There are various means used to stratify patients prognostically with adenocarcinoma of the esophagus who receive preoperative chemoradiotherapy.
The American Joint Committee on cancer stage, and pathologic complete response are used for prognostic stratification after surgery.
Estimated treatment response is also used for prognostic stratification after surgery.
However, none of these methods has been formally evaluated.
Dr Nabil Rizk and colleagues from New York established prognostic pathologic variables after chemoradiotherapy.
|Involved lymph nodes is one of the best predictor of survival|
|Journal of Clinical Oncology|
The research team performed a retrospective review of patients with esophageal adenocarcinoma.
The patients received chemoradiotherapy before esophagectomy.
Data collected included demographics, chemoradiotherapy details, pathologic findings, and survival.
The team used recursive partitioning and Kaplan-Meier analyses.
The research team identified 276 patients that were appropriate for this analysis.
The team found that the current American Joint Committee on Cancer system poorly distinguishes between stages 0 to 2A, 2B to 3, and 4A to 4B.
The presence of a pathologic complete response conferred improved survival over residual disease.
Recursive partitioning analysis indicates that involved lymph nodes and metastatic disease are the best predictors of survival.
The research team observed that the depth of invasion and degree of treatment response are less predictive.
Dr Rizk's team concludes, “The current American Joint Committee on Cancer staging system is not a good predictor of survival after chemoradiotherapy.”
“Although patients with a pathologic complete response do have improved long-term survival relative to patients with residual disease, this method places too much emphasis on residual depth of invasion.”
“It fails to identify patients with residual disease who have good long-term survival.”
“Recursive partitioning analysis more accurately identifies nodal disease, and metastatic disease as the most important prognostic variables.”
“Degree of treatment response is less prognostic than nodal involvement.”