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Clinical Significance of Endoscopic Response Evaluation to Predict the Distribution of Residual Tumor after Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

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

Abstract

Purpose

To appropriately adopt the organ preservation approach, including subsequent chemoradiotherapy (CRT) in patients who respond to neoadjuvant chemotherapy (NAC), the distribution of residual disease, including pathological lymph nodes (LNs) and recurrence site, needs to be recognized preoperatively. This study was designed to evaluate whether endoscopic response evaluation can predict residual tumor distribution.

Methods

Patients with esophageal squamous cell carcinoma who underwent transthoracic esophagectomy (TTE) were retrospectively reviewed. Endoscopic responder (ER) to NAC was defined according to primary tumor endoscopic findings. Recurrence-free survival (RFS), overall survival (OS), and residual tumor patterns were compared between groups.

Results

Of 193 patients, 40 (20%) were classified as ER. ERs showed significantly better RFS and OS. The pN location was found within the primary tumor and cN field in 88% of ERs, which was significantly higher than non-ERs at 63% (p = 0.004). Furthermore, the postoperative recurrence incidence in the distant organ was significantly lower in the ERs than the non-ERs (8%, 32%, respectively, p = 0.002). Residual disease, including postoperative initial recurrence, existed within the same field as the primary tumor and cN in 88% of ERs, significantly higher than 42% in the non-ERs (p < 0.001).

Conclusions

Endoscopic response evaluation can preoperatively predict distribution of residual tumors after NAC, which could help radiation field selection in subsequent definitive CRT when patients prefer to omit TTE. Along with improvements in NAC response rate, this could facilitate organ preservation in patients who respond to NAC.

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Funding

Yuko Kitagawa received lecture fees from Asahi Kasei Co., Ltd., Taiho Pharmaceutical Co., Ltd, Chugai Pharmaceutical Co., Ltd., EA Pharma Co., Ltd., Yakult Honsha Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., Shionogi & Co., Ltd., Astellas Pharma Inc., Dainippon Sumitomo Pharma Co., Ltd., Taisho Toyama Pharmaceutical Co., Ono Pharmaceutical Co., Nihon Pharmaceutical Co., Ltd., Sanofi K.K., Eisai Co., Ltd., Kaken Pharmaceutical Co., Ltd.. Yuko Kitagawa. Moreover, he received research expenses and scholarship donations (grants) from Taiho Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Yakult Honsha Co. Ltd., Daiichi Sankyo Co., Ltd., Merck Serono Co., Ltd., Asahi Kasei Co., Ltd., EA Pharma Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., Shionogi Co., Ltd., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Astellas Pharma Inc., Medicon Inc., Dainippon Sumitomo Pharma Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Kyouwa Hakkou Kirin Co., Ltd., Pfizer Japan Inc., Ono Pharmaceutical Co., Ltd., Nihon Pharmaceutical Co., Ltd., Japan Blood Products Organization Medtronic Japan Co., Ltd., Sanofi K.K., Eisai Co., Ltd., Tsumura & Co., Ltd., KCI Licensing, Inc., Abbott Japan Co., Ltd., Fujifilm, and Toyama Chemical Co., Ltd. Finally, he worked as a director of endowed chair supported from Taiho Pharmaceutical Co., Ltd, Chugai Pharmaceutical Co., Ltd.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Satoru Matsuda MD, PhD, Hirofumi Kawakubo MD, PhD, Takayuki Tsuji MD, Junya Aoyama MD, PhD, Yuki Hirata MD, Shuhei Mayanagi MD, PhD, Tomoyuki Irino MD, PhD, Kazumasa Fukuda MD, Rieko Nakamura MD, PhD & Yuko Kitagawa MD, PhD, FACS

  2. Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan

    Ryo Takemura PhD

  3. Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Hiroya Takeuchi MD, PhD, FACS

Authors
  1. Satoru Matsuda MD, PhD
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  2. Hirofumi Kawakubo MD, PhD
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  3. Takayuki Tsuji MD
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  4. Junya Aoyama MD, PhD
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  5. Yuki Hirata MD
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  6. Ryo Takemura PhD
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  7. Shuhei Mayanagi MD, PhD
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  8. Tomoyuki Irino MD, PhD
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  9. Kazumasa Fukuda MD
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  10. Rieko Nakamura MD, PhD
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  11. Hiroya Takeuchi MD, PhD, FACS
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  12. Yuko Kitagawa MD, PhD, FACS
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Correspondence to Hirofumi Kawakubo MD, PhD.

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Matsuda, S., Kawakubo, H., Tsuji, T. et al. Clinical Significance of Endoscopic Response Evaluation to Predict the Distribution of Residual Tumor after Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 29, 2673–2680 (2022). https://doi.org/10.1245/s10434-021-11009-7

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  • DOI: https://doi.org/10.1245/s10434-021-11009-7

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