Updates in staging and pathologic evaluation of esophageal carcinoma following neoadjuvant therapy

Abstract

Esophageal carcinoma comprises two major subtypes-squamous cell carcinoma and adenocarcinoma, the incidences of which vary widely across the world and also depend on the location within the esophagus. The staging of esophageal cancer (EC) also remains unique among various gastrointestinal carcinomas, as it takes into account the location, histologic type, and grade. Its management has been evolving over the years and the recent American Joint Committee on Cancer staging system has been updated to reflect the changing practice and new data. It is clear that preoperative neoadjuvant therapy is increasingly being used for the treatment of locally advanced esophageal carcinomas, followed by surgical resection that improves survival. A variety of histologic changes can be seen after neoadjuvant therapy, which can be challenging for the pathologists. The presence of residual tumor in the surgically resected specimen and lymph node following neoadjuvant therapy is associated with poor prognosis. Hence, a thorough pathologic assessment of tumor regression grade and accurate tumor staging is required by pathologists to provide valuable prognostic information to guide further management. Tumor regression grading in ECs needs to be improved and standardized.

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“…There are a wide range of risk factors for EC, such as smoking, alcohol intake, obesity, gastroesophageal reflux disease, and genetic factors 2 . Preoperative neoadjuvant therapy is increasingly applied to treat locally advanced EC to improve survival 3 . However, both intrinsic or acquired drug resistance generally contributes to the treatment failure of EC 4 .…”

The Sequence of Chemotherapy and Toripalimab Might Influence the Efficacy of Neoadjuvant Chemoimmunotherapy in Locally Advanced Esophageal Squamous Cell Cancer—A Phase II Study

“…The depth of tumor invasion, lymph node metastasis, and surgical margin were evaluated according to the American Joint Committee on Cancer Criteria for esophageal carcinoma ( 12 ). The extent of the residual tumors was divided into four categories: grade 0, no evidence of viable tumor cells (pCR); grade 1, single cells or rare small groups of cancer cells (near-complete response); grade 2, residual cancer cells with evident tumor regression, but more than single cells or rare small groups of cancer cells (partial response); and grade 3, extensive residual cancer without evident tumor regression (poor or no response) ( 13 ). The postoperative pathological evaluation was carried out by two experienced pathologists.…”

Toripalimab Used on the Same Day or Third Day With Chemotherapy for Neoadjuvant Chemoimmunotherapy in Locally Advanced Esophageal Squamous Cell Cancer—A Phase II Study

“…The depth of tumor invasion, lymph node metastasis, and surgical margin were evaluated according to the American Joint Committee on Cancer Criteria for esophageal carcinoma [12]. The extent of the residual tumors was divided into four categories: grade 0, no evidence of viable tumor cells (pathologic complete response, pCR); grade 1, single cells or rare small groups of cancer cells (near complete response); grade 2, residual cancer cells with evident tumor regression, but more than single cells or rare small groups of cancer cells (partial response); and grade 3, extensive residual cancer without evident tumor regression (poor or no response) [13]. The postoperative pathological evaluation was carried out by two experienced pathologists.…”