Abstract
Purpose: To analyze the differences in clinical stage, pathologic response to chemoradiotherapy, patterns of failure, and overall survival (OS) between patients with squamous cell carcinoma (SCC) and adenocarcinoma (ACA) of the esophagus.
Patients and Methods: We stratified patients by two histologies, ACA and SCC, and statistically compared their clinical stage, post-therapy pathologic response, patterns of failure, and OS.
Results: Of the 235 patients who underwent preoperative chemoradiotherapy, 42 (18%) had SCC and 193 (82%) had ACA. Among the ACA patients, a significantly larger proportion was male (93% vs 7%; p<0.001), whereas sex was distributed similarly among SCC patients (55% male vs 45% female; p=0.5). A significantly larger percentage of SCC patients were classified as lower TN and overall stage than ACA patients (T2=41% vs 28%, p<0.0001; N0=69% vs 48%, p=0.01; stage II=76% vs 55%, p<0.001). A significantly greater portion of SCCs was categorized as pathologic N0 after treatment (71% vs 65%; p=0.02). Among the pathCR patients in clinical stage II, there were significantly greater proportion of SCC patients (77% vs 63%; p<0.001) than ACA patients. Among the pathCR patients in clinical stage III patients, a significantly greater proportion were ACA patients (38% vs 23%; p<0.001) than SCC patients. The median and 5-yr OS was 53±11 mo and 39% for ACA patients and 35±14 mo and 37% for SCC (median OS, p=0.3). Among pathCR patients, median OS of ACA patients (133 mo) was longer than that of SCC patients but nonsignificant (29 mo; p=0.07); results were similar for non-pathCR patients. DFS results were similar in all subgroups. Among the whole cohort, incidence of local-regional recurrence and distant metastases did not vary significantly. The median time to distant metastases did not vary significantly for pathCR and non-pathCR patients.
Conclusions: We believe this is the first study that compares failure outcome of ACA and SCC patients with similar clinical stage after trimodality therapy. Our data suggest that significant differences in clinical stage and post-therapy pathologic stage exist between ACA and SCC. Frequent presence of malignant nodes in the resected specimens of ACA patients resulted in a shorter time-to-metastases suggesting that ACA patients need better systemic control.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Posner MC, Gooding WE, Landreneau RJ, et al. Preoperative chemoradiotherapy for carcinoma of the esophagus and gastroesophageal junction. Cancer J Sci Am 1998;4(4):237–246.
Jones DR, Detterbeck FC, Egan TM, et al. Induction chemoradiotherapy followed by esophagectomy in patients with carcinoma of the esophagus. Soc Thoracic Surg 1997;64:185–192.
Forastiere AA, Orringer MB, Perez-Tamayo C, et al. Concurrent chemotherapy and radiation therapy followed by transhiatal esophagectomy for local-regional cancer of the esophagus. J Clin Oncol 1990;8(1):119–127.
De Vita F, Martino ND, Orditura M, et al. Preoperative chemoradiotherapy for squamous cell carcinoma and adenocarcinoma of the esophagus. Chest 2002;122:1302–1308.
Makary MA, Kiernan PD, Sheridan MJ, et al. Multimodality treatment for esophageal cancer: the role of surgery and neoadjuvant therapy. Am Surg 2003;69:693–702.
Heath EI, Burtness BA, Heitmiller RF, et al. Phase II evaluation of preoperative chemoradiation and postoperative adjuvant chemotherapy for squamous cell and adenocarcinoma of the esophagus. J Clin Oncol 2000;18(4):868–876.
Lew JI, Gooding WE, Ribeiro U Jr, et al. Long-term survival following induction chemoradiotherapy and esophagectomy for esophageal carcinoma. Arch Surg 2001;136(7):737–743.
Forastiere AA, Heitmiller RF, Lee DJ, et al. Intensive chemoradiation followed by esophagectomy for squamous cell and adenocarcinoma of the esophagus. Cancer J Sci Am 1997;3(3):144–152.
Stahl M, Wilke H, Fink U, et al. Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer. Interim analysis of a phase II trial. J Clin Oncol 1996;14(3):829–837.
Meneu-Diaz JC, Blazquez LA, Vicente E, et al. The role of multimodality therapy for resectable esophageal cancer. Am J Surg 2000;179:508–513.
Slater MS, Holland J, Faigel DO, et al. Does neoadjuvant chemoradiation downstage esophageal carcinoma? Am J Surg 2001;181:440–444.
Greene FL, Page DL, Fleming ID, et al. AJCC Cancer Staging Manual, 6th Ed. Springer, New York, NY; 2002; pp. 91–98.
Kalha I, Kaw M, Fukami, N, et al. The accuracy of endoscopic ultrasound for restaging esophagel carcinoma after chemoradiation therapy. Cancer 2004;101(5):940–947.
Chirieac LR, Swisher SG, Ajani JA, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer 2005;103(7):1347–1355.
Kitajima M, Kitagawa Y. Surgical treatment of esophageal cancer—the advent of the era of individualization. N Engl J Med 2002;347:1705–1709.
Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002;347:1662–1669.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rohatgi, P.R., Swisher, S.G., Correa, A.M. et al. Comparison of clinical stage, therapy response, and patient outcome between squamous cell carcinoma and adenocarcinoma of the esophagus. Int J Gastrointest Canc 36, 69–76 (2005). https://doi.org/10.1385/IJGC:36:2:69
Issue Date:
DOI: https://doi.org/10.1385/IJGC:36:2:69