Your browser doesn't support javascript.
loading
External Validation of Pretreatment Pathological Tumor Extent in Patients with Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal Cancer.
Brinkmann, Sebastian; Noordman, Bo J; Hölscher, Arnulf H; Biermann, Katharina; van Klaveren, David; Bollschweiler, Elfriede; Pütz, Katharina; van Lanschot, J Jan B; Drebber, Uta.
Affiliation
  • Brinkmann S; Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
  • Noordman BJ; Department of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands. b.noordman@erasmusmc.nl.
  • Hölscher AH; Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
  • Biermann K; Centre for Esophageal and Gastric Surgery, AGAPLESION Markus Krankenhaus, Frankfurt, Germany.
  • van Klaveren D; Department of Pathology, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
  • Bollschweiler E; Department of Public Health, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
  • Pütz K; Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
  • van Lanschot JJB; Institute of Pathology, University of Cologne, Cologne, Germany.
  • Drebber U; Department of Surgery, Erasmus MC - University Medical Centre, Rotterdam, The Netherlands.
Ann Surg Oncol ; 27(4): 1250-1258, 2020 Apr.
Article in En | MEDLINE | ID: mdl-31691114
ABSTRACT

BACKGROUND:

This study was conducted to validate a pretreatment (i.e. prior to neoadjuvant chemoradiotherapy) pathological staging system in the resection specimen after neoadjuvant chemoradiotherapy for esophageal cancer. The study investigated the prognostic value of pretreatment pathological T and N categories (prepT and prepN categories) in both an independent and a combined patient cohort.

METHODS:

Patients with esophageal cancer treated with neoadjuvant chemotherapy and esophagectomy between 2012 and 2015 were included. PrepT and prepN categories were estimated based on the extent of tumor regression and regressional changes of lymph nodes in the resection specimen. The difference in Akaike's information criterion (ΔAIC) was used to assess prognostic performance. PrepN and ypN categories were combined to determine the effect of nodal sterilization on prognosis. A multivariable Cox regression model was used to identify combined prepN and ypN categories as independent prognostic factors.

RESULTS:

The prognostic strength of the prepT category was better than the cT and ypT categories (ΔAIC 7.7 vs. 3.0 and 2.9, respectively), and the prognostic strength of the prepN category was better than the cN category and similar to the ypN category (ΔAIC 29.2 vs. - 1.0 and 27.9, respectively). PrepN + patients who became ypN0 had significantly worse survival than prepN0 patients (2-year overall survival 69% vs. 86% in 137 patients; p = 0.044). Similar results were found in a combined cohort of 317 patients (2-year overall survival 62% vs. 85%; p = 0.002). Combined prepN/ypN stage was independently associated with overall survival.

CONCLUSIONS:

These results independently confirm the prognostic value of prepTNM staging. PrepTNM staging is of additional prognostic value to cTNM and ypTNM. PrepN0/ypN0 patients have a better survival than prepN +/ypN0 patients.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Esophageal Neoplasms / Carcinoma, Squamous Cell / Adenocarcinoma / Esophagectomy / Neoadjuvant Therapy / Chemoradiotherapy, Adjuvant Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Ann Surg Oncol Journal subject: NEOPLASIAS Year: 2020 Type: Article Affiliation country: Germany

Full text: 1 Database: MEDLINE Main subject: Esophageal Neoplasms / Carcinoma, Squamous Cell / Adenocarcinoma / Esophagectomy / Neoadjuvant Therapy / Chemoradiotherapy, Adjuvant Type of study: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limits: Aged / Female / Humans / Male / Middle aged Language: En Journal: Ann Surg Oncol Journal subject: NEOPLASIAS Year: 2020 Type: Article Affiliation country: Germany