Prognostic histological factors in patients with esophageal squamous cell carcinoma after preoperative chemoradiation followed by surgery

Abstract

BackgroundPathological response is an important marker for tumor aggressiveness in patients with esophageal squamous cell carcinoma (ESCC) who receive preoperative chemoradiation followed by esophagectomy. We aim to evaluate the prognostic value of histological factors after trimodality treatments.Methods91 patients who received preoperative chemoradiation followed by transthoracic esophagectomy between 2009 and 2014 were included. The pathological examination was reviewed. Overall survival and disease free survival were recorded. Survival analysis was performed using the Cox regression model, and the survival curves were compared by the log-rank test.ResultsSurvival analysis showed lymphovascular invasion (LVI, hazard ratio [HR]: 2.009, p = 0.029), perineural invasion (PNI, HR: 2.226, p = 0.019), ypN stage (HR: 2.041, p = 0.019), extracapsular invasion (ECI, HR: 2.804, p = 0.003), and incomplete resection (HR: 1.897, p = 0.039) as unfavorable prognostic factors affecting overall survival (OS). Moreover, tumor regression grade (TRG, HR: 1.834, p = 0.038), LVI (HR: 1.975, p = 0.038), ECI (HR: 2.836, p = 0.003), and incomplete resection (HR: 2.254, p = 0.007) adversely affected disease-free survival (DFS). Prognostic classification based on poor primary tumor (TRG2/3, LVI(+), and PNI (+)), lymph node (ypN(+) and ECI(+)), and surgical (incomplete resection) factors significantly predicts OS (p = 0.013) and DFS (p = 0.017). However, the use of postoperative adjuvant therapy was not a significant prognostic factor even in medium- and high-risk ESCC patients who underwent trimodality treatments.ConclusionsHistological factors, including primary tumor, lymph node, and surgical factors has high prognostic value for predicting outcomes in ESCC patients receiving preoperative chemoradiation followed by surgery.

Contrast-Enhanced CT-Based Radiomics Analysis in Predicting Lymphovascular Invasion in Esophageal Squamous Cell Carcinoma

“…As a routine examination, CECT is a useful tool for differential diagnosis, preoperative evaluation, treatment, and prognosis of patients with esophageal cancer (30,31,(42)(43)(44)(45). The significance of the present study is that it proposes a novel method for predicting LVI in ESCC for the first time.…”

“…Pathological studies have now incorporated LVI into the TNM staging system for multiple cancers (46,47). Many studies have revealed that LVI is an independent risk factor for survival in patients with ESCC (44,48). Preoperative prediction of LVI status is necessary for patients to implement an aggressive treatment plan (49).…”

Change in Maximal Esophageal Wall Thickness Provides Prediction of Survival and Recurrence in Patients with Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemoradiotherapy and Surgery

“…Lagarde et al and Tu et al concluded that the presence of PNI had an adverse impact on survival time. 26,27 In addition, we found that LVI was independently associated with a shorter DFS. Previous studies by Lagarde et al and Gu et al proposed that LVI was an indicator of adverse prognosis.…”

Early Recurrence and Cancer Death After Trimodal Therapy for Esophageal Squamous Cell Carcinoma

“…Lymphatic and venous invasion are independent prognostic factors for survival after initial surgical resection of ESCC (26- 28) and after neoadjuvant therapy followed by surgery (29)(30)(31). Among these reports, lymphovascular invasion had prognostic value in patients with ESCC treated by NCRT followed by surgery, which are the same histological type and treatment modality as the present study (30,31). Therefore, lymphatic/vascular invasion is very important for the prognosis of esophageal cancer, not only after surgery, but also after neoadjuvant therapy followed by surgery.…”