Neoadjuvant Chemo-Radiotherapy Modifies the Histologic Grade of Esophageal Cancer
Renato Salvador1, Gianpietro Zanchettin*1, Mantoan Silvia1, Luca Faccio1, Angela Pecchielan1, Antonio Rella1, Francesco Cavallin2, Michele Valmasoni1, Carlo Castoro2, Matteo Cagol2, Rita Alfieri2, Ermanno Ancona1, Alberto Ruol1
1Department of Surgical and Gastroenterological Sciences, Clinica Chirurgica I, University of Padova, Padua, Italy; 2Surgical Oncology, Istituto Oncologico Veneto, IOV-IRCCS, Padova, Italy
Background
The introduction of the number of nodal metastasis, grading and tumor location in the 2010 TNM staging could redefine the management of esophageal cancer. In early stages (T1a/T1b and T2a/T2b) histologic grade modulates stage grouping and prognosis. The aim of the study was to investigate the hypothesis that neoadjuvant Chemo or Chemo-RadioTherapy (nCRT) may modify the grading of esophageal cancer.
Patients and methods
We evaluated 463 patients who underwent surgical resection for esophageal cancer or esophago-gastric junction: 252 had surgery (SURG) as first treatment and 211 had nCRT before surgery. Pathological findings were evaluated from the pre-treatment endoscopic biopsies and the surgical specimen. Patients who had R1-R2 resection or a pathological stage M1 were excluded. The change of histologic grade (i.e. shift from well-differentiated to less well-differentiated and vice versa) were retrospectively investigated analyzing prospectively collected data.
Results
The histological type was adenocarcinoma (AK) in 170 pts (123 SURG / 47 nCRT) and squamous cell carcinoma (SCC) in 293 pts (129 SURG / 164 nCRT). Median age was statistically different between SURG 60.4 years (IQR 53.9-66.3) and nCRT 65.6 years (IQR 58-71.2)(p<0.0001), while the sex distribution was similar in the SURG and nCRT. Histologic grade was unchanged in 172/252 (68.3%) in SURG group and 63/211 (29.9%) in nCRT group (p<0.0001). The shift from less well-differentiated to well-differentiated grade was statistically different between the two groups: 9.5% (24/252) for SURG group and 64% (135/ 211) for nCRT group (p<0.0001). The shift from less well-differentiated to well-differentiated grade wasn’t correlated with the histological type: 9/123 AK (7.3%) and 15/129 SCC (11.6%) for the SURG group and 28/47 AK (59.6%) and 107/168 SCC (65.2%) for the nCRT group.
Conclusions
nCRT can modify the histologic grade of both AK and SCC of the esophagus. This findings, based on the 2010 TNM classification, affects stage grouping and prognosis.
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