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. 2023 May 1;277(5):721-726.
doi: 10.1097/SLA.0000000000005693. Epub 2022 Sep 2.

High-Risk Features of Esophageal Adenocarcinoma Following Neoadjuvant Chemoradiation: Patients for Whom Surgery Should Not Be Delayed

Erin M Bayley  1 , Megan L Ivy  2 , Jitesh B Shewale  1 , Phillip S Ge  3 , Mara B Antonoff  1 , Ashleigh M Francis  4 , Wayne L Hofstetter  1 , Reza J Mehran  1 , Ravi Rajaram  1 , David C Rice  1 , Jack A Roth  1 , Boris Sepesi  1 , Ara A Vaporciyan  1 , Garrett L Walsh  1 , J Jack Lee  5 , Brian E Louie  2 , Stephen G Swisher  1
Affiliations

High-Risk Features of Esophageal Adenocarcinoma Following Neoadjuvant Chemoradiation: Patients for Whom Surgery Should Not Be Delayed

Erin M Bayley et al. Ann Surg. .

Abstract

Objective: Clinical predictors of pathological complete response have not reliably identified patients for whom an organ-sparing approach following neoadjuvant chemoradiation be undertaken for esophageal cancer patients. We sought to identify high-risk predictors of residual carcinoma that may preclude patients from a selective surgical approach.

Background: Patients treated with neoadjuvant chemoradiation followed by esophagectomy for esophageal adenocarcinoma were identified.

Patients and methods: Correlation between clinical and pathologic complete responses were examined. Regression models and recursive partitioning were utilized to identify features associated with residual carcinoma. External validation of these high-risk factors was performed on a data set from an independent institution.

Results: A total of 326 patients were identified, in whom clinical complete response was noted in 104/326 (32%). Pathologic complete response was noted in only 33/104 (32%) of these clinical complete responders. Multivariable analysis identified that the presence of stricture ( P =0.011), positive biopsy ( P =0.010), and signet ring cell histology ( P =0.019) were associated with residual cancer. Recursive partitioning corroborated a 94% probability of residual disease, or greater, for each of these features. The positive predictive value was >90% for these characteristics. A SUV max >5.4 at the esophageal primary in the absence of esophagitis was also a high-risk factor for residual carcinoma. External validation confirmed these high-risk factors to be implicated in the finding of residual carcinoma.

Conclusions: Clinical parameters of response are poor predictors of complete pathologic response leading to challenges in selecting candidates for active surveillance. However, we characterize several high-risk features for residual carcinoma which indicate that esophagectomy should not be delayed.

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Conflict of interest statement

The authors report no conflicts of interest.

References

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Supplementary concepts