Clinicopathological Significance of Pathologic Complete Lymph Node Regression After Neoadjuvant Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Hsu, Po Kuei; Yeh, Yi Chen; Chien, Li-Yin; Huang, Chien Sheng; Hsu, Han Shui

doi:10.1245/s10434-020-09363-z

Cited by 13 publications

(16 citation statements)

References 17 publications

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“…Hamai et al reported that 49.3% of patients had down-staged nodal disease after neoadjuvant chemoradiotherapy. It suggested that the synergistic effect of immunotherapy on chemotherapy may be weaker than on radiotherapy; similar findings were reported by Hsu et al [9]. The distinct response to NAIC between primary tumor and lymph nodes could be attributed to their structural and microenvironmental heterogeneity, such as types and abundance of immune cells, oxygen levels, and cytokines [30][31][32].…”

Section: Discussionsupporting

confidence: 68%

“…The lymph node response to neoadjuvant therapy was crucial in subsequently followed-up patients with ESCC, especially those with tumor recurrence and metastases [9,29]. A recent study reported that the predictive values of lymph node response to neoadjuvant therapy were more reliable than those of tumor response [29].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical and histopathological responses of target tumor lesion and local-distant micrometastatic sites (e.g., regional lymph node metastasis or distant micrometastases) are considered to be independent prognosticators for EC [7][8][9]. The research on residual tumor patterns and locoregional lymph node metastases of the resected specimen was found to be compelling.…”

Section: Introductionmentioning

confidence: 99%

“…The research on residual tumor patterns and locoregional lymph node metastases of the resected specimen was found to be compelling. A few studies have addressed this issue via multiple approaches [8][9][10][11][12]. Recent studies on patients with EC showed satisfying feasibility, efficacy, and safety of a novel treatment strategy -the neoadjuvant immunotherapy combined with chemotherapy (neoadjuvant immunochemotherapy (NAIC)) [13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pathological Responses of the Primary Tumor and Locoregional Lymph Nodes After Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Cancer

Huang¹,

Tian

Wang

et al. 2022

World J Oncol

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Background:The current study attempted to describe the specific patterns of pathological tumor response and locoregional node metastases from surgically resected esophageal squamous cell carcinoma after neoadjuvant immunochemotherapy (NAIC), as well as to explore the association between clinicopathological characteristics and such oncological patterns.Methods: Fifty-one patients with cT3 or deeper esophageal squamous cell cancer underwent subtotal esophagectomy after NAIC. The NAIC regimen included intravenous administration of platinum-based and docetaxel-and taxane-based chemotherapeutics along with a 200 mg fixed dose of one programmed death 1 (PD-1) inhibitor, given every 3 weeks. We divided patients into tumor/nodal good-responders and poor-responders based on the pathological observation of the tumor or nodal responses. We also examined the association between clinicopathological factors and tumor/nodal responses. Further, significant baseline predictors for tumor and nodal good-responders were identified using multivariate binary logistic regression.Results: Of the 51 patients, 68.6% achieved marked primary tumor response. Notably, 21.6% of patients achieved complete pathological response. Significant differences in treatment cycles between tumor good-responders and tumor poor-responders (P = 0.019) were observed. For locoregional nodal responses, only 33.3% of patients achieved down-staged nodal disease. Of the investigated variables, neoadjuvant cycles (odds ratio (OR): 5.271, 95% confidence interval (CI): 1.278 -21.740, P = 0.022) and pretreatment platelets (OR: 0.979, 95% CI: 0.962 -0.996, P = 0.017) were identified as independent predictors for good tumor and nodal responses. Conclusions:We conclusively noted that most patients receiving NAIC were tumor good-responders, whereas only one-third of patients were nodal good-responders. Furthermore, we identified that treatment cycle number and baseline platelet counts were independent predictors of combined tumor and nodal responses.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pathological Responses of the Primary Tumor and Locoregional Lymph Nodes After Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Cancer

Huang¹,

Tian

Wang

et al. 2022

World J Oncol

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“…This may be due to the better performance of radiotherapy in the control of the primary tumor in the NCRT group. Furthermore, the pCR of positive LNs after neoadjuvant therapy is considered as an important predictor for better prognosis ( 19 , 24 , 25 ). The pCR rate of positive LNs was reported to be 30.0% in patients receiving NCT and 29.2% in those receiving NCRT ( 18 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

Pathologic responses and surgical outcomes after neoadjuvant immunochemotherapy versus neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma

Wei²,

Li³

et al. 2022

Front. Immunol.

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BackgroundCurrently, the role of immunotherapy in neoadjuvant setting for patients with locally advanced esophageal squamous cell carcinoma (ESCC) is gradually attracting attention. Few studies compared the efficacy of neoadjuvant immunochemotherapy (NICT) and neoadjuvant chemoradiotherapy (NCRT). Our study aimed to compare treatment response and postoperative complications after NICT followed by surgery with that after conventional NCRT in patients with locally advanced ESCC.MethodsOf 468 patients with locally advanced ESCC, 154 received conventional NCRT, whereas 314 received NICT. Treatment response, postoperative complications and mortality between two groups were compared. Pathological response of primary tumor was evaluated using the Mandard tumor regression grade (TRG) scoring system. Pathological complete response (pCR) of metastatic lymph nodes (LNs) was defined as no viable tumor cell within all resected metastatic LNs. According to regression directionality, tumor regression pattern was summarized into four categories: type I, regression toward the lumen; type II, regression toward the invasive front; type III, concentric regression; and type IV, scattered regression. Inverse probability propensity score weighting was performed to minimize the influence of confounding factors.ResultsAfter adjusting for baseline characteristics, the R0 resection rates (90.9% vs. 89.0%, P=0.302) and pCR (ypT0N0) rates (29.8% vs. 34.0%, P=0.167) were comparable between two groups. Patients receiving NCRT showed lower TRG score (P<0.001) and higher major pathological response (MPR) rate (64.7% vs. 53.6%, P=0.001) compared to those receiving NICT. However, NICT brought a higher pCR rate of metastatic LNs than conventional NCRT (53.9% vs. 37.1%, P<0.001). The rates of type I/II/III/IV regression patterns were 44.6%, 6.8%, 11.4% and 37.1% in the NICT group, 16.9%, 8.2%, 18.3% and 56.6% in the NCRT group, indicating a significant difference (P<0.001). Moreover, there were no significant differences in the incidence of total postoperative complications (35.8% vs. 39.9%, P=0.189) and 30-d mortality (0.0% vs. 1.1%, P=0.062).ConclusionFor patients with locally advanced ESCC, NICT showed a R0 resection rate and pCR (ypT0N0) rate comparable to conventional NCRT, without increased incidence of postoperative complications and mortality. Notablely, NICT followed by surgery might bring a promising treatment response of metastatic LNs.

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Molecular and immunological characteristics of postoperative relapse in lymph node‐positive esophageal squamous cell cancer

Pan,

Fang,

Zhu

et al. 2024

Cancer Medicine

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BackgroundThe molecular and immunological characteristics of primary tumors and positive lymph nodes in esophageal squamous cell carcinoma (ESCC) are unknown and the relationship with recurrence is unclear, which this study attempted to explore.MethodsA total of 30 ESCC patients with lymph node positive (IIB‐IVA) were enrolled. Among them, primary tumor and lymph node specimens were collected from each patient, and subjected to 551‐tumor‐targeted DNA sequencing and 289‐immuno‐oncology RNA panel sequencing to identify the different molecular basis and immunological features, respectively.ResultsThe primary tumors exhibited a higher mutation burden than lymph nodes (p < 0.001). One‐year recurrent ESCC exhibited a higher Mucin16 (MUC16) mutation rate (p = 0.038), as well as univariate and multivariate analysis revealed that MUC16 mutation is independent genetic factor associated with reduced relapse‐free survival (univariate, HR: 5.39, 95% CI: 1.67–17.4, p = 0.005; multivariate, HR: 7.36, 95% CI: 1.79–30.23, p = 0.006). Transcriptomic results showed non‐relapse group had higher cytolytic activity (CYT) score (p = 0.025), and was enriched in the IFN‐α pathway (p = 0.036), while those in the relapsed group were enriched in the TNF‐α/NF‐κB (p = 0.001) and PI3K/Akt pathway (p = 0.014).ConclusionThe difference in molecular characteristics between primary lesions and lymph nodes may be the cause of the inconsistent clinical outcomes. Mutations of MUC16 and poor immune infiltration are associated with rapid relapse of nodes‐positive ESCC.

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Clinicopathological Significance of Pathologic Complete Lymph Node Regression After Neoadjuvant Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Cited by 13 publications

References 17 publications

Pathological Responses of the Primary Tumor and Locoregional Lymph Nodes After Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Cancer

Pathological Responses of the Primary Tumor and Locoregional Lymph Nodes After Neoadjuvant Immunochemotherapy in Esophageal Squamous Cell Cancer

Pathologic responses and surgical outcomes after neoadjuvant immunochemotherapy versus neoadjuvant chemoradiotherapy in patients with locally advanced esophageal squamous cell carcinoma

Molecular and immunological characteristics of postoperative relapse in lymph node‐positive esophageal squamous cell cancer

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