A Potential Indication for Adjuvant Therapy in Node-Negative Esophageal Squamous Cell Carcinoma
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EDITORIAL – THORACIC ONCOLOGY
A Potential Indication for Adjuvant Therapy in Node-Negative Esophageal Squamous Cell Carcinoma Andrew M. Popoff, MD Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Henry Ford Hospital/Henry Ford Health System, Detroit, MI
The National Comprehensive Cancer Network guidelines establish indications for adjuvant therapy in esophageal adenocarcinomas.1 The guidelines include consideration of high-risk features, such as lymphovascular invasion (LVI) and perineural invasion (PNI), among others. At present, guidelines for adjuvant therapy for resected squamous cell carcinomas of the esophagus are lacking due to clear evidence of therapeutic benefit. Guo and colleagues evaluate the potential significance of PNI and its possible importance on tailored adjuvant therapy for pN0M0 squamous cell carcinomas of the esophagus.2 The authors review a series of pN0M0 resected esophageal squamous cell carcinomas and attempt to understand high-risk features that may represent indications for adjuvant therapy. They employ a relatively sophisticated methodology and subanalyses to conclude that Neural Invasion Index (NII) is the most consistent measure of PNI and that it affords greater fidelity than dichotomous PNI±. They further conclude that in this series LVI was not predictive of outcomes and that adjuvant radiotherapy in the high NII subset conferred a statistically significant survival advantage. Perineural Invasion has previously been shown to negatively impact disease-free survival and disease-specific survival in esophageal squamous cell carcinomas.3 Gao et al. add to the body of evidence that tumor characteristics influence prognosis and could serve as targets for more
Ó Society of Surgical Oncology 2020 First Received: 7 June 2020 Accepted: 30 June 2020 A. M. Popoff, MD e-mail: [email protected]
individualized adjuvant therapy. The work put forth addresses a specific subset of node-negative squamous cell carcinomas. While the authors use NII to better characterize perineural invasion and its potential impact on both prognosis and as an indication for adjuvant radiotherapy, it is not clear that this is applicable clinically. As the standard clinicopathologic evaluation at present for esophageal squamous cell carcinomas typically report perineural invasion in a dichotomous fashion. This may represent an opportunity for our colleagues in pathology to further refine their characterizations for ESCC. The authors go on to report that in those with a high NII, and PNI, adjuvant radiotherapy can improve outcomes in those with pN0M0 ESCC. They posit that even patients with pT1–T2 tumors may benefit. Relatively few of the cohort received adjuvant chemotherapy, and they suggest this as a possible avenue of further exploration. However, none of the T3–T4 subset received neoadjuvant chemoradiotherapy, and the authors acknowledge this. This comprises 81% (132/162) of the study population. It is likely that in current treatment paradigms, especially in the west, this subset would have rec
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