pathological response in terms of pMR in oesophageal cancer patients. No radiation dose-response effect was observed for pCR. Further prospective trials are needed to investigate the dose-response relation in terms of pCR ARTICLE HISTORY

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Remnant lymph node metastases after neoadjuvant therapy and surgery in patients with pathologic T0 esophageal carcinoma impact on prognosis

Abstract: Supplemental Digital Content is available in the text

Cited by 7 publications

References 22 publications

Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields

Locoregional Residual Esophageal Cancer after Neo-adjuvant Chemoradiotherapy and Surgery Regarding Anatomic Site and Radiation Target Fields

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy

Radiation dose and pathological response in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy followed by surgery: a multi-institutional analysis

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