Esophageal Adenocarcinoma Stage III: Survival based on pathological response to neoadjuvant treatment.

Katrin Schwameis, MD, Zehetner Joerg, MD, Jeffrey A Hagen, MD, Daniel Oh, MD, Stephanie Worrell, MD, Kais Rona, MD, Nathan Cheng, Kyle Green, Jamil Samaan, Steven R DeMeester, MD, John C Lipham, MD. Keck hospital, USC

Background. Neoadjuvant chemo- and chemoradiotherapy (CTX and CRT) are considered the gold standard in the treatment of locally advanced adenocarcinomas of the distal esophagus (EAC) prior to surgical resection. The degree of pathological response to neoadjuvant treatment is thought to be a major prognostic factor for survival after surgical resection, however limited data exists.

Aim of the study. To compare the survival of complete and incomplete responders to neoadjuvant chemo(radio)therapy in patients with stage III EAC. Furthermore, to determine the frequency of complete response in stage III disease.

Methods. A retrospective chart review was performed of all patients that underwent neoadjuvant therapy and esophagectomy for stage III EAC between 01/1999 and 08/2013. Demographic, clinical, histopathological and survival data were collected and analyzed. Patients were classified into complete (no residual tumor; pCR) versus incomplete responders (residual tumor; pIR) to neoadjuvant CTX/CRT based on the findings in the esophagectomy specimen.

Results. 101 EAC stage III patients (m:f=92:9) underwent esophagectomy at a mean age of 62.7 (26-84) years. 21.8% (n=22) and 78.2% (n=79) had received CXT and CRT, respectively. R0 resection was achieved in 95% (n=96). pCR and pIR was found in 19.8% (n=20) and 80.2% (n=81). Overall mean F/U time was 34.5 (0.2-172.9) months. The overall mean survival was 18.6 (0.2-111.8) months while it was 18.8 (0.2-111.8) and 17.5 (1.1-58.7) months for pIR and pCR, respectively (p=0.8). 3-year-survival in pIR and pCR was 35.5% and 52.9% respectively (p=0.18). Positive lymph node status (ypN+) was found in 54 patients (66.7%) of pIR group and none of the pCR patients. 3 year survival was 53.8% in ypN0 and 28.3% in ypN+ (p=0.02*).

Conclusion. A complete pathologic response of 20% was found in this series. Complete responders were found to have a trend toward better survival compared to incomplete responders at 3 year follow up. Residual lymph node status was a stronger prognostic factor than pathologic response with a significant survival benefit in node negative patients.

Figure: Survival of complete vs. incomplete responders to neoadjuvant therapy.

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