Validation of the post-neoadjuvant staging system of the American joint committee on cancer, 8th edition, in patients treated with neoadjuvant chemoradiotherapy followed by curative esophagectomy for localized esophageal squamous cell carcinoma

Comparison and validation of the Japanese classification 12th edition and American joint committee on cancer 8th edition on intrathoracic esophageal squamous cell carcinoma

BACKGROUND

The American Joint Committee on Cancer (AJCC) 8th edition and Japanese classification 12th edition can be applied for esophageal cancer staging. This retrospective study aimed to compare these two staging systems in patients with surgically treated esophageal squamous cell carcinoma (ESCC).

METHODS

We retrospectively reviewed 2,853 patients who underwent esophagectomy and lymphadenectomy from 1994 to 2020. Patients were divided into the upfront (n = 2156) and neoadjuvant (n = 697) groups.

RESULTS

The mean age of the patients was 63.5 ± 8.2 years with a median follow-up of 7.6 years. Comparing both staging systems showed that patients were more likely to be staged lower by the Japanese classification. Survival curves for overall survival (OS) and disease-free survival in the upfront group were well separated in the two staging systems (p < 0.01), and the HR for survival significantly increased as the stage increased. In the neoadjuvant group, there were crossovers of survival curves between stages II and III in the AJCC, and crossovers between stages I and II, and stages III and IV in the Japanese classification. The HR for OS demonstrated less statistical differences in the neoadjuvant group.

CONCLUSION

The AJCC 8th edition and Japanese classification 12th edition predicted survival well for patients received the upfront surgery, whereas both showed crossovers of survival curves for patients undergoing neoadjuvant therapy. More accurate staging systems for patients with ESCC who received neoadjuvant therapy and surgery are needed.

Lymph-node ratio as a risk factor for recurrence following neoadjuvant docetaxel, cisplatin, and 5-fluorouracil therapy for locally advanced esophageal squamous cell carcinoma

BACKGROUND AND PURPOSE

It remains unclear whether the lymph-node ratio (LNR) is a relevant factor for the risk of recurrence following neoadjuvant chemotherapy (nCT) with docetaxel, cisplatin, and 5-fluorouracil (DCF), which is a new standard of care for locally advanced esophageal squamous cell carcinoma (ESCC) in Japan. This study aimed to evaluate the clinical utility of LNR as a risk factor for recurrence.

MATERIALS AND METHODS

We retrospectively analyzed 75 patients who underwent nCT-DCF followed by curative surgery for resectable ESCC. The cut-off for the LNR was determined using receiver-operating characteristic curve analysis for recurrence.

RESULTS

A higher LNR was observed in 34 (45.3%) patients. At a median follow-up of 19.2 months, the median disease-free survival (DFS)/recurrence-free survival (RFS) rate was not reached in patients with a lower LNR and was 8.0 months in those with a higher LNR (P < 0.01). The estimated 1-year DFS/RFS rate was 47.8% and 100% for patients with a higher LNR and lower LNR, respectively. LNR remained a risk factor, even when stratified by non-pathological complete response, the presence of positive ypN, or ypStage III. In those with a higher LNR, the median DFS/RFS was 18.3 versus 8.0 months with and without adjuvant nivolumab treatment, respectively.

CONCLUSIONS

Higher LNR indicates a more aggressive phenotype with worse DFS/RFS rates and increased recurrence following nCT-DCF treatment and curative surgery for ESCC.

Pathological response to neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma in Eastern versus Western countries: meta-analysis

OBJECTIVE

Locally advanced oesophageal squamous cell carcinoma can be treated with neoadjuvant chemoradiotherapy or chemotherapy followed by oesophagectomy. Discrepancies in pathological response rates have been reported between studies from Eastern versus Western countries. The aim of this study was to compare the pathological response to neoadjuvant chemoradiotherapy in Eastern versus Western countries.

METHODS

Databases were searched until November 2022 for studies reporting pCR rates after neoadjuvant chemoradiotherapy for oesophageal squamous cell carcinoma. Multi-level meta-analyses were performed to pool pCR rates separately for cohorts from studies performed in centres in the Sinosphere (East) or in Europe and the Anglosphere (West).

RESULTS

For neoadjuvant chemoradiotherapy, 51 Eastern cohorts (5636 patients) and 20 Western cohorts (3039 patients) were included. Studies from Eastern countries included more men, younger patients, more proximal tumours, and more cT4 and cN+ disease. Patients in the West were more often treated with high-dose radiotherapy, whereas patients in the East were more often treated with a platinum + fluoropyrimidine regimen. The pooled pCR rate after neoadjuvant chemoradiotherapy was 31.7% (95% c.i. 29.5% to 34.1%) in Eastern cohorts versus 40.4% (95% c.i. 35.0% to 45.9%) in Western cohorts (fixed-effect P = 0.003). For cohorts with similar cTNM stages, pooled pCR rates for the East and the West were 32.5% and 41.9% respectively (fixed-effect P = 0.003).

CONCLUSION

The pathological response to neoadjuvant chemoradiotherapy is less favourable in patients treated in Eastern countries compared with Western countries. Despite efforts to investigate accounting factors, the discrepancy in pCR rate cannot be entirely explained by differences in patient, tumour, or treatment characteristics.

Prognostic value of baseline 18F-FDG PET/CT in patients with esophageal squamous cell carcinoma treated with definitive (chemo)radiotherapy

PURPOSE

To investigate the prognostic value of baseline ¹⁸F-FDG PET/CT in patients with esophageal squamous cell carcinoma (ESCC) treated with definitive (chemo)radiotherapy.

METHODS

A total of 98 ESCC patients with cTNM stage T1-4, N1-3, M0 who received definitive (chemo)radiotherapy after ¹⁸F-FDG PET/CT examination from December 2013 to December 2020 were retrospectively analyzed. Clinical factors included age, sex, histologic differentiation grade, tumor location, clinical stage, and treatment strategies. Parameters obtained by ¹⁸F-FDG PET/CT included SUV_max of primary tumor (SUV_Tumor), metabolic tumor volume (MTV), total lesion glycolysis (TLG), SUV_max of lymph node (SUV_LN), PET positive lymph nodes (PLNS) number, the shortest distance between the farthest PET positive lymph node and the primary tumor in three-dimensional space after the standardization of the patient BSA (SD_max(LN-T)). Univariate and multivariate analysis was conducted by Cox proportional hazard model to explore the significant factors affecting overall survival (OS) and progression-free survival (PFS) in ESCC patients.

RESULTS

Univariate analysis showed that tumor location, SUV_Tumor, MTV, TLG, PLNS number, SD_{max (LN-T)} were significant predictors of OS and tumor location, and clinical T stage, SUV_Tumor, MTV, TLG, SD_{max (LN-T)} were significant predictors of PFS (all p < 0.1). Multivariate analysis showed that MTV and SD_{max (LN-T)} were independent prognostic factors for OS (HR = 1.018, 95% CI 1.006-1.031; p = 0.005; HR = 6.988, 95% CI 2.119-23.042; p = 0.001) and PFS (HR = 1.019, 95% CI 1.005-1.034; p = 0.009; HR = 5.819, 95% CI 1.921-17.628; p = 0.002). Combined with independent prognostic factors MTV and SD_{max (LN-T)}, we can further stratify patient risk.

CONCLUSIONS

Before treatment, ¹⁸F-FDG PET/CT has important prognostic value for patients with ESCC treated with definitive (chemo)radiotherapy. The lower the value of MTV and SD_{max (LN-T)}, the better the prognosis of patients.

Construction of the Six-lncRNA Prognosis Signature as a Novel Biomarker in Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) is a common malignant gastrointestinal tumor threatening global human health. For patients diagnosed with ESCC, determining the prognosis is a huge challenge. Due to their important role in tumor progression, long non-coding RNAs (lncRNAs) may be putative molecular candidates in the survival prediction of ESCC patients. Here, we obtained three datasets of ESCC lncRNA expression profiles (GSE53624, GSE53622, and GSE53625) from the Gene Expression Omnibus (GEO) database. The method of statistics and machine learning including survival analysis and LASSO regression analysis were applied. We identified a six-lncRNA signature composed of AL445524.1, AC109439.2, LINC01273, AC015922.3, LINC00547, and PSPC1-AS2. Kaplan-Meier and Cox analyses were conducted, and the prognostic ability and predictive independence of the lncRNA signature were found in three ESCC datasets. In the entire set, time-dependent ROC curve analysis showed that the prediction accuracy of the lncRNA signature was remarkably greater than that of TNM stage. ROC and stratified analysis indicated that the combination of six-lncRNA signature with the TNM stage has the highest accuracy in subgrouping ESCC patients. Furthermore, experiments subsequently confirmed that one of the lncRNAs LINC01273 may play an oncogenic role in ESCC. This study suggested the six-lncRNA signature could be a valuable survival predictor for patients with ESCC and have potential to be an auxiliary biomarker of TNM stage to subdivide ESCC patients more accurately, which has important clinical significance.

Perioperative risk factors for survival outcomes in elective colorectal cancer surgery: a retrospective cohort study

Background

Surgical resection remains the best option for long-term survival in colorectal cancer (CRC); however, surgery can lead to tumor cell release into the circulation. Previous studies have also shown that surgery can affect cancer cell growth. The role of perioperative factors influencing long-term survival in patients presenting for CRC surgery remains to be investigated.

Methods

This retrospective single–center cohort study was conducted to collect the clinical data of patients who underwent elective laparoscopic resection for CRC from January 2014 to December 2015, namely clinical manifestations, pathological results, and perioperative characteristics. Survival was estimated using the Kaplan–Meier log-rank test. Univariable and multivariable Cox regression models were used to compare hazard ratios (HR) for death.

Results

A total of 234 patients were eligible for analysis. In the multivariable Cox model, tumor-node-metastasis (TNM) stage (stage IV: HR 30.63, 95% confidence interval (CI): 3.85–243.65; P = 0.001), lymphovascular invasion (yes: HR 2.07, 95% CI 1.09–3.92; P = 0.027), inhalational anesthesia with isoflurane (HR 1.96, 95% CI 1.19–3.21; P = 0.008), and Klintrup–Makinen (KM) inflammatory cell infiltration grade (low-grade inflammation: HR 2.03, 95% CI 1.20–3.43; P = 0.008) were independent risk factors affecting 5-year overall survival after laparoscopic resection for CRC.

Conclusions

TNM stage, lymphovascular invasion, isoflurane, and KM grade were independent risk factors affecting CRC prognosis. Sevoflurane and high-grade inflammation may be associated with improved survival in CRC patients undergoing resection.