Clinical impact of remnant lymphatic invasion on the recurrence of esophageal squamous cell carcinoma after esophagectomy with neoadjuvant chemotherapy

Okuda, Sho; Ohuchida, Kenoki; Shindo, Koji; Moriyama, Taiki; Kawata, Jun; Tamura, Koji; Sada, Masafumi; Nagayoshi, Kinuko; Mizuuchi, Yusuke; Ikenaga, Naoki; Nakata, Kohei; Oda, Yoshinao; Nakamura, Masafumi

doi:10.3892/ol.2022.13457

Cited by 3 publications

(2 citation statements)

References 45 publications

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“…It was worth mentioning that further studies were needed to determine whether patients with esophageal cancer needed further adjuvant therapy after surgery. Evidence showed that esophageal cancer patients with residual lymphatic invasion after surgery needed adjuvant therapy [23]. Secondly, some patients with esophageal cancer receiving neoadjuvant therapy may not be sensitive to immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma

et al. 2023

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Background Neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy followed by surgery has been recommended as standard treatment in patients with locally advanced esophageal cancer (LAEC). But the risk of tumor recurrence still remained, and many patients refused or abandoned radiotherapy because of the intolerable adverse effects in China. Neoadjuvant immunochemotherapy (nICT) followed by surgery has become an emerging treatment in patients with esophageal cancer. There was still no consensus on whether nICT was superior to nCT alone in patients with esophageal cancer. Methods In this retrospective study, patients with resectable esophageal cancer who received surgery after nICT (n=26, 40%) or nCT alone (n=39, 60%) were included. The patients were classified as nICT or nCT arm. The primary endpoints were pathological tumor response (PTR) and event-free survival (EFS). The different clinic-pathological features were compared by the Kruskal-Wallis test for continuous variables and the Chi-square (χ2) test for categorical variables. Kaplan-Meier curves were used to estimate EFS from the date of treatment to recurrence or death. All tests were 2-sided with a significative P-value defined <.05. Results Three (11.5%) of the 26 patients achieved pathological complete remission (pCR) in the nICT group, and four (10.3%) of the 39 patients achieved pCR in the nCT group, respectively (P=1.000). Six (23.1%) of the 26 patients achieved major pathological response (MPR) in the nICT group, and 11 (28.2%) of the 39 patients achieved MPR in the nCT group, respectively (P=0.645). Downstaging was achieved in 13 (44.8%) patients in the nICT group and 16 (55.2%) patients in the nCT group, respectively (P=0.732). To verify the tumor regression grade (TRG) results, we compared them with MPR and pCR, which showed a significant dependency (P< 0.001). Patients who achieved downgrading showed better MPR and pCR rates (P<0.001 and P =0.010). There was no significant difference in EFS between the nICT and nCT groups (HR=1.011, 95% CI: 0.421–2.425, P = 0.981). Conclusions Neoadjuvant PD-1 blockade combined with chemotherapy was not superior to chemotherapy alone for patients with resectable locally advanced esophageal carcinoma. However, more studies with long-term follow-up were needed to confirm this result.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma

et al. 2023

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show abstract

“…It was worth mentioning that further studies were needed to determine whether patients with esophageal cancer needed further adjuvant therapy after surgery. Evidence showed that esophageal cancer patients with residual lymphatic invasion after surgery needed adjuvant therapy [15]. Secondly, some patients with esophageal cancer receiving neoadjuvant therapy may not be sensitive to immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant PD-1 blockade combined with chemotherapy or chemotherapy alone for patients with resectable locally advanced esophageal carcinoma: A real-world data analysis

Cheng

Zhao

Chen

et al. 2022

Preprint

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Background Neoadjuvant concurrent chemoradiotherapy with surgery was the standard of therapy for esophageal cancer. But many patients refused or abandoned radiotherapy because of the intolerable adverse effects in China. Neoadjuvant immunochemotherapy (nICT) followed by surgery has become an emerging treatment in patients with esophageal cancer. There was still no consensus on whether neoadjuvant immunochemotherapy was superior to neoadjuvant chemotherapy (nCT) alone in patients with esophageal cancer. Methods In this retrospective study, patients with resectable esophageal cancer received surgery after neoadjuvant immunochemotherapy (nICT) (n = 26, 40%) or neoadjuvant chemotherapy (nCT) alone (n = 39, 60%) were included. The patients were classified as nICT or nCT arm. The primary end points were pathological tumor response (PTR) and event-free survival (EFS). The different clinic-pathological features were compared by the Kruskal-Wallis test for continuous variables and the Chi-square (χ2) test for categorical variables. Kaplan-Meier curves were used to estimate EFS from the date of treatment to recurrence or death. All tests were 2-sided with a significative P-value defined < .05. Results Three (11.5%) of the 26 patients achieved pathological complete remission (pCR) in the nICT group, and four (10.3%) of the 39 patients achieved pCR in the nCT group, respectively (P = 1.0). Six (23.1%) of the 26 patients achieved major pathological response (MPR) in the nICT group, and eleven (28.2%) of the 39 patients achieved MPR in the nCT group, respectively (P = 0.645). Downstaging was achieved in 13 (44.8%) patients in the nICT group and 16 (55.2%) patients in the nCT group, respectively (P = 0.732). To verify the TRG results, we compared them with MPR and pCR, which showed a significant dependency (P < 0.001). Patients who achieved downgrading showed better MPR and pCR rates (P<0.001 and P = 0.010). There was no significant difference in EFS between nICT and nCT group (HR = 1.011, 95%CI: 0.421–2.425, P = 0.981). Conclusions

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Prognostic impact of nodal status and lymphovascular invasion in patients undergoing neoadjuvant chemotherapy for esophageal squamous cell carcinoma

Miyata,

Sugimura,

Kanemura

et al. 2024

Diseases of the Esophagus

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Summary Nodal status is well known to be the most important prognostic factor for esophageal cancer patients, even if they are treated with neoadjuvant therapy. To establish an optimal postoperative adjuvant strategy for patients, we aimed to more accurately predict the prognosis of patients and systemic recurrence by using clinicopathological factors, including nodal status, in patients with esophageal cancer who received neoadjuvant chemotherapy. The clinicopathological factors associated with survival and systemic recurrence were investigated in 488 patients with esophageal squamous cell carcinoma who received neoadjuvant chemotherapy. Overall survival differed according to tumor depth, nodal status, tumor regression, and lymphovascular (LV) invasion. In the multivariate analysis, nodal status and LV invasion were identified as independent prognostic factors (P < 0.0001, P = 0.0008). Nodal status was also identified as an independent factor associated with systemic recurrence, although LV invasion was a borderline factor (P = 0.066). In each pN stage, patients with LV invasion showed significantly worse overall survival than those without LV invasion (pN0: P = 0.036, pN1: P = 0.0044, pN2: P = 0.0194, pN3: P = 0.0054). Patients with LV invasion were also more likely to have systemic, and any recurrence than those without LV invasion in each pN stage. Pathological nodal status and LV invasion were the most important predictors of survival and systemic recurrence in patients with esophageal cancer who underwent neoadjuvant chemotherapy followed by surgery. This finding could provide useful information about selecting candidates for adjuvant therapy among these patients. Our analysis showed that LV invasion was an independent prognostic factor in patients with esophageal cancer who underwent neoadjuvant chemotherapy and that combining LV invasion with pathological nodal status makes it possible to stratify the prognosis in those patients.

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Clinical impact of remnant lymphatic invasion on the recurrence of esophageal squamous cell carcinoma after esophagectomy with neoadjuvant chemotherapy

Cited by 3 publications

References 45 publications

Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma

Neoadjuvant PD-1 blockade combined with chemotherapy is not superior to neoadjuvant chemotherapy alone in resectable locally advanced esophageal carcinoma

Neoadjuvant PD-1 blockade combined with chemotherapy or chemotherapy alone for patients with resectable locally advanced esophageal carcinoma: A real-world data analysis

Prognostic impact of nodal status and lymphovascular invasion in patients undergoing neoadjuvant chemotherapy for esophageal squamous cell carcinoma

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