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Prognostic Significance of Stratification Using Pathological Stage and Response to Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Risk stratification to select appropriate candidates for adjuvant therapy is required for esophageal cancer patients based on adjuvant therapy advancement including immunotherapy. The current study aims to develop a novel staging system using pathological stage (pStage) and response to neoadjuvant chemotherapy (NAC) for esophageal squamous cell carcinoma (ESCC).

Methods

ESCC patients who received NAC and underwent transthoracic esophagectomy at two Japanese high-volume esophageal centers were retrospectively reviewed. The prognostic value of NAC response was evaluated within the same pStage, and a novel risk stratification to predict cancer-specific survival (CSS) was developed.

Results

The HR (95% CI) of pathological responders in pStage 0–I, II, III, and IV was 0.29 (0.07–1.17), 0.37 (0.12–1.10), 0.37 (0.15–0.92), and 0.24 (0.06–0.98), respectively. Responders in pStage 0–II were classified to be in the same class and those in pStage III/IV in another group, because the 5-year CSS (5y-CSS) rate of responders in pStage 0–I, II, III, and IV was 94%, 92%, 76%, and 71%, respectively. Combining nonresponders in pStage 0–II as the same group, all patients were subdivided into five groups. Intriguingly, the 5y-CSS in pStage III–IV responders was 75%, almost identical to that of nonresponders in pStage 0–II (78%).

Conclusions

The histological response influenced the long-term outcomes of patients who underwent esophagectomy after NAC, even within groups stratified by pathologic stage. The current risk stratification system will contribute to selecting appropriate candidates for adjuvant therapy.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Satoru Matsuda MD, PhD, Hirofumi Kawakubo MD, PhD, Shuhei Mayanagi MD, PhD & Yuko Kitagawa MD, PhD, FACS

  2. Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Akihiko Okamura MD, PhD, Keita Takahashi MD, PhD, Tasuku Toihata MD & Masayuki Watanabe MD, PhD, FACS

  3. Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan

    Ryo Takemura PhD

  4. Department of Surgery, Hamamatsu University School of Medicine, Tokyo, Japan

    Hiroya Takeuchi MD, PhD, FACS

Authors
  1. Satoru Matsuda MD, PhD
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  2. Hirofumi Kawakubo MD, PhD
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  3. Akihiko Okamura MD, PhD
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  4. Keita Takahashi MD, PhD
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  5. Tasuku Toihata MD
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  6. Ryo Takemura PhD
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  7. Shuhei Mayanagi MD, PhD
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  8. Hiroya Takeuchi MD, PhD, FACS
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  9. Masayuki Watanabe MD, PhD, FACS
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  10. Yuko Kitagawa MD, PhD, FACS
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Corresponding author

Correspondence to Hirofumi Kawakubo MD, PhD.

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Disclosure

Yuko Kitagawa received lecture fees from Asahi KASEI Co., Ltd., TAIHO PHARMACEUTICAL CO., LTD, CHUGAI PHARMACEUTICAL CO., LTD., EA Pharma Co., Ltd., Yakult Honsha Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., SHIONOGI & CO., LTD., Astellas Pharma Inc., DAINIPPON SUMITOMO PHARMA Co., Ltd., Taisho Toyama Pharmaceutical Co., ONO PHARMACEUTICAL CO., NIHON PHARMACEUTICAL CO., LTD., Sanofi K.K., Eisai Co., Ltd., KAKEN PHARMACEUTICAL CO.,LTD.. Yuko Kitagawa. Moreover, he received research expenses and scholarship donations (grants) from Taiho Pharmaceutical Co., Ltd., Chugai Pharmaceutical Co., Ltd., Yakult Honsha Co. Ltd., Daiichi Sankyo Co., Ltd., Merck Serono Co., Ltd., Asahi Kasei Co., Ltd., EA Pharma Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co., Ltd., Otsuka Pharmaceutical Factory Inc., Shionogi Co., Ltd., Kaken Pharmaceutical Co., Ltd., Kowa Pharmaceutical Co., Ltd., Astellas Pharma Inc., Medicon Inc., Dainippon Sumitomo Pharma Co., Ltd., Taisho Toyama Pharmaceutical Co., Ltd., Kyouwa Hakkou Kirin Co., Ltd., Pfizer Japan Inc., Ono Pharmaceutical Co., Ltd., Nihon Pharmaceutical Co., Ltd., Japan Blood Products Organization Medtronic Japan Co., Ltd., Sanofi K.K., Eisai Co., Ltd., Tsumura & Co., Ltd., KCI Licensing, Inc., Abbott Japan Co., Ltd., FUJIFILM, and Toyama Chemical Co., Ltd. Finally, he worked as a director of endowed chair supported from TAIHO PHARMACEUTICAL CO., LTD, CHUGAI PHARMACEUTICAL CO., LTD.

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Matsuda, S., Kawakubo, H., Okamura, A. et al. Prognostic Significance of Stratification Using Pathological Stage and Response to Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 28, 8438–8447 (2021). https://doi.org/10.1245/s10434-021-10221-9

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  • DOI: https://doi.org/10.1245/s10434-021-10221-9

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