Long-term outcomes following neoadjuvant chemoradiotherapy for esophageal cancer

• Published in: Annals of surgery Vol. 245; no. 5; pp. 707 - 716
• Main Authors: REYNOLDS, John Vincent, MULDOON, Cian, HOLLYWOOD, Donal, RAVI, Narayanasamy, ROWLEY, Suzanne, O'BYRNE, Ken, KENNEDY, John, MURPHY, Thomas J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 01.05.2007
• Subjects: Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Antineoplastic Agents - administration & dosage; Biological and medical sciences; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy; Esophagus; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Male; Medical sciences; Middle Aged; Neoadjuvant Therapy; Neoplasm Staging; Original; Prospective Studies; Radiotherapy, Adjuvant; Survival Rate; Treatment Outcome; Tumors; Medicine; Prognosis; Surgery; Esophageal disease; Digestive diseases; Evolution; Malignant tumor; Chemoradiotherapy; Long term; Esophagus cancer; Neoadjuvant treatment
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/01.sla.0000254367.15810.38

We present and analyze long-term outcomes following multimodal therapy for esophageal cancer, in particular the relative impact of histomorphologic tumor regression and nodal status. A total of 243 patients [(adenocarcinoma (n = 170) and squamous cell carcinoma (n = 73)] treated with neoadjuvant chemoradiotherapy in the period 1990 to 2004 were followed prospectively with a median follow-up of 60 months. Pathologic stage and tumor regression grade (TRG) were documented, the site of first failure was recorded, and Kaplan-Meier survival curves were plotted. Thirty patients (12%) did not undergo surgery due to disease progression or deteriorated performance status. Forty-one patients (19%) had a complete pathologic response (pCR), and there were 31(15%) stage I, 69 (32%) stage II, and 72 (34%) stage III cases. The overall median survival was 18 months, and the 5-year survival was 27%. The 5-year survival of patients achieving a pCR was 50% compared with 37% in non-pCR patients who were node-negative (P = 0.86). Histomorphologic tumor regression was not associated with pre-CRT cTN stage but was significantly (P < 0.05) associated with ypN stage. By multivariate analysis, ypN status (P = 0.002) was more predictive of overall survival than TRG (P = 0.06) or ypT stage (P = 0.39). Achieving a node-negative status is the major determinant of outcome following neoadjuvant chemoradiotherapy. Histomorphologic tumor regression is less predictive of outcome than pathologic nodal status (ypN), and the need to include a primary site regression score in a new staging classification is unclear.