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Optimal Treatment of cT2N0 Esophageal Carcinoma: Is Upfront Surgery Really the Way?

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Staging is inaccurate for cT2N0 esophageal cancer, and patients often are clinically mis-staged. This study aimed to evaluate the outcome after upfront surgery or neoadjuvant therapy, considering the impact of clinical “mis-staging.”

Methods

This study reviewed patients with squamous cell carcinoma (SCC) or adenocarcinoma (ADK) of the esophagus who underwent upfront surgery (S group) or neoadjuvant treatment (chemoradiotherapy [CRT] group) for cT2N0 cancer. Overall survival (OS), disease-free survival (DFS), morbidity, and mortality were evaluated. Correctly staged (cTNM = pTNM), understaged (cTNM < pTNM), and overstaged (cTNM > pTNM) patients in the S group and the CRT group were analyzed. Risk factors for unexpected lymph-node involvement were identified in the S group and for cancer-related death in the whole study cohort.

Results

The study enrolled 229 patients with cT2N0 esophageal cancer. The 5-year OS rate was 34.2% in the S group versus 55.7% in the CRT group (p = 0.0088). The DFS also was significantly higher (p = 0.01). The morbidity and mortality rates were similar. In the S group, the cTNM was correctly staged for 21.4% and understaged for 63.4% of the patients, with 48.7% of the patients showing unexpected nodal involvement. A tumor length of 3 cm or more was an independent predictor of nodal metastases in SCC (p = 0.03), as was lymphovascular invasion (LVI) in ADK (p < 0.01). Cancer-related mortality was independently associated with lymph-node metastases (p = 0.03) and treatment by upfront surgery (p = 0.01).

Conclusion

Given the high rate of understaged patients in this study (63.4%), the authors advocate for combining the induction therapy with surgery in cT2N0, achieving better survival with similar morbidity and mortality.

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Acknowledgments

We acknowledge the role of Luca Giarrizzo in the data collection for this study.

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Authors and Affiliations

  1. Clinica Chirurgica 3, Department of Surgical, Oncological and Gastroenterological Sciences, Università di Padova, Padova, Italy

    Giovanni Capovilla MD, Lucia Moletta MD, Elisa Sefora Pierobon MD, PhD, Renato Salvador MD, Luca Provenzano MD, Gianpietro Zanchettin MD, PhD, Mario Costantini MD, Stefano Merigliano MD & Michele Valmasoni MD, PhD, FACS

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  1. Giovanni Capovilla MD
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  2. Lucia Moletta MD
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  3. Elisa Sefora Pierobon MD, PhD
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  9. Michele Valmasoni MD, PhD, FACS
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Contributions

Capovilla: data collection, data analysis, manuscript writing and editing, paper revision, final approval. Moletta: data collection, data analysis, manuscript editing, paper revision, final approval. Pierobon: data collection, manuscript editing, paper revision, final approval. Salvador: protocol/project development, data collection, manuscript editing, paper revision, final approval. Zanchettin: data collection, manuscript editing, paper revision, final approval. Provenzano: data collection, manuscript editing, paper revision, final approval. Merigliano: protocol/project developing, manuscript editing, paper revision, final approval. Costantini: protocol/project developing, manuscript editing, paper revision, final approval. Valmasoni: protocol/project developing, manuscript editing, paper revision, final approval.

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Correspondence to Elisa Sefora Pierobon MD, PhD.

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Capovilla, G., Moletta, L., Pierobon, E.S. et al. Optimal Treatment of cT2N0 Esophageal Carcinoma: Is Upfront Surgery Really the Way?. Ann Surg Oncol 28, 8387–8397 (2021). https://doi.org/10.1245/s10434-021-10194-9

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