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Long-Term Outcomes After Multimodal Therapy for Esophageal Cancer
Helen M. Heneghan*, Alexandra Zaborowski, John V. Reynolds, Narayanasamy Ravi, Sinead King
National Esophageal and Gastric Cancer Center, Trinity College Dublin & St. James's Hospital, Dublin, Dublin, Ireland
Background
Multimodal therapy [Neoadjuvant chemoradiotherapy (nCRT) prior to resection] is increasingly the standard of care for locally advanced oesophageal and junctional tumors. Tumor regression at the primary site is considered a proxy of survival benefit, but long-term outcome data is rarely reported. Furthermore, little is known about the long-term outcomes of the unique group of patients who achieve a complete pathologic response (pCR) to nCRT.
Objective:
To analyze long-term outcomes following multimodal therapy for oesophageal and junctional cancer, and the impact of tumor regression and pCR on survival.
Patients and Methods:
Retrospective analysis of a prospectively registered 10-year cohort, with a minimum of 3 years follow-up.
Results:
Between 2000-2010, 265 patients underwent multimodal treatment for oesophageal/junctional cancer (76% males, mean age 58.7 years, 71% adenocarcinoma). Of these, 45 (17%) did not progress to surgery due to disease progression or decreased performance status. At a median follow-up of 56 months, 44 (20%) achieved pCR (ypT0N0) to nCRT. The overall median survival was 28 months, and 5-year survival was 28.1%. Histomorphologic tumor regression grades (TRG) was not associated with pre-nCRT cTN stage but was significantly associated with ypN stage (p<0.001). On multivariate analysis, ypN status (p=0.048) and R0 resection were independent predictors of overall survival, but not TRG (p=0.611).
Patients achieving pCR had 5-yr disease-free survival and overall survival of 51.6% and 56.8%, respectively, compared to 19.1% and 26.7% in NR (p=0.001). Disease recurrence was less frequent in pCR group (47.7% vs. 66.5%, p=0.021), and the patterns of recurrence varied significantly. Local recurrence alone was less common in pCR group (9.1% vs. 20.5%, p=0.05). Time to recurrence or death was similar in both groups [12.0 vs. 12.5 months (p=0.848), and 25.2 vs. 24.9 months (p=0.953), respectively].
Conclusion:
Achieving a node-negative (ypN0) and R0 resection status are the major determinants of outcome following neoadjuvant chemoradiotherapy for oesophageal and OGJ cancers. A pCR confers survival benefit, but TRG is not an independent predictor of survival.
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