AccScience Publishing / ARNM / Online First / DOI: 10.36922/arnm.3821
Submit to ARNM
Cite this article
23
Download
521
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL RESEARCH ARTICLE

Neoadjuvant chemoradiotherapy for T3N0M0 esophageal squamous cell carcinoma

Ying Liu1† ,  Yehan Zhou2† ,  Xiaoding Zhou1 ,  Jingqiu Li1 ,  Jie Zhu1 ,  Yi Wang1 ,  Lei Wu1 ,  Gang Wan1 ,  Xuefeng Leng3 ,  Guangyuan Liu3 ,  Yongtao Han3 ,  Yang Liu2 ,  Lin Peng3 ,  Qifeng Wang1*
Show Less
1 Department of Radiation Oncology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
2 Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
3 Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
ARNM 2024, 2(3), 3821 https://doi.org/10.36922/arnm.3821
Submitted: 2 June 2024 | Accepted: 8 July 2024 | Published: 11 September 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

The optimal treatment for patients with pretreatment T3N0M0 (pre-T3N0M0) esophageal squamous cell carcinoma (ESCC) remains controversial. This study evaluated the impact of neoadjuvant chemoradiotherapy (NCRT) on the survival outcomes of individuals diagnosed with pre-T3N0M0 ESCC. A total of 443 patients with pre-T3N0M0 ESCC who underwent either NCRT plus surgery (NCRT + S) or surgery alone were included in the study. In the surgery group, patients with post-operative staging of pathological T3N0M0 (pT3N0M0) were classified as pre-T3N0M0. In the NCRT + S group, due to tumor downstaging after NCRT, patients with pre-treatment clinical T3 and post-operative pathology indicating lymph nodes without evidence of tumor involvement or regression were considered to have pre-T3N0M0. Univariate and multivariate Cox analyses were conducted to identify independent prognostic factors influencing overall survival (OS) in pre-T3N0M0 patients. Kaplan–Meier curves were employed to assess disparities in OS and disease-free survival (DFS) between the two groups. Compared to surgery alone, NCRT + S significantly enhanced the OS (Hazard ratio [HR] = 0.572, 95% Confidence interval [CI] = 0.407 – 0.804; P = 0.0059); however, it did not show a significant benefit in DFS (HR = 0.784, 95% CI = 0.564 – 1.09; P = 0.17). Compared with the surgery group, patients who achieved a pathologically complete response (pCR) after NCRT showed significantly improved OS (HR = 0.522, 95% CI = 0.339 – 0.804; P = 0.019). The overall and locoregional recurrence rates were significantly lower in the NCRT + S group than in the surgery group. Compared with surgery alone, NCRT + S significantly improved OS in patients with pre-T3N0M0 stage disease, especially in those who achieved pCR after NCRT.

Keywords
Esophageal cancer
Neoadjuvant chemoradiotherapy
Surgery
T3N0M0
Prognosis
Funding
This work was supported by the Science and Technology Department of Sichuan Province (2023YFS0488 and 2023YFQ0055), Sichuan.
Conflict of interest
The authors declare no conflicts of interest.
References
  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi: 10.3322/caac.21660

 

  1. Cao W, Chen HD, Yu YW, Li N, Chen WQ. Changing profiles of cancer burden worldwide and in China: A secondary analysis of the global cancer statistics 2020. Chin Med J (Engl). 2021;134(7):783-791. doi: 10.1097/CM9.0000000000001474

 

  1. Eyck BM, Van Lanschot JJ, Hulshof M, et al. Ten-year outcome of neoadjuvant chemoradiotherapy plus surgery for esophageal cancer: The randomized controlled CROSS trial. J Clin Oncol. 2021;39(18):1995-2004. doi: 10.1200/JCO.20.03614

 

  1. Yang H, Liu H, Chen Y, et al. Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): A phase III multicenter, randomized, open-label clinical trial. J Clin Oncol. 2018;36(27):2796-2803. doi: 10.1200/JCO.2018.79.1483

 

  1. Shapiro J, Van Lanschot JJ, Hulshof M, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): Long-term results of a randomised controlled trial. Lancet Oncol. 2015;16(9):1090-1098. doi: 10.1016/S1470-2045(15)00040-6

 

  1. Markar SR, Gronnier C, Pasquer A, et al. Role of neoadjuvant treatment in clinical T2N0M0 oesophageal cancer: Results from a retrospective multi-center European study. Eur J Cancer. 2016;56:59-68. doi: 10.1016/j.ejca.2015.11.024

 

  1. Mantziari S, Gronnier C, Renaud F, et al. Survival benefit of neoadjuvant treatment in clinical T3N0M0 esophageal cancer: Results from a retrospective multicenter European study. Ann Surg. 2017;266:805-813. doi: 10.1097/sla.0000000000002402

 

  1. Rhodin KE, Raman V, Jawitz OK, et al. Patterns of use of induction therapy for t2n0 esophageal cancer. Ann Thorac Surg. 2021;111(2):440-447. doi: 10.1016/j.athoracsur.2020.05.089

 

  1. Goense L, Visser E, Haj Mohammad N, et al. Role of neoadjuvant chemoradiotherapy in clinical T2N0M0 esophageal cancer: A population-based cohort study. Eur J Surg Oncol. 2018;44(5):620-625. doi: 10.1016/j.ejso.2018.02.005

 

  1. Mariette C, Dahan L, Mornex F, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: Final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;32(23):2416-2422. doi: 10.1200/jco.2013.53.6532

 

  1. Robb WB, Dahan L, Mornex F, et al. Impact of neoadjuvant chemoradiation on lymph node status in esophageal cancer. Ann Surg. 2015;261(5):902-908. doi: 10.1097/sla.0000000000000991

 

  1. Dijksterhuis WP, Hulshoff JB, Van Dullemen HM, et al. Reliability of clinical nodal status regarding response to neoadjuvant chemoradiotherapy compared with surgery alone and prognosis in esophageal cancer patients. Acta Oncol. 2019;58(11):1640-1647. doi: 10.1080/0284186X.2019.1648865

 

  1. Wang Q, Peng L, Li T, et al. Postoperative chemotherapy for thoracic pathological T3N0M0 esophageal squamous cell carcinoma. Ann Surg Oncol. 2020;27(5):1488-1495. doi: 10.1245/s10434-019-08112-1

 

  1. Yang J, Zhang W, Xiao Z, et al. The impact of postoperative conformal radiotherapy after radical surgery on survival and recurrence in pathologic T3N0M0 esophageal carcinoma: A propensity score-matched analysis. J Thorac Oncol. 2017;12(7):1143-1151. doi: 10.1016/j.jtho.2017.03.024

 

  1. Rice TW, Gress DM, Patil DT, Hofstetter WL, Kelsen DP, Blackstone EH. Cancer of the esophagus and esophagogastric junction-Major changes in the American joint committee on cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017;67(4):304-317. doi: 10.3322/caac.21399

 

  1. Davies AR, Myoteri D, Zylstra J, et al. Lymph node regression and survival following neoadjuvant chemotherapy in oesophageal adenocarcinoma. Br J Surg. 2018;105(12):1639-1649. doi: 10.1002/bjs.10900

 

  1. Hsu PK, Yeh YC, Chien LI, Huang CS, Hsu HS. Clinicopathological significance of pathologic complete lymph node regression after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma. Ann Surg Oncol. 2021;28(4):2048-2058. doi: 10.1245/s10434-020-09363-z

 

  1. Hagi T, Makino T, Yamasaki M, et al. Pathological regression of lymph nodes better predicts long-term survival in esophageal cancer patients undergoing neoadjuvant chemotherapy followed by surgery. Ann Surg. 2022;275(6):1121-1129. doi: 10.1097/SLA.0000000000004238

 

  1. Lightdale CJ, Kulkarni KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol. 2005;23(20):4483-4489. doi: 10.1200/JCO.2005.20.644

 

  1. Puli SR, Reddy JB, Bechtold ML, Antillon D, Ibdah JA, Antillon MR. Staging accuracy of esophageal cancer by endoscopic ultrasound: A meta-analysis and systematic review. World J Gastroenterol. 2008;14(10):1479-1490. doi: 10.3748/wjg.14.1479

 

  1. Lee G, Hoseok H, Kim SJ, et al. Clinical implication of PET/MR imaging in preoperative esophageal cancer staging: Comparison with PET/CT, endoscopic ultrasonography, and CT. J Nucl Med. 2014;55(8):1242-1247. doi: 10.2967/jnumed.114.138974

 

  1. Gabriel E, Attwood K, Du W, et al. Association between clinically staged node-negative esophageal adenocarcinoma and overall survival benefit from neoadjuvant chemoradiation. JAMA Surg. 2016;151(3):234-245. doi: 10.1001/jamasurg.2015.4068

 

  1. Gao HJ, Wei YC, Gong L, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for clinical node-negative esophageal carcinoma. Thorac Cancer. 2020;11(9):2618-2629. doi: 10.1111/1759-7714.13586

 

  1. Van Hagen P, Hulshof MC, Van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074-2084. doi: 10.1056/NEJMoa1112088

 

  1. Speicher PJ, Wang X, Englum BR, et al. Induction chemoradiation therapy prior to esophagectomy is associated with superior long-term survival for esophageal cancer. Dis Esophagus. 2015;28(8):788-796. doi: 10.1111/dote.12285

 

  1. Li T, Fu X, Xiao L, et al. The long-term impact of tumor burden in pT3N0M0 esophageal squamous cell carcinoma. Medicine. 2019;98(42):e17637. doi: 10.1097/md.0000000000017637

 

  1. Situ D., Wei W, Lin P, et al. Do tumor grade and location affect survival in esophageal squamous cell carcinoma? Survival analysis of 302 cases of pT3N0M0 esophageal squamous cell carcinoma. Ann Surg Oncol. 2012;20(2):580-585. doi: 10.1245/s10434-012-2656-0

 

  1. Ho HJ, Chen HS, Hung WH, et al. Survival impact of total resected lymph nodes in esophageal cancer patients with and without neoadjuvant chemoradiation. Ann Surg Oncol. 2018;25(13):3820-3832. doi: 10.1245/s10434-018-6785-y

 

  1. Wong IY, Chung JC, Zhang RQ, et al. A novel tumor staging system incorporating tumor regression grade (TRG) with lymph node status (ypN-category) results in better prognostication than ypTNM stage groups after neoadjuvant therapy for esophageal squamous cell carcinoma. Ann Surg. 2022;276(5):784-791. doi: 10.1097/SLA.0000000000005636

 

  1. Steffen T, Dietrich D, Schnider A, et al. Recurrence patterns and long-term results after induction chemotherapy, chemoradiotherapy, and curative surgery in patients with locally advanced esophageal cancer. Ann Surg. 2019;269(1):83-87. doi: 10.1097/SLA.0000000000002435
Share
Back to top
Advances in Radiotherapy & Nuclear Medicine, Electronic ISSN: 2972-4392 Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept