Prognostic value of recurrence pattern in locally advanced esophageal squamous cell carcinoma: Results from the phase III trial NEOCRTEC5010

Chen, Dong; Kong, Min; Sun, Jiajing; Yang, Hong; Chen, Yuping; Fang, Wentao; Yu, Zhentao; Mao, Weimin; Xiang, Jiaqing; Han, Yongtao; Chen, Zhijian; Yang, Haihua; Wang, Jiaming; Pang, Qingsong; Zheng, Xunhua; Yang, Heqing; Li, Tao; Zhang, Xu; Li, Qun; Wang, Geng; Mao, Teng; Guo, Xufeng; Lin, Ting; Liu, Mengzhong; Witharana, Pasan; Fu, Jianhua; Chen, Baofu; Shen, Jianfei; Zhu, Chengchu

doi:10.1016/j.jtcvs.2022.08.009

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…After recurrence, speci c treatment measures were not analyzed in this study, as they were not the focus of our article. In line with ndings from other studies, the majority of patients in this cohort were men [21]. The applicability of our prognostic classi cation to female esophageal cancer patients requires further investigation.…”

Section: Discussionsupporting

confidence: 88%

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Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

Liu,

Zhang,

Chen

et al. 2023

Preprint

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Background Accurate restaging and histological assessment of esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT) provide valuable prognostic information. We aimed to elucidate proper classification methods to discriminate and predict prognosis in ESCC patients who received nCRT followed by surgery and in the recurrent subgroup. Methods We included 309 patients with ESCC who underwent nCRT followed by complete resection for analysis of overall survival (OS). Among them, 304 patients were eligible for recurrence-free survival (RFS) analysis, and OS analysis was also separately performed on 98 recurrent patients. Tumor regression grade (TRG) was assessed using the modified Ryan scheme and ypTNM was recorded based on the 8th edition of the AJCC TNM classification. The combination of TRG and lymph node status resulted in two ypTN systems: ypTN (four categories) and ypTN (three categories). In the ypTN (four categories) system, the categories were ypT-N-, ypT + N-, ypT-N+, and ypT + N+. When considering ypT + N- and ypT-N + as one category, it produced the ypTN (three categories) system. We plotted Kaplan-Meier survival curves based on various classification methods. The log-rank test was used to examine differences in survival rates and calculate P values. The selected classification methods underwent univariable and multivariable Cox regression analyses. Results The mean follow-up period was 39.2 months (range, 0.6–70.4). Compared to classification methods of TRG, ypT, ypN, ypTNM, and ypTN (four categories), ypTN (three categories) performed the best ability to distinguish and predict OS and RFS in overall population with P < 0.001 for overall models and significant differences between adjacent groups. In the recurrent population, we found the binary classification of ypN was a good predictor of OS (ypN- vs. ypN+, HR: 1.819, 95%CI: 1.150–2.878, P = 0.011). The reliability of these classification methods in both the overall population and the recurrent population was confirmed by univariable and multivariable Cox regression analyses. Conclusions The prognosis of ESCC patients who received nCRT followed by surgery can be distinguished and predicted by ypTN (three categories) system. Lymph node status was an ideal prognostic classification for the recurrent subgroup.

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Section: Discussionsupporting

confidence: 88%

“…Furthermore, reanalysis of the NEOCRTEC5010 trial found that ypN1 was associated with early recurrence and shortened survival after [21]. Based on our data, recurrent patients can be classi ed into two groups, namely ypN-and ypN + patients, according to the different ypN status.…”

Section: Discussionmentioning

confidence: 71%

Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

Liu,

Zhang,

Chen

et al. 2023

Preprint

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“…Apart from the correlation between lymph node metastasis and recurrence rate as well as prognosis, the NEOCRTEC5010 trial also identified pN1 stage as an independent risk factor for early postoperative recurrence for overall patients who received surgery with or without nCRT ( 19 ). Our research showed that ypN status was associated with the time interval between surgery to the first recurrence in the recurrent population (ypN- vs. ypN+: 7.8 months vs. 5.8 months, P = 0.0056).…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the NEOCRTEC5010 trial found that patients with distant metastasis and those with locoregional recurrence shared comparable post-recurrence survival and 5-year OS after undergoing esophagectomy with or without preoperative nCRT ( 19 ). When the population was specifically defined as patients who experienced postoperative recurrence after receiving nCRT, Nagaki Y et al.…”

Section: Discussionmentioning

confidence: 99%

Recurrence timing and patterns incorporating lymph node status after neoadjuvant chemoradiotherapy plus esophagectomy for esophageal squamous cell carcinoma

Liu,

Hu,

Chen

et al. 2024

Front. Oncol.

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PurposeAbout 40% of esophageal squamous cell carcinoma (ESCC) patients experienced recurrence after neoadjuvant chemoradiotherapy (nCRT) plus esophagectomy. While limited information was available on recurrence risk stratification in ESCC after neoadjuvant treatment. Our previous study showed ypN status was a reliable tool to differentiate and predict the prognosis in the recurrent population. Here, we evaluated recurrence timing and patterns in ESCC patients, taking into consideration lymph node status after nCRT.Materials and methodsA total of 309 ESCC patients treated with nCRT plus esophagectomy between 2018 and 2021 were enrolled in this observational cohort study. Lymph node status was recorded by the pathologist according to the surgical specimens. We retrospectively investigated the timing and patterns of recurrence and the prognoses in ESCC patients, taking into consideration lymph node status after nCRT.ResultsAfter nCRT plus surgery in ESCC patients, lymph node metastasis was associated with unfavorable clinicopathological factors and high risks of recurrence. In the recurrent subgroup, ypN+ patients experienced earlier recurrence, especially for locoregional recurrence within the first year. Moreover, ypN+ patients had poorer prognosis. However, the recurrence patterns in the ypN- and ypN+ groups were similar. Besides, there were no significant differences in surgery to recurrence, recurrence to death, or overall survival among patients with locoregional or distant recurrence for overall patients and within ypN- or ypN+ groups.ConclusionsLymph node metastasis was correlated with unfavorable clinicopathological factors and high risks of recurrence. Despite a similar recurrence pattern in the recurrent subgroup between the ypN- and ypN+ groups, ypN+ patients exhibited earlier recurrence and a worse prognosis.

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“…Alternatively, could neoadjuvant chemoradiotherapy be replaced by neoadjuvant chemotherapy or immunotherapy? Within the framework of trimodality therapy (radiotherapy, chemotherapy and surgery), distant metastasis remains the most predominant mode of subsequent failure ( 12 ), and minimal residual disease (MRD) may be the source of relapse and metastasis; could it be eradicated by intensified postoperative adjuvant immunotherapy? For unresectable locally advanced esophageal cancer, definitive chemoradiotherapy is the current standard treatment.…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy combined with immune checkpoint inhibitors in locally advanced/metastatic esophageal squamous cell carcinoma: clinical trials, efficacy and future directions

Jiang

Liu

et al. 2023

Front. Immunol.

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Esophageal squamous cell carcinoma (ESCC) is a common malignancy worldwide and often diagnosed at advanced stages with poor prognosis. Combination of radiotherapy and immunotherapy seems to be a promising approach for treating ESCC. This comprehensive review article summarizes the current state of combination of radiotherapy and immunotherapy in locally advanced/metastatic ESCC, delineates the clinical trials that merit attention, and outlines unresolved issues and future research directions in this field. The clinical trial findings suggest that radio-immunotherapy combination may improve tumor response and overall survival with manageable side effects, highlighting the importance of patient selection and the necessity for further research to optimize treatment strategies. Issues such as irradiation dosage, fractionation regimen, irradiation site and technique of radiotherapy, as well as the timing, sequence and duration of combination therapy will all affect treatment outcomes, justifying further in-depth investigation.

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Prognostic value of recurrence pattern in locally advanced esophageal squamous cell carcinoma: Results from the phase III trial NEOCRTEC5010

Cited by 11 publications

References 19 publications

Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

Proper prognostic classification of histopathologic response to neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma

Recurrence timing and patterns incorporating lymph node status after neoadjuvant chemoradiotherapy plus esophagectomy for esophageal squamous cell carcinoma

Radiotherapy combined with immune checkpoint inhibitors in locally advanced/metastatic esophageal squamous cell carcinoma: clinical trials, efficacy and future directions

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