Moderately differentiated esophageal squamous cell carcinoma has a poor prognosis after neoadjuvant chemoradiotherapy

Abstract

Background: Neoadjuvant chemoradiotherapy (NCRT) plus surgery is the standard treatment for esophageal squamous cell carcinoma (ESCC); however, further analysis is needed to detail the histopathological characteristics of ESCC and their clinical significance after NCRT. This study aimed to present the pathological characteristics of ESCC and their association with prognosis after NCRT.Methods: All patients with ESCC who underwent NCRT followed by surgical resection at Sichuan Cancer Hospital (China) from January 2018 to December 2019 were included. Resection specimens of both the primary disease and lymph nodes were re-evaluated by an experienced pathologist. After NCRT, the pathological characteristics of the residual tumor were evaluated based on the Japanese residual tumor pattern, Mandard tumor regression grade (Mandard-TRG), local inflammatory infiltration classification, and lymph node status.Results: Among the 103 patients with ESCC included in this study, the pathological complete response (pCR) rate was 34% (35/103). The pCR rate of patients with poorly differentiated tumors (31/72) was higher (43.1%) than that of patients with well or moderately differentiated tumors (P<0.05). The residual tumor rate was 66% (68/103). A positive correlation was noted between the Japanese residual tumor pattern and Mandard-TRG (Kendall's tau-b =0.857, P<0.001). Tumor infiltration depth, lymph node positivity, moderate differentiation, and tumor recurrence were associated with poor oncological outcomes (P<0.05).Conclusions: Patients with poorly differentiated tumors can obtain an excellent short-term response; however, they have extremely poor long-term survival. For patients with moderately differentiated tumors, both the short-and long-term outcomes are poor. Lymph node status after NCRT is a prognostic factor for ESCC treated with NCRT.

Prognostic Nomogram for Predicting Long-Term Overall Survival of Esophageal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy Plus Surgery: A Population-Based Study

“…Based on the latest AJCC staging system (the 8th edition), pathological grade is not a staging factor for patients receiving neoadjuvant therapy. However, we found that the pathological grade was an independent risk factor for OS among patients receiving nCRT plus surgery, which was consistent with that of other reports ( 9 , 10 ). He et al noted that EC patients with poorly differentiated tumors respond better to nCRT than those with well-differentiated or moderately differentiated tumors; however, they have extremely poor long-term survival rates ( 10 ).…”

“…However, we found that the pathological grade was an independent risk factor for OS among patients receiving nCRT plus surgery, which was consistent with that of other reports ( 9 , 10 ). He et al noted that EC patients with poorly differentiated tumors respond better to nCRT than those with well-differentiated or moderately differentiated tumors; however, they have extremely poor long-term survival rates ( 10 ). One possible reason is that due to the high turnover, poorly differentiated tumors have a higher probability of being affected by DNA damage and apoptosis following nCRT, which contributes to a higher pathological response ( 10 ).…”

“…He et al noted that EC patients with poorly differentiated tumors respond better to nCRT than those with well-differentiated or moderately differentiated tumors; however, they have extremely poor long-term survival rates ( 10 ). One possible reason is that due to the high turnover, poorly differentiated tumors have a higher probability of being affected by DNA damage and apoptosis following nCRT, which contributes to a higher pathological response ( 10 ). For EC patients with the same pathological stage, a worse pathological grade often indicates a worse prognosis and a higher postoperative recurrence rate ( 11 ).…”

Assessment of clinico-pathological and radiological features of oral squamous cell carcinoma cases from CMH Kharian Pakistan.

“…The oral cancer varies widely with respect to different geographic areas, due to differences in lifestyles, culture and developmental status. 14 Out of the 145,000 deaths reported due to oral cancer, about 77% were reported from less developed countries. 15 Approximately 30,000 new oral cancer cases are identified annually and most of them are in critical stage III or IV.…”

“…Oral squamous cell carcinoma 2 assessment of clinico-demographic, histopathological staging and radiological evaluations are considered paramount for timely diagnosis of oral carcinomas. [11][12][13][14][15] MATERIAL & METHODS Current one year (July 2019 to June 2020) crosssectional descriptive study following convenient sampling approach was conducted at Out Patient Department (OPD), Combined Military Hospital Kharian, Gujrat Pakistan. Patients from both genders presenting oral squamous cell carcinoma, above 20-year of age, and willing to participate in the study were included in the study.…”