Survival after trimodality therapy in patients with locally advanced esophagogastric adenocarcinoma: Does only a complete pathologic response matter? Journal Article
| Authors: | Sihag, S.; Nobel, T.; Hsu, M.; De La Torre, S.; Tan, K. S.; Janjigian, Y. Y.; Ku, G. Y.; Tang, L. H.; Wu, A. J.; Maron, S. B.; Bains, M. S.; Jones, D. R.; Molena, D. |
| Article Title: | Survival after trimodality therapy in patients with locally advanced esophagogastric adenocarcinoma: Does only a complete pathologic response matter? |
| Abstract: | Objective: To evaluate whether pCR exclusively defines major pathologic response to treatment with improved survival. Summary Background Data: pCR after trimodality therapy for EAC is infrequent but associated with improved prognosis. Yet most clinical trials and correlative studies designate pCR as the primary endpoint. Methods: We analyzed our prospectively maintained database for patients who underwent trimodality therapy for locally advanced esophageal adeno-carcinoma between 1995 and 2017. Overall survival (OS) was examined by percentage TR in the primary tumor bed and pathologic nodal stage (ypN0) using Kaplan-Meier plots. Optimal thresholds of TR for differentiating patients in terms of OS were investigated with descriptive plots using restricted cubic spline functions; associations were quantified using Cox multivariable analysis. Results: Among 788 patients, median follow-up was 37.5 months (range, 0.4210.6); median OS was 48.3 months (95% CI, 42.2-58.8). Absence of residual nodal disease was independently associated with improved survival (P < 0.001). Survival curves for 90% to 99% TR and 100% TR were similar, and a change in probability of improved OS was observed at 90% TR. On multivariable analysis, combining 90% to 99% and 100% TR was independently associated with improved OS, compared with 50% to 89% and <50% TR. Conclusions: ypN0 status is the strongest indicator of major pathologic response to trimodality therapy, in addition to >90% TR in the primary tumor bed. These findings may allow the definition of major pathologic response to be expanded, from pCR to > 90% TR and ypN0. This has meaningful implications for future clinical trials and correlative studies. © 2022 Lippincott Williams and Wilkins. All rights reserved. |
| Keywords: | retrospective studies; neoadjuvant therapy; cancer staging; neoplasm staging; adenocarcinoma; pathology; retrospective study; minimal residual disease; neoplasm, residual; remission; remission induction; esophagus tumor; esophageal neoplasms; pathologic complete response; trimodality therapy; humans; human; esophagogastric adenocarcinoma; major pathologic response |
| Journal Title: | Annals of Surgery |
| Volume: | 276 |
| Issue: | 6 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2022-12-01 |
| Start Page: | 1017 |
| End Page: | 1022 |
| Language: | English |
| DOI: | 10.1097/sla.0000000000004638 |
| PUBMED: | 33214465 |
| PROVIDER: | scopus |
| PMCID: | PMC8126574 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
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