Clinical relevance of histologic subtypes in locally advanced esophageal carcinoma treated with pre-operative chemoradiotherapy: Experience of a monographic oncologic centre

Abstract

BackgroundLocally advanced esophageal carcinoma (LAEC) represents less than 30% of all diagnosed esophageal carcinoma worldwide. The standard of care for resectable tumours consists of preoperative chemoradiotherapy (CRT) followed by surgery. Despite the curative intent, the prognosis is still poor mainly due to relapse. A multidisciplinary approach is required in order to optimize the therapeutic strategy and follow-up. Differences in outcomes between the two main histological subtypes, adenocarcinoma (ADC) and squamous cell carcinoma (SCC), have been reported. Nevertheless, the heterogeneity in trials design and data available have hampered the achievement of clear conclusions. The purpose of this study is to report the outcomes from a cohort of patients with LAEC treated with a multidisciplinary approach and to remark the differences observed between the two main histologic subtypes and their clinical implications.MethodsWe retrospectively reviewed 100 patients diagnosed with LAEC that were treated with preoperative CRT at our institution and integrated centres. Histopathological characteristics and toxicities during treatment were recorded. Patterns of recurrence at the first relapse were analysed. Survival curves were plotted using the Kaplan Meier method and multivariate Cox proportional hazards models were used.ResultsAmong the patients who received preoperative CRT, 83% underwent surgery. The median overall survival (mOS) was 31.7 months, 26.9 months for ADC and 45.5 for SCC (p-value = 0.33). In the multivariate Cox regression analysis, ypN+ was the only factor that negatively influenced in OS (OR = 4.1, p-value = 0.022). Patterns of recurrence differed according to histologic subtype. Distant relapse was more frequent in ADC (62%), whereas locoregional relapse was higher in SCC (50%) (p-value = 0.027). Second line therapeutic strategies could be offered to 50% of those patients who relapsed.ConclusionsDifferences in outcomes and recurrence pattern could be observed between the two main histologic subtypes of LAEC. A better molecular characterization, adapted therapeutic regimens and follow up strategies should be adopted in order to improve survival of these patients.

Prognostic Impact of Lymph Node Localization in Node-Positive Esophageal Cancer

“…A recent study of Saigi et al declared that patterns of disease recurrence differentiate regarding histological tumor subtype. According to this study, distant metastasis was more abundant in adenocarcinoma, whereas local disease recurrence was related to SCC (62% versus 50%, p=0.027) [38].…”

Incidence and management of esophageal cancer recurrence to regional lymph nodes after curative esophagectomy

“…[38][39][40] Conversely, other studies have suggested that the pattern of recurrence is heavily influenced and have shown that patients with ESCC treated with neoadjuvant chemoradiotherapy followed by surgery have a higher incidence of locoregional recurrence. 2,7,[41][42][43] Ultimately, our analysis may be limited due to the variation in the neoadjuvant treatment regimens given, our decision to include patients who received no neoadjuvant treatment, and the small sample size of patients with isolated regional recurrence.…”

Esophageal Cancer Mortality in Brazil: A Time-Series Analysis From the Global Burden of Disease Study

“…Such facts could be the result of a probable predominance in the carcinoma histological subtype of squamous cells, which have a relationship that is inversely proportional to the human development index (21) . Besides that, this type of cancer has demonstrated better survival rates and a lower rate of relapse in comparison to adenocarcinomas (14) . Inequality in the country persists, even though enhancements were verified in the last years (27) .…”

“…However, more than 30% of patients develop metastasis, lowering the survival rate in five years to 4.5% (1) . Differences in the outcome of treatment, in terms of survivability and recurrence, can be found according histological type, but it also depends on the state of the disease and the treatment done (13,14) .…”