Pretreatment Primary Tumor Stage is a Risk Factor for Recurrence in Patients with Esophageal Squamous Cell Carcinoma Who
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Pretreatment Primary Tumor Stage is a Risk Factor for Recurrence in Patients with Esophageal Squamous Cell Carcinoma Who Achieve Pathological Complete Response After Neoadjuvant Chemoradiotherapy Roberta La Mendola, MD1 , Maria Bencivenga, MD1, Lorena Torroni, MSc2, Luca Alberti, MD1, Michele Sacco, MD1, Francesco Casella, MD1, Cecilia Ridolfi, MD1, Nicola Simoni, MD3, Renato Micera, MD3, Michele Pavarana, MD4, Giuseppe Verlato, MD2, and Simone Giacopuzzi, MD, PhD1 1
General and Upper GI Surgery Division, University of Verona, Verona, Italy; 2Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; 3Unit of Radiotherapy, Verona University Hospital, Verona, Italy; 4Unit of Medical Oncology, Verona University Hospital, Verona, Italy
ABSTRACT Background. Although pathological complete response (pCR) after multimodal treatment for esophageal cancer is associated to the best prognosis, recurrence may occur in 20–40% of cases. The present study investigated the recurrence pattern and predictive factors of recurrence after pCR in patients with esophageal cancer. Methods. In this study, 427 patients received preoperative treatment for either esophageal squamous cell carcinoma (SCC) or adenocarcinoma at Verona University Hospital between 2000 and 2018. Of these, 145 patients (34%) achieved a pCR. Long-term prognosis, recurrence pattern, and risk factors for relapse in pCR patients were analysed. Results. During a median follow-up of 52 months, 37 relapses (25.5%) occurred, mostly at distant level (n = 28). Nearly all locoregional relapses (8/9) were detected in SCC cases. The 5-year overall survival and cancer-related survival were 71.7% (95% confidence interval [CI] 62.6–78.9%) and 77.5% (95% CI 68.5–84.2%) respectively. Male sex, higher body mass index, and cT4 were significant risk factors for recurrence at univariate analysis. The multivariate analysis confirmed the role of cT4 as predictor of recurrence only in SCCs.
Ó The Author(s) 2020 First Received: 17 May 2020 Accepted: 14 September 2020 R. La Mendola, MD e-mail: [email protected]
Conclusions. Esophageal cancer recurs in about onefourth of pCR cases. A fair number of local recurrences occurs in SCCs, but the main problem is the systemic disease control. According to our analysis, SCCs patients with cT4 stage have an increased risk to recur, so they should be managed differently by a personalized approach in terms of adjuvant treatment and follow-up.
During the past two decades, neoadjuvant chemoradiotherapy followed by surgery was established as the standard of care in patients. Locally advanced esophageal cancer (EC) was associated with a higher rate of radical (R0) resections and better overall survival (OS) and cancerrelated survival (CRS) compared with surgery alone.1,2 Preoperative treatments allow a pathological complete response (pCR) to be obtained, defined as the total regression of the tumor both at the site of the primary lesion and
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