Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation

Abstract

BACKGROUNDIn patients with locoregional carcinoma of the esophagus or esophagogastric junction who underwent preoperative chemoradiation, it is unclear whether survival was better predicted by pretherapy clinical stage or by posttherapy pathologic stage.METHODSThe authors studied 235 consecutive patients with pretherapy clinical Stage II, III, or IVA (according to American Joint Committee on Cancer criteria) carcinoma of the esophagus or esophagogastric junction who were treated with chemoradiation followed by esophagectomy. Posttherapy cancer status was classified using pathologic stage and semiquantitative assessment of residual carcinoma. Clinicopathologic features, residual carcinoma status, and pretherapy and posttherapy stage were compared with disease‐free and overall survival.RESULTSPosttherapy pathologic stage was Stage 0 in 29% of patients, Stage I in 11% of patients, Stage II in 34% of patients, Stage III in 20% of patients, and Stage IV in 6% of patients. Cancer downstaging occurred in 56% of patients. In univariate analysis, disease‐free and overall survival were predicted by posttherapy pathologic stage (both with P < 0.001), margin status (P = 0.002 and P = 0.01, respectively), extent of residual carcinoma (both with P < 0.001), and downstaging (both with P = 0.001), but not by age, gender, type of cancer, pretherapy clinical stage, or preoperative regimen. However, in multivariate analysis, disease‐free and overall survival were independently predicted by posttherapy pathologic stage (both with P = 0.02). Extent of residual carcinoma was a marginally significant predictor of overall survival (P = 0.04).CONCLUSIONSPosttherapy pathologic stage was the best available predictor of outcome for patients with locoregional carcinoma of the esophagus or esophagogastric junction who underwent chemoradiation therapy followed by esophagectomy. The findings in the current study supported the concept of downstaging by preoperative therapy. Cancer 2005. © 2005 American Cancer Society.

Value of baseline positron emission tomography for predicting overall survival in patient with nonmetastatic esophageal or gastroesophageal junction carcinoma

“…[15][16][17][18] Baseline clinical stage lacks the ability to predict OS or DFS, particularly when patients are treated before surgery. 10 Whether surgery is undertaken or preoperative therapy is given, it would be important to have a prognostic tool at baseline. In this context, PET has not been evaluated.…”

“…10 Positron emission tomography (PET) measures the uptake of a fluorinated glucose analog ( 18 F-fluorodeoxy-D-glucose; [FDG]) in cells, therefore, measuring their metabolic activity. It is known that malignant cells have an altered metabolic activity, therefore, increased uptake of FDG.…”

The higher the decrease in the standardized uptake value of positron emission tomography after chemoradiation, the better the survival of patients with gastroesophageal adenocarcinoma

“…The resected surgical specimen from each patient was examined to determine the degree of pathologic response based on the criteria described previously. 18,31 Information on OS was obtained for each patient. Data were collected from the hospital records, patient follow-up data, death records in the public databases, and the M. D. Anderson tumor registry.…”

“…We used the criteria for rating the surgical specimen previously described by our group 18 and validated by other institutions. 31 Resistance to chemoradiation was designated when >50% residual cancer was noted in the surgical specimen, and response to chemoradiation was designated when 50% residual cancer was noted in the surgical specimen.…”

“…Currently, clinical parameters do not predict outcome before the start of therapy. [15][16][17][18] However, the initial results and subsequent changes in positron emission tomography (PET) show promise. [19][20][21][22][23][24][25] Many investigators have demonstrated that decrease in metabolic activity as measured by the standardized uptake value (SUV) on PET/computed tomography (CT) as a result of therapy is of prognostic value.…”