Ali Al-Kaabi1, Rachel S van der Post2, Leonie R van der Werf3, Bas P L Wijnhoven3, Camiel Rosman4, Maarten C C M Hulshof5, Hanneke W M van Laarhoven6, Rob H A Verhoeven4,7, Peter D Siersema1. 1. Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. 2. Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands. 3. Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. 4. Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 5. Department of Radiotherapy, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 7. Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
Abstract
BACKGROUND: With increasing interest in organ-preserving strategies for potentially curable esophageal cancer, real-world data is needed to understand the impact of pathological tumor response after neoadjuvant chemoradiotherapy (CRT) on patient outcome. The objective of this study is to assess the association between pathological tumor response following CROSS neoadjuvant CRT and long-term overall survival (OS) in a nationwide cohort. MATERIAL AND METHODS: All patients diagnosed in the Netherlands with potentially curable esophageal cancer between 2009 and 2017, and treated with neoadjuvant CRT followed by esophagectomy were included. Through record linkage with the nationwide Dutch Pathology Registry (PALGA), pathological data were obtained. The primary outcome was pathological tumor response based on ypTNM, classified into pathological complete response (ypT0N0) and incomplete responders (ypT0N+, ypT+N0, and ypT+N+). Multivariable logistic and Cox regression models were used to identify predictors of pathological complete response (pCR) and survival. RESULTS: A total of 4946 patients were included. Overall, 24% achieved pCR, with 19% in adenocarcinoma and 42% in squamous cell carcinoma. Patients with pCR had a better estimated 5-year OS compared to incomplete responders (62% vs. 38%, p< .001). Of the patients with incomplete response, ypT+N+ patients (32% of total population) had the lowest estimated 5-year OS rate, followed by ypT0N+ and ypT+ N0 (22%, 47%, and 49%, respectively, p< .001). Adenocarcinoma, well to moderate differentiation, cT3-4, cN+, signet ring cell differentiation and lymph node yield (≥15) were associated with lower likelihood of pCR. CONCLUSION: In this population-based study, pathological tumor response based on the ypTNM-stage was associated with different prognostic subgroups. A quarter of patients achieved ypT0N0 with favorable long-term survival, while one-third had an ypT+N+ response with very poor survival. The association between pathological tumor response and long-term survival could help in more accurate assessments of individual prognosis and treatment decisions.
BACKGROUND: With increasing interest in organ-preserving strategies for potentially curable esophageal cancer, real-world data is needed to understand the impact of pathological tumor response after neoadjuvant chemoradiotherapy (CRT) on patient outcome. The objective of this study is to assess the association between pathological tumor response following CROSS neoadjuvant CRT and long-term overall survival (OS) in a nationwide cohort. MATERIAL AND METHODS: All patients diagnosed in the Netherlands with potentially curable esophageal cancer between 2009 and 2017, and treated with neoadjuvant CRT followed by esophagectomy were included. Through record linkage with the nationwide Dutch Pathology Registry (PALGA), pathological data were obtained. The primary outcome was pathological tumor response based on ypTNM, classified into pathological complete response (ypT0N0) and incomplete responders (ypT0N+, ypT+N0, and ypT+N+). Multivariable logistic and Cox regression models were used to identify predictors of pathological complete response (pCR) and survival. RESULTS: A total of 4946 patients were included. Overall, 24% achieved pCR, with 19% in adenocarcinoma and 42% in squamous cell carcinoma. Patients with pCR had a better estimated 5-year OS compared to incomplete responders (62% vs. 38%, p< .001). Of the patients with incomplete response, ypT+N+ patients (32% of total population) had the lowest estimated 5-year OS rate, followed by ypT0N+ and ypT+ N0 (22%, 47%, and 49%, respectively, p< .001). Adenocarcinoma, well to moderate differentiation, cT3-4, cN+, signet ring cell differentiation and lymph node yield (≥15) were associated with lower likelihood of pCR. CONCLUSION: In this population-based study, pathological tumor response based on the ypTNM-stage was associated with different prognostic subgroups. A quarter of patients achieved ypT0N0 with favorable long-term survival, while one-third had an ypT+N+ response with very poor survival. The association between pathological tumor response and long-term survival could help in more accurate assessments of individual prognosis and treatment decisions.
Authors: Marieke Pape; Pauline A J Vissers; Laurens V Beerepoot; Mark I van Berge Henegouwen; Sjoerd M Lagarde; Stella Mook; Markus Moehler; Hanneke W M van Laarhoven; Rob H A Verhoeven Journal: Ther Adv Med Oncol Date: 2022-02-26 Impact factor: 8.168
Authors: Marieke Pape; Pauline A J Vissers; Judith de Vos-Geelen; Maarten C C M Hulshof; Suzanne S Gisbertz; Paul M Jeene; Hanneke W M van Laarhoven; Rob H A Verhoeven Journal: Cancer Sci Date: 2022-01-25 Impact factor: 6.716
Authors: Sonay Kus Öztürk; Ali Al-Kaabi; Maria J Valkema; Cristina Graham Martinez; John-Melle Bokhorst; Camiel Rosman; Heidi Rütten; Carla A P Wauters; Michail Doukas; Joseph Jan-Baptist van Lanschot; Peter D Siersema; Iris D Nagtegaal; Rachel Sofia van der Post Journal: Histopathology Date: 2022-04-06 Impact factor: 7.778