While the majority of advanced-stage esophageal cancers are treated with surgery after neoadjuvant chemoradiotherapy (NCRT), the utility of prognostication of pathologic TNM stage (pTNM) after NCRT (ypTNM) remains elucidated. Since ypTNM stage could be influenced by pretreatment tumor burden or treatment efficacy of NCRT, ypTNM stage-specific groups might be heterogeneous in terms of prognosis. Identifying prognostic factors in ypTNM stage-specific groups would guide more detailed prognostication.
From 2007 to 2014, 569 patients with squamous cell carcinoma who underwent R0 surgery with NCRT (n = 222) or who underwent R0 surgery alone (n = 347) were included. We performed uni- and multivariate analysis to identify prognostic factors for overall survival (OS) in patients with surgery after NCRT based on pTNM stages (AJCC 7th).
The 5-year OS rates for patients with ypTNM stage 0, 1 (including pT0N+M0), 2 and 3 in surgery after NCRT group were 74.1%, 51.6%, 29.4%, and 17.5% (P
In patients with surgery after NCRT, pathologic prognostic factors (LVI and PNI) were significantly associated with the prognosis of advanced stages, whereas clinical prognostic factors (cCR, clinical stages and age) were of early stages. Although further studies are needed to validate the results of this study, we carefully suggest that clinical and pathological factors have a role in predicting survival outcome in detail based on ypTNM stage by stratifying each ypTNM stage into groups showing distinct survival profiles.
Clinical trial identification
Legal entity responsible for the study
Asan Medical Center, Department of Oncology
All authors have declared no conflicts of interest.