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Change in Density Not Size of Esophageal Adenocarcinoma During Neoadjuvant Chemotherapy Is Associated with Improved Survival Outcomes

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Changes in the size and density of esophageal malignancy during neoadjuvant chemotherapy (NCT) may be useful in predicting overall survival (OS). The aim of this study was to explore this relationship in patients with adenocarcinoma.

Methods

A retrospective single-centre cohort study was performed. Consecutive patients with esophageal adenocarcinoma who received NCT followed by en bloc resection with curative intent were identified. Pre- and post-NCT computed tomography scans were reviewed. The percentage difference between the greatest tumor diameter, esophageal wall thickness and tumor density was calculated. Multivariate Cox regression analysis identified variables independently associated with OS. A ROC analysis was performed on radiological markers to identify optimal cut-off points with Kaplan–Meier plots subsequently created.

Results

Of the 167 identified, 88 (51.5%) had disease of the gastro-esophageal junction and 149 (89.2%) were clinical T3. In total, 122 (73.1%) had node-positive disease. Increased tumor density (HR 1.01 per % change, 95% CI 1.00–1.02, p = 0.007), lymphovascular invasion (HR 3.23, 95% CI 1.34–7.52, p = 0.006) and perineural invasion (HR 2.51, 95% CI 1.03–6.08, p = 0.048) were independently associated with a decrease in OS. Patients who had a decrease in their tumor density during the time they received NCT of ≥ 20% in Hounsfield units had significantly longer OS than those who did not (75.5 months versus 34.4 months, 95% CI 38.83–105.13/18.63–35.07, p = 0.025).

Conclusions

Interval changes in the density, not size, of esophageal adenocarcinoma during the time that NCT are independently associated with OS.

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Funding

JT received a travel grant of $4000 from Medtronic and a regular consulting fee from Google.

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Author notes

  1. James Tankel and Henna Söderström contributed equally to the creation of this manuscript.

Authors and Affiliations

  1. Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada

    James Tankel, Alexander Calderone, Carmen Mueller, Sara Najmeh, Jonathan Spicer, Lorenzo Ferri & Jonathan Cools-Lartigue

  2. Department of General Thoracic Surgery, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland

    Henna Söderström

  3. Department of Radiology, APHP, Imagerie Medicale, CHU Henri Mondor, Creteil, Val-de-Marne, France

    Edouard Reizine

  4. Department of Radiology, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada

    Giovanni Artho

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All authors contributed to the conception and design of the manuscript, analysis and interpretation of the results, drafting and critical revision of the manuscript and agree to be accountable for all aspects of this work.

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Correspondence to James Tankel.

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Institutional ethical approval was sought and given. The requirement for informed consent was waived in light of the anonymous and retrospective nature of the study.

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JT received a $4000 travel grant from Medtronic and receives regular consulting fees from Google. The remaining authors have no conflict of interests to declare.

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Tankel, J., Söderström, H., Reizine, E. et al. Change in Density Not Size of Esophageal Adenocarcinoma During Neoadjuvant Chemotherapy Is Associated with Improved Survival Outcomes. J Gastrointest Surg 26, 2417–2425 (2022). https://doi.org/10.1007/s11605-022-05422-w

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