Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer

Shapiro, Joel MD; Biermann, Katharina MD, PhD; van Klaveren, David MSc; Offerhaus, G. Johan A. MD, PhD; ten Kate, Fiebo J. W. MD, PhD; Meijer, Sybren L. MD, PhD; van Berge Henegouwen, Mark I. MD, PhD; Steyerberg, Ewout W. MD, PhD; Wijnhoven, Bas P. L. MD, PhD; Lanschot, J. Jan B. van MD, PhD

Annals of Surgery: February 2017 - Volume 265 - Issue 2 - p 356–362

doi: 10.1097/SLA.0000000000001630

Original Articles

Objective: We aimed to determine pretreatment pathological tumor extent in the resection specimen after neoadjuvant chemoradiotherapy (nCRT) and to assess its prognostic value in patients with esophageal cancer.

Results: Overall concordance for prepT-stage and prepN-stage was 0.69 and 0.84, respectively. Prognostic strength of prepT-stage was similar to clinical T-stage and worse compared with ypT-stage (ΔAIC 1.3 versus 2.0 and 8.9, respectively). In contrast, prognostic strength of prepN-stage was better than cN-stage and similar to ypN-stage (ΔAIC 17.9 versus 6.2 and 17.2, respectively). PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients, with a five year overall survival of 51% versus 68%, P = 0.019, respectively.

Conclusions: PrepT-stage and prepN-stage can be estimated reproducibly. Prognostic strength of prepT-stage is comparable with clinical T-stage, whereas prepN-stage is better than cN-stage. PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients. Pretreatment pathological staging should be considered useful as a new staging parameter for esophageal cancer and could also be of interest for other tumor types.

http://journals.lww.com/annalsofsurgery/Abstract/2017/02000/Prognostic_Value_of_Pretreatment_Pathological.19.aspx