Back to 2025 Posters

---

PATHOLOGICAL COMPLETE RESPONSE AFTER RADIOCHEMOTHERAPY AND ESOPHAGECTOMY - FALSE SENSE OF SECURITY?
Sarah Gerber^*, Dino Kröll, Tobias Haltmeier, Martin D. Berger, Hossein Hemmatazad, Borbély Yves
Inselspital Universitatsspital Bern, Bern, BE, Switzerland

Background
Esophageal cancer (EC) is associated with a high morbidity and mortality, even in a curative treatment approach. The current standard of care for curative treatment of EC consists of neoadjuvant radiochemotherapy (RCT) followed by resection. Pathological response in the resected tissue is a well-known predictor of disease-free (DFS) and overall survival (OS). Yet, even in a pathological complete response (pCR), defined as no vital tumor cells or involved lymph nodes in the resected specimen, cancer recurrence is not infrequent.

Aim
To analyze DFS and OS in patients with pCR after trimodal therapy and identify risk factors for recurrence.

Methods
We retrospectively analyzed all patients with pCR after RCT and esophagectomy treated for EC between 01/2014 and 12/2021. Clinical data, such as demographic data, tumor characteristics at staging and restaging, and postoperative follow-up, were extracted from electronic medical records. Overall- and disease-free survival were calculated using Kaplan-Meier survival analysis, differences between groups were assessed using appropriate statistical tests, such as the Mann-Whitney U test for continuous variables, and the Fisher's exact test for categorical variables. A p-value < 0.05 was considered statistically significant.

Results
Of 28 patients, 10 (35.7%) developed cancer recurrence. There were no statistically significant differences in patient or tumor characteristics between patients with or without recurrence.
Recurrence occurred after a median 21 months (IQR 30). Median OS was 40.5 months (IQR 40) in patients with and 48.5 months (IQR 32) in patients without recurrence (p=0.121) (Fig. 1). Recurrence was mostly distant (n= 9, 90%). 4 (of 10, 40%) patients were then addressed in curative, 6 (60%) in palliative intention.
Table 1 shows predictive factors for recurrence. Notably, persistent thickening of the esophageal wall at restaging in upper endosonography and/or computed tomography, independent of malignancy in biopsies, was the only significant, non-clinical factor.

Conclusion
Even in patients with the "optimal scenario", a pathological complete response after RCT and esophagectomy, around one third develops cancer recurrence. A tight follow-up with special attention to distant rather than local recurrence seems beneficial. Patients with an aspect of only partial response at restaging are at higher risk for recurrence and should be monitored even closer.


Figure 1: overall survival in patients with pathological complete response after neoadjuvant therapy and esophagectomy

Table 1: predictive factors for recurrence in pathological complete response

---

Back to 2025 Posters