Pathological complete response in patients with esophageal cancer after the trimodality approach: The association with baseline variables and survival—The University of Texas MD Anderson Cancer Center experience

• Published in: Cancer 2017-11, Vol.123 (21), p.4106-4113
• Main Authors: Blum Murphy, Mariela, Xiao, Lianchum, Patel, Viren R., Maru, Dipen M., Correa, Arlene M., G. Amlashi, Fatemeh, Liao, Zhongxing, Komaki, Ritsuko, Lin, Steven H., Skinner, Heath D., Vaporciyan, Ara, Walsh, Garrett L., Swisher, Stephen G., Sepesi, Boris, Lee, Jeffrey H., Bhutani, Manoop S., Weston, Brian, Hofstetter, Wayne L., Ajani, Jaffer A.
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adenocarcinoma - secondary; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Brain; Brain Neoplasms - secondary; Cancer; Cancer Care Facilities; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy - methods; Combined Modality Therapy - methods; Disease-Free Survival; Esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagus; Female; Humans; Linear Models; Male; Metastases; Metastasis; Middle Aged; neoadjuvant; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Oncology; pathological complete response; Patients; Regression analysis; remission; Remission Induction; Squamous cell carcinoma; Surgery; Survival; Texas; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.30953

BACKGROUND Reports are limited regarding clinical and pretreatment features that might predict a pathological complete response (pathCR) after treatment in patients with esophageal cancer (EC). This might allow patient selection for different strategies. This study examines the association of a pathCR with pretreatment variables, overall survival (OS), recurrence‐free survival (RFS), and patterns of recurrence in a large cohort from a single institution. METHODS The baseline clinical features of 911 consecutive patients with EC who were treated with trimodality therapy from January 2000 to November 2013 were analyzed. A pathCR was defined as a surgical specimen with no residual carcinoma (primary or nodes). Logistic regressions were used to identify independent baseline features associated with a pathCR. We applied log‐rank testing and Cox models to determine the association between a pathCR and the time‐to‐event outcomes (OS and RFS). RESULTS Of 911 patients, 218 (23.9%) achieved a pathCR. The pathCR rate was 23.1% for adenocarcinoma and 32.2% for squamous cell carcinoma. A lower pathCR rate was observed for 1) older patients (>60 years), 2) patients with poorly differentiated tumors, 3) patients with signet ring cells (SRCs), and 4) patients with a higher T stage. Patients with a pathCR had longer OS and RFS than those without a pathCR (P = .0021 and P = .0011, respectively). Recurrences occurred more in non‐pathCR patients. Distant metastases were the most common type of recurrence. PathCR patients developed brain metastases at a marginally higher rate than non‐pathCR patients (P = .051). CONCLUSIONS In this large cohort study, a pathCR is confirmed to be associated with better OS and RFS. The presence of a poorly differentiated tumor or SRCs reduces the likelihood of a pathCR. Future research should focus on molecular classifiers. Cancer 2017;123:4106–4113. © 2017 American Cancer Society. A pathological complete response is associated with better overall survival and recurrence‐free survival. A higher T stage and the presence of poorly differentiated tumors or signet ring cells reduce the likelihood of a pathological complete response. See also pages 4097‐8.