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Impact of Tumor Size on Survival Outcome in Esophageal Squamous Cell Carcinoma After Esophagectomy Following Neoadjuvant Chemotherapy

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

Abstract

Background

Large tumor size is a prognostic factor in esophageal squamous cell carcinoma (ESCC). However, the effect of tumor size on outcomes following neoadjuvant chemotherapy (NAC) has not been evaluated. This study aimed to assess the influence of tumor size on prognosis of patients undergoing esophagectomy after NAC.

Patients and Methods

This study was made up of 272 patients who underwent esophagectomy after NAC at Kobe University Hospital. We evaluated the pathological tumor size and determined the cutoff level for tumor size using receiver operating characteristics analysis to the survival status. Cox proportional hazards regression analyses were performed to identify prognostic factors.

Results

The patients were categorized into two groups: patients with tumor sizes ≥ 36 mm and < 36 mm. Deep pathological tumor invasion and worse histological response to NAC were associated with tumor size ≥ 36 mm. In patients with pT0–1, pT2, and pT4 ESCC, no significant differences in overall survival (OS) rates were observed between the two groups. In patients with pT3, OS of the tumor size ≥ 36 mm group was significantly worse than that of the tumor size < 36 mm group (p < 0.0001). Multivariate analysis in pT3 patients revealed tumor size ≥ 36 mm was an independent risk factor for OS. The 5-year OS rate was 10% in patients with tumor size ≥ 36 mm pT3 ESCC with pathological lymph node metastasis (p < 0.0001).

Conclusions

Tumor size ≥ 36 mm is an independent risk factor for poorer survival in pT3 patients. Furthermore, tumor size ≥ 36 mm with pathological lymph node metastasis in pT3 patients was associated with very poor survival.

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References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–442.

    Article  PubMed  Google Scholar 

  2. Chen D, Wang W, Mo J, et al. Minimal invasive versus open esophagectomy for patients with esophageal squamous cell carcinoma after neoadjuvant treatments. BMC Cancer. 2021;21:145.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  PubMed  Google Scholar 

  4. Makino T, Doki Y, Miyata H, et al. Use of (18)F-fluorodeoxyglucose-positron emission tomography to evaluate responses to neo-adjuvant chemotherapy for primary tumor and lymph node metastasis in esophageal squamous cell carcinoma. Surgery. 2008;144:793–802.

    Article  PubMed  Google Scholar 

  5. Sjoquist KM, Burmeister BH, Smithers BM, et al. Australasian Gastro-Intestinal Trials Group. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol. 2011;12:681–92.

    Article  PubMed  Google Scholar 

  6. Zhao Y, Dai Z, Min W, et al. Perioperative versus preoperative chemotherapy with surgery in patients with resectable squamous cell carcinoma of esophagus: a phase III randomized trial. J Thorac Oncol. 2015;10:1349–56.

    Article  CAS  PubMed  Google Scholar 

  7. Wang BY, Goan YG, Hsu PH, Hsu WH, Wu YC. Tumor length as a prognostic factor in esophageal squamous cell carcinoma. Ann Thorac Surg. 2011;3:887–93.

    Article  Google Scholar 

  8. Griffiths EA, Brummell Z, Gorthi G, Pritchard SA, Welch IM. Tumor length as a prognostic factor in esophageal malignancy: Univariate and multivariate survival analyses. J Surg Oncol. 2006;93:258–67.

    Article  PubMed  Google Scholar 

  9. Wu J, Chen QX. Prognostic and predictive significance of tumor length in patients with esophageal squamous cell carcinoma undergoing radical resection. BMC Cancer. 2016;16:394.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hollis AC, Quinn LM, Hodson J, et al. Prognostic significance of tumor length in patients receiving esophagectomy for esophageal cancer. J Surg Oncol. 2017;116:1114–22.

    Article  PubMed  Google Scholar 

  11. Koterazawa Y, Oshikiri T, Takiguchi G, et al. Prophylactic cervical lymph node dissection in thoracoscopic esophagectomy for esophageal cancer increases postoperative complications and does not improve survival. Ann Surg Oncol. 2019;26:2899–904.

    Article  PubMed  Google Scholar 

  12. Oshikiri T, Nakamura T, Miura Y, et al. A new method (the “Pincers maneuver”) for lymphadenectomy along the right recurrent laryngeal nerve during thoracoscopic esophagectomy in the prone position for esophageal cancer. Surg Endosc. 2017;31:1496–504.

    Article  PubMed  Google Scholar 

  13. Oshikiri T, Takiguchi G, Urakawa N, et al. Novel “Modified Bascule Method” for lymphadenectomy along the left recurrent laryngeal nerve during robot-assisted minimally invasive esophagectomy. Ann Surg Oncol. 2021;28:4918–27.

    Article  PubMed  Google Scholar 

  14. Oshikiri T, Yasuda T, Kawasaki K, et al. Hand-assisted laparoscopic surgery (HALS) is associated with less-restrictive ventilatory impairment and less risk for pulmonary complication than open laparotomy in thoracoscopic esophagectomy. Surgery. 2016;159:459–66.

    Article  PubMed  Google Scholar 

  15. Rice TW, Ishwaran H, Ferguson MK, Blackstone EH, Goldstraw P. Cancer of the esophagus and esophagogastric junction: an eighth edition staging primer. J Thorac Oncol. 2017;12:36–42.

    Article  PubMed  Google Scholar 

  16. Kato K, Ito Y, Daiko H, et al. A randomized controlled phase III trial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer, JCOG1109 NExT study. J Clin Oncol. 2022;40:238–238.

    Article  Google Scholar 

  17. Kitagawa Y, Ishihara R, Ishikawa H, et al. Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: part 1. Esophagus. 2023;18:1–18.

    Google Scholar 

  18. Clavien PA, Barkin J, de Oliveria ML, et al. The Clavien-Dindo classification of surgical complication: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  19. Japan Esophageal Society. Japanese classification of esophageal cancer, 11th edition: part I. Esophagus. 2017;14:1–36.

    Article  Google Scholar 

  20. Thompson WM. Esophageal cancer. Int J Radiat Oncol Biol Phys. 1983;9:1533–65.

    Article  CAS  PubMed  Google Scholar 

  21. Loc NVV, Vuong NL, Trung LV, Trung TT. Effect of time to minimally invasive esophagectomy after neoadjuvant chemotherapy for esophageal squamous cell carcinoma. J Gastrointest Cancer. 2023;1:1–12.

    Google Scholar 

  22. Makino T, Miyata H, Yamasaki M, et al. Utility of response evaluation to neo-adjuvant chemotherapy by (18)F-fluorodeoxyglucose-positron emission tomography in locally advanced esophageal squamous cell carcinoma. Surgery. 2010;148:908–18.

    Article  PubMed  Google Scholar 

  23. Rice TW, Blackstone EH, Rybicki LA, et al. Refining esophageal cancer staging. J Thorac Cardiovasc Surg. 2003;125:1103–13.

    Article  PubMed  Google Scholar 

  24. Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the survival of patients with esophageal carcinoma in the US. The importance of tumor length and lymph node status. Cancer. 2002;95:1434–43.

    Article  PubMed  Google Scholar 

  25. Kelly RJ, Mendez G, Feliciano J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer. N Engl J Med. 2021;384:1191–203.

    Article  CAS  PubMed  Google Scholar 

  26. Semenkovich TR, Subramanian M, Yan Y, et al. Adjuvant therapy for node-positive esophageal cancer after induction and surgery: a multisite study. Ann Thorac Surg. 2019;108:828–36.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Wang Q, Lang J, Li T, et al. Postoperative adjuvant chemotherapy versus chemoradiotherapy for node-positive esophageal squamous cell carcinoma: a propensity score-matched analysis. Radiat Oncol. 2020;15:119.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Zhang C, Xu F, Qiang Y, Cong ZZ, et al. Prognostic significance of tumor regression grade in esophageal squamous cell carcinoma after neoadjuvant chemoradiation. Front Surg. 2023;9:1029575.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Xu X, Zheng G, Zhang T, Zhao Y, Zheng Z. Is pathologic tumor regression grade after neo-adjuvant chemotherapy a promising prognostic indicator for patients with locally advanced gastric cancer? A cohort study evaluating tumor regression response. Cancer Chemother Pharmacol. 2019;84:635–46.

    Article  PubMed  Google Scholar 

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Acknowledgement

We thank Keiichiro Uehara from the Department of Pathology, Kobe University Graduate School of Medicine, for reviewing the descriptions regarding pathological issues in this manuscript.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe City, Hyogo, Japan

    Yasufumi Koterazawa MD, Taro Oshikiri MD, Hironobu Goto MD, Takashi Kato MD, Ryuichiro Sawada MD, Hitoshi Harada MD, Naoki Urakawa MD, Hiroshi Hasegawa MD, Shingo Kanaji MD, Kimihiro Yamashita MD, Takeru Matsuda MD & Yoshihiro Kakeji MD

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  1. Yasufumi Koterazawa MD
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  2. Taro Oshikiri MD
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Correspondence to Taro Oshikiri MD.

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Koterazawa, Y., Oshikiri, T., Goto, H. et al. Impact of Tumor Size on Survival Outcome in Esophageal Squamous Cell Carcinoma After Esophagectomy Following Neoadjuvant Chemotherapy. Ann Surg Oncol 31, 2482–2489 (2024). https://doi.org/10.1245/s10434-023-14692-w

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