Should adenosquamous esophageal cancer be treated like adenocarcinoma or squamous cell carcinoma?

Abstract

Background Esophageal adenocarcinoma (AC) and squamous cell carcinoma (SCC) have distinct outcomes, treatment strategies, and response profiles to therapy. Adenosquamous carcinoma (ASC) is thought to behave more aggressively than each of its counterparts. The aim of this study is to determine ifASC is best managed as AC or SCC. Methods National Cancer Database (2004‐2015) was queried for patients with nonmetastatic esophageal ASC. The analysis was stratified by clinical node‐negative (cN0) or clinical node‐positive (cN1‐3). Treatment was categorized into chemoradiation alone, surgery alone, or preoperative chemoradiation followed by surgery. The primary outcome was 5‐year overall survival (OS). Results Among 352 patients, 43% were cN0 (n = 151), 57% were cN1‐3 (n = 201) and 55% had chemoradiation alone (n = 194), 15% surgery alone (n = 53), and 30% preoperative chemoradiation (n = 105). Among patients who had preoperative chemoradiation, 20% had pathologic complete response (n = 17). For either cN0 or cN1‐3, Charlson‐Deyo Comorbidity Index did not differ among the treatment groups(all p > 0.05). On Kaplan‐Meier analysis for cN0, treatment with surgery alone had comparable OS to preoperative chemoradiation (47% vs 34%; P = .5) and each had improved OS compared to chemoradiation alone (30%; P = .02; P = .06). On univariate analysis for cN0, clinical T category was not associated with OS. For cN1‐3, however, preoperative chemoradiation was associated with improved OS when compared to chemoradiation alone or surgery alone (27% vs 19% vs 0%; P < .001). This persisted when accounting for age and clinical T category (hazard ratio: 0.45; P < .001). Conclusion Esophageal ASC behaves more like AC in response to chemoradiation and survival based on treatment modality. A complete response to chemoradiation is only 20% unlike what has been shown for SCC, where chemoradiation is an acceptable definitive therapy. Esophageal ASC should be managed more like AC.

Post-Neoadjuvant Surveillance and Surgery as Needed Compared with Post-Neoadjuvant Surgery on Principle in Multimodal Treatment for Esophageal Cancer: A Scoping Review

“…Patient populations of these studies are heterogeneous. Two studies [ 10 , 21 ] only included patients with ESCC, one study only included patients with EAC [ 24 ], one study included only patients with the rare adenosquamous histological subtype of EC [ 20 ], and six studies included patients with EAC and ESCC [ 11 , 22 , 23 , 25 , 26 , 27 ]. Median patient ages ranged from 58.8–75 years.…”

“…Protocols included either neoadjuvant [ 10 , 11 , 22 , 23 , 26 ] or definitive chemoradiation [ 21 ]. Two register studies did not specify chemoradiation [ 20 , 25 ] and one study included different protocols for neoadjuvant and definitive/palliative treatment [ 27 ]. No study included chemotherapeutic protocols without radiation.…”

“…Münch et al and Denham et al compared dCRT and nCRT in ESCC without a therapeutic consequence being triggered by the CR status [ 21 , 27 ]. The reasons for surgical treatment or surveillance remained unclear in the cancer registry analyses performed by McKenzie et al and Gamboa et al [ 20 , 25 ].…”

“…Further relevant outcomes were reported in other studies. pCR rates in the surgical groups following nCRT ranged between 20% and 69% [ 10 , 20 , 22 ]. Surgery during surveillance was performed in 16–48% of the patients [ 22 , 23 ].…”

Adenosquamous carcinoma of the breast: a population-based study

“…As an example, patients with gallbladder ASC were similar to those with adenocarcinoma of the gallbladder in clinical characteristics and features, although the ASC patients were more prone to infiltration of multiple adjacent organs and lymphatic metastasis [ 17 ]. In addition, esophageal ASC behaves more like adenocarcinoma in response to chemoradiotherapy and survival based on treatment modality [ 18 ]. Under these circumstances, we recommended clinical doctors not evaluating prognosis of ASC patients only by tumor size, histological grade or lymph node metastasis.…”