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Can Clinical Response Predict Pathologic Response Following Neoadjuvant Chemoradiation for Esophageal Cancer?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Objectives

Approximately 20–40% of patients with locally advanced esophageal cancer will achieve a pathologic complete response (ypCR) following neoadjuvant chemoradiotherapy (nCRT). Predicting ypCR based on a clinical complete response (ycCR) has been a challenge. This study assessed the correlation between ycCR and ypCR, as determined from esophagectomy specimens.

Methods

Patients undergoing esophagectomy following nCRT at three major institutions between 2005 and 2018 were reviewed. Restaging, including PET/CT, endoscopy with biopsy, and esophageal ultrasound (EUS), was performed to determine ycCR.

Results

Six hundred sixty patients were included, with 93.3% with esophageal adenocarcinoma histology. Six hundred fifty-eight of these patients underwent PET, 304 EUS, and 584 underwent a biopsy. Following nCRT, 148 (22.4%) were found to have a ypCR. Only 12/32 (37.5%) determined to have a ycCR were found to have a ypCR, while 136/628 (21.6%) with a non-ycCR were found to have a ypCR (p 0.075). Individual modality PPV was 28% for PET, 54% for EUS, and 26% for biopsy. When PET was combined with EUS, 168 reports were concordant and the PPV of ypCR was 50%, though the number of patients was low (1/2). With all 3 re-staging modalities combined, the PPV and NPV both rose to 100%.

Conclusions

Current restaging tools cannot reliably predict ypCR after nCRT. While multimodal restaging appears to be a more accurate predictor of ypCR than any testing modality alone, patients cannot reliably be advised to avoid an esophagectomy on the assumption that ycCR predicts ypCR at this time.

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Abbreviations

CRT:

Chemoradiation therapy (CRT)

CT:

Computed tomography

EAC:

Esophageal adenocarcinoma

ESCC:

Esophageal squamous cell carcinoma

EUS:

Endoscopic ultrasound

nCRT:

Neoadjuvant chemoradiation therapy

NPV:

Negative predictive value

PET:

Positron emission tomography

PPV:

Positive predictive value

SUV:

Standardized uptake value

ycCR:

Clinical complete response

ypCR:

Pathologic complete response

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Acknowledgements

Medstar Surgical Resident Research Program.

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Author notes

  1. Puja G. Khaitan and Tyler Holliday contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW (G253), Washington DC, 20010, USA

    Puja G. Khaitan

  2. Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA

    Puja G. Khaitan, Tyler Holliday & Austin Carroll

  3. Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Wayne L. Hofstetter, Erin M. Bayley & Nicolas Zhou

  4. Department of Biostatistics and Biomedical Informatics, Medstar Health Research Institute, Hyattsville, MD, USA

    Sameer Desale

  5. Department of Surgery, Division of Thoracic and Esophageal Surgery, Beaumont Health, Detroit, MI, USA

    Thomas J. Watson

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Contributions

PGK: project development, data analysis, and manuscript writing. TH: project development, data analysis and collection, and manuscript writing. AC: project development, data analysis and collection, and manuscript editing. WLH: project development, data analysis, and manuscript writing/editing. EMB: project development, data analysis and collection, and manuscript editing. NZ: project development, data analysis and collection, and manuscript editing. SD: project development, data analysis, statistics, and manuscript editing. TJW: project development, data analysis, and manuscript writing/editing.

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Correspondence to Puja G. Khaitan.

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Khaitan, P.G., Holliday, T., Carroll, A. et al. Can Clinical Response Predict Pathologic Response Following Neoadjuvant Chemoradiation for Esophageal Cancer?. J Gastrointest Surg 26, 1345–1351 (2022). https://doi.org/10.1007/s11605-022-05315-y

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  • DOI: https://doi.org/10.1007/s11605-022-05315-y

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