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- Title
Pathological complete response in patients with esophageal cancer after the trimodality approach: The association with baseline variables and survival-The University of Texas MD Anderson Cancer Center experience.
- Authors
Blum Murphy, Mariela; Xiao, Lianchum; Patel, Viren R.; Maru, Dipen M.; Correa, Arlene M.; G. Amlashi, Fatemeh; Liao, Zhongxing; Komaki, Ritsuko; Lin, Steven H.; Skinner, Heath D.; Vaporciyan, Ara; Walsh, Garrett L.; Swisher, Stephen G.; Sepesi, Boris; Lee, Jeffrey H.; Bhutani, Manoop S.; Weston, Brian; Hofstetter, Wayne L.; Ajani, Jaffer A.
- Abstract
<bold>Background: </bold>Reports are limited regarding clinical and pretreatment features that might predict a pathological complete response (pathCR) after treatment in patients with esophageal cancer (EC). This might allow patient selection for different strategies. This study examines the association of a pathCR with pretreatment variables, overall survival (OS), recurrence-free survival (RFS), and patterns of recurrence in a large cohort from a single institution.<bold>Methods: </bold>The baseline clinical features of 911 consecutive patients with EC who were treated with trimodality therapy from January 2000 to November 2013 were analyzed. A pathCR was defined as a surgical specimen with no residual carcinoma (primary or nodes). Logistic regressions were used to identify independent baseline features associated with a pathCR. We applied log-rank testing and Cox models to determine the association between a pathCR and the time-to-event outcomes (OS and RFS).<bold>Results: </bold>Of 911 patients, 218 (23.9%) achieved a pathCR. The pathCR rate was 23.1% for adenocarcinoma and 32.2% for squamous cell carcinoma. A lower pathCR rate was observed for 1) older patients (>60 years), 2) patients with poorly differentiated tumors, 3) patients with signet ring cells (SRCs), and 4) patients with a higher T stage. Patients with a pathCR had longer OS and RFS than those without a pathCR (P = .0021 and P = .0011, respectively). Recurrences occurred more in non-pathCR patients. Distant metastases were the most common type of recurrence. PathCR patients developed brain metastases at a marginally higher rate than non-pathCR patients (P = .051).<bold>Conclusions: </bold>In this large cohort study, a pathCR is confirmed to be associated with better OS and RFS. The presence of a poorly differentiated tumor or SRCs reduces the likelihood of a pathCR. Future research should focus on molecular classifiers. Cancer 2017;123:4106-4113. © 2017 American Cancer Society.
- Subjects
TEXAS; ESOPHAGEAL cancer; LOGISTIC regression analysis; ADENOCARCINOMA; SQUAMOUS cell carcinoma; CANCER chemotherapy; BRAIN tumors; CANCER relapse; CANCER treatment; COMBINED modality therapy; PROGNOSIS; ESOPHAGEAL tumors; REGRESSION analysis; TUMOR classification; SPECIALTY hospitals; DISEASE remission; TUMOR treatment
- Publication
Cancer (0008543X), 2017, Vol 123, Issue 21, p4106
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.30953