Tumor differentiation impacts response to neoadjuvant therapy and survival in patients with esophageal adenocarcinoma

新辅助治疗 食管腺癌 肿瘤科 内科学 腺癌 医学 癌症 乳腺癌
作者
Sarah C. McKay,Brian E. Louie,Daniela Molena,Weston Andrews,Thomas Boerner,Wayne L. Hofstetter,Jonathan Yeung,Gail Darling,Ahmed Sharata,Christian Peyre,Colin P. Dunn,John C. Lipham,Horia Marginean,Steven R. DeMeester
出处
期刊:The Journal of Thoracic and Cardiovascular Surgery [American Association for Thoracic Surgery]
卷期号:167 (6): 1943-1950 被引量:1
标识
DOI:10.1016/j.jtcvs.2023.09.055
摘要

Objective The current staging system for esophageal adenocarcinoma only considers tumor grade in early tumors. The aim of this study was to evaluate the impact of tumor differentiation on response to neoadjuvant chemoradiotherapy and survival in patients with locally advanced esophageal adenocarcinoma. Methods This was a multi-institution retrospective review of all patients with esophageal cancer who underwent neoadjuvant chemoradiotherapy followed by esophagectomy from January 2010 to December 2017. Response to neoadjuvant therapy and survival was compared between patients with well- or moderately differentiated (G1/2) tumors versus poorly differentiated (G3) tumors. Results There were 550 patients, 485 men (88.2%) and 65 women. The median age was 61 years, and the tumor was G1/2 in 288 (52.4%) and G3 in 262 patients. Overall clinical stage before neoadjuvant therapy was similar between groups. Pathologic complete response (pCR) was found in 87 patients (15.8%). The frequency of pCR was similar between groups, but residual disease in the esophagus and lymph nodes was significantly more likely with G3 tumors. Median follow-up was 63 months and absolute survival, overall survival, and disease-free survival were all significantly worse in patients with G3 tumors. Further, even with pCR, patients with G3 tumors had significantly worse survival. Conclusions This study showed that response to neoadjuvant therapy was not affected by tumor differentiation. However, poor differentiation was associated with worse survival compared with patients with G1/2 tumors, even among those with pCR. These results suggest that poor differentiation should be considered as an added risk factor for clinical staging in patients with locally advanced esophageal adenocarcinoma.
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