Predicting Outcome After Neoadjuvant Therapy for Esophageal Adenocarcinoma

Summary and Comment |
October 11, 2013

Predicting Outcome After Neoadjuvant Therapy for Esophageal Adenocarcinoma

  1. Henry Mark Kuerer, MD, PhD, FACS

Extent of residual disease at pathology was an independent predictor of survival.

  1. Henry Mark Kuerer, MD, PhD, FACS

As with several solid organ malignancies, the extent of histopathologic tumor viability (HTV) — defined by the percent of viable tumor in the surgical specimen — has been shown to correlate with outcome following neoadjuvant chemoradiotherapy (CRT) for esophageal adenocarcinoma. But this parameter has yet to be incorporated into the current esophageal carcinoma staging system from the American Joint Committee on Cancer.

To assess the effect of HTV on survival, investigators conducted a large, single-institution study involving 602 esophageal cancer patients who underwent CRT followed by esophagectomy. HTV was classified as 0%–10%, 11%–50%, and >50%.

At median follow-up of 67 months, multivariate analysis showed that independent predictors of survival were HTV of >50% (hazard ratio, 2.5; P<0.001), positive pathologic nodal status (HR, 1.6; P<0.001), and positive clinical nodal status (HR 1.5; P=0.002). Five-year and 10-year survival rates for HTVs of 0%–10%, 11%–50%, and >50%, were 52% and 43%, 45% and 33%, and 16% and 16%, respectively. Node-negative patients with HTV of 0%–10% achieved the best 5-year survival (56%; HR, 1.0; P=0.056); in contrast, node-positive patients with HTV of >50% experienced extremely poor 5-year survival (6%; HR 3.1; P<0.001). HTV of >50% was associated with distant recurrence more often than was HTV of ≤50% (51% vs. 33%; odds ratio, 2.2; P=0.010).

Comment

Histologic tumor viability and nodal status are the best predictors of long-term outcomes for patients with esophageal carcinoma who undergo preoperative chemoradiotherapy. These findings add to the existing literature on solid organ malignancies and indicate that HTV is an additional powerful prognostic variable after CRT. Incorporating residual disease burden after CRT for esophageal adenocarcinoma appears to be a judicious consideration for future incorporation into American Joint Committee on Cancer staging.

Editor Disclosures at Time of Publication

  • Disclosures for Henry Mark Kuerer, MD, PhD, FACS at time of publication Consultant / Advisory board Bayer Pharma AG Speaker's bureau AstraZeneca Grant / research support Susan G. Komen Foundation Leadership positions in professional societies Alliance for Clinical Trials in Oncology (Chair, Education Committee)

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