The Pattern of Residual Tumor After Neoadjuvant Chemotherapy for Locally Advanced Esophageal Cancer and Its Clinical Significance

• Published in: Annals of surgery Vol. 271; no. 5; p. 875
• Main Authors: Hashimoto, Tadayoshi, Makino, Tomoki, Yamasaki, Makoto, Tanaka, Koji, Miyazaki, Yasuhiro, Takahashi, Tsuyoshi, Kurokawa, Yukinori, Motoori, Masaaki, Kimura, Yutaka, Nakajima, Kiyokazu, Morii, Eiichi, Mori, Masaki, Doki, Yuichiro
• Format: Journal Article
• Language: English
• Published: United States 01.05.2020
• Subjects: Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Neoplasm, Residual - pathology; Prognosis
• ISSN: 1528-1140
• DOI: 10.1097/SLA.0000000000003129

To investigate the residual pattern of esophageal cancer in the esophageal wall after neoadjuvant chemotherapy (NAC) and its clinical significance. NAC is a standard treatment for locally advanced esophageal cancer; however, residual tumor patterns in resected specimens after NAC and their clinico-pathological characteristics remain unknown. One hundred twenty consecutive patients with cT3 or deeper esophageal cancer underwent curative esophagectomy after NAC and achieved grade 2 histological responses between 2000 and 2016. Hematoxylin-eosin staining of residual tumor sections revealed 4 remnant categories: Type 1: shallow, Type 2: central, Type 3: deep, and Type 4: diffuse. We examined associations between these Types and clinico-pathological factors, including prognosis. Forty-five (38%) specimens had no residual tumor cells in the mucosal layer. The adventitia layer displayed the lowest residual tumor cell frequency (18%) among all layers. Types 1, 2, 3, and 4 residual tumor patterns were found in 49 (41%), 33 (28%), 9 (8%), and 29 (24%) patients, respectively. Type 4 showed the maximum standard uptake value after NAC; Types 3 and 4 had higher ratios of venous invasion than Type 1 or 2. Patients with Type 3 or 4 more frequently developed pleural dissemination or distant metastasis than patients with Type 1 or 2. Survival was similar among the 4 Types. After NAC for locally advanced esophageal cancer, the shallow residual tumor pattern was most common, but approximately 40% of specimens showed no tumor cells in the mucosal layer. Deep and diffuse remnant patterns were associated with high risks of pleural dissemination and distant metastasis.