804 THE PATTERN OF CT RECURRENCE FOLLOWING RESECTION OF ESOPHAGEAL CARCINOMA

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sheuli Chowdhury ◽  
Lye-Yeng Wong ◽  
Melissa L DeSouza ◽  
Elizabeth N Dewey ◽  
John G Hunter ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cox Regression ◽  
Clinical Symptoms ◽  
Regional Lymph Node ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Esophageal Disease ◽  
Surveillance Program ◽  
Cancer Type ◽  
Risk Of Recurrence

Abstract   While esophagectomy is the mainstay of multimodal treatment of esophageal cancer, the risk of recurrence is high. In spite of this, no formal recommendations exist on frequency or duration of computed tomography (CT) imaging for surveillance. The goal of this study was to determine the pattern of cancer recurrence following esophagectomy to develop an optimal surveillance program. Methods We performed a retrospective review of a single-institution esophageal disease registry, evaluating patients who underwent esophagectomy for esophageal cancer between 2000–2019. The surveillance protocol is CT in 3-month intervals for one year, 6-month intervals in year 2, then annually until the fifth year. Rates of recurrence were compared by stage, tumor factors, and chemoradiation status using chi-square tests. Monthly rates of recurrence and overall survival were assessed using Kaplan–Meier. Risk ratios for recurrence were evaluated with multivariate Cox regression accounting for age, gender, cancer type, stage, chemoradiation therapy, and tumor grade. Results Of the 368 included, 88% had Adenocarcinoma, 85% male, 96% Caucasian, 85% received chemotherapy, and 82% received radiation. 24% had pathologic complete response (pCR). The recurrence rate was 33%. 46% had clinical symptoms at time of recurrence, and 58% were diagnosed by routine surveillance CT. 21% of pCR had recurrence. 85% of recurrences occurred within 5 years, 72% within 3 years, and 56% within 2 years of surgery. Most frequent recurrence was lung (22%), followed by multi-site (21%), and regional lymph node (17%). There were notable differences in time to recurrence by site of recurrence (Figure 1) (p = 0.03). Conclusion In our population, 33% of patients had recurrence of esophageal cancer following surgical resection, with highest risk of recurrence within the first 3 postoperative years. These findings favor more frequent surveillance during this period, followed by annual surveillance until 5 years.

Changes in neutrophil-to-lympocyte and platelet-to-lymphocyte ratios to predict survival and pathologic complete response in esophageal cancer patients who receive trimodality therapy.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 170-170
Author(s):  
Jalal Hyder ◽  
Drexell Boggs ◽  
Andrew Hanna ◽  
Mohan Suntharalingam ◽  
Michael David Chuong
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Cox Regression ◽  
Locally Advanced ◽  
Pathologic Complete Response ◽  
Prognostic Significance ◽  
Progression Free Survival ◽  
Complete Response ◽  
Trimodality Therapy ◽  
Lymphocyte Ratio

170 Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multi-modality therapy, the effect of each specific therapy on the NLR and PLR is not well understood. We therefore evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. Methods: We performed a retrospective analysis of non-metastatic patients with esophageal cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained the following time points (TP): 1) at diagnosis before CRT, 2) after CRT prior to surgery, and 3) after surgery. We also evaluated change in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: 83 patients with stage II-IV esophageal cancer and median age 60 years were included. Median follow up was 29.3 months. Median dose of 50.4 Gy (50.4-59.4) in 28 fractions (28-33) was used. Median NLR and PLR at the each TP: 1) 3.3 and 157.2, 2) 12 and 645, and 11.5 and 391.7, respectively. On multivariate analysis, inferior OS was associated with PLR ≥250 at TP 3 (p=.03), PLR decrease ≥609.2 from TP 2-3 (p=.02), and PLR ratio (TP 1/TP3) ≥1.08 (p=.03). Inferior progression free survival (PFS) was associated with NLR at TP 2 ≥36 (p=.0008), NLR increase ≥28.3 from TP 1-2 (p=.0005), PLR increase from TP 1-3 ≥19 (p=.01), and PLR ratio (TP 2/TP 3) ≥0.34 (p=0.1). Pathologic complete response (pCR) was less likely for adenocarcinoma histology (p=.03), NLR at TP 2 ≥10.6 (p=.04), and NLR increase from TP 1 to TP 2 ≥4.6 (p=.03). Conclusions: This is the first study to demonstrate that changes in NLR and PLR throughout trimodality therapy for esophageal cancer correlate with OS, PFS, and pCR. Further evaluation is warranted to better define which of the identified cut-off values are most clinically significant.

Factors Predictive of Distant Metastases in Patients With Breast Cancer Who Have a Pathologic Complete Response After Neoadjuvant Chemotherapy

2005 ◽  
Vol 23 (28) ◽  
pp. 7098-7104 ◽  
Author(s):  
Ana M. Gonzalez-Angulo ◽  
Sean E. McGuire ◽  
Thomas A. Buchholz ◽  
Susan L. Tucker ◽  
Henry M. Kuerer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Distant Metastasis ◽  
Cox Regression ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Distant Metastases ◽  
Complete Response ◽  
Cox Regression Analysis

Purpose To identify clinicopathological factors predictive of distant metastasis in patients who had a pathologic complete response (pCR) after neoadjuvant chemotherapy (NC). Methods Retrospective review of 226 patients at our institution identified as having a pCR was performed. Clinical stage at diagnosis was I (2%), II (36%), IIIA (27%), IIIB (23%), and IIIC (12%). Eleven percent of all patients were inflammatory breast cancers (IBC). Ninety-five percent received anthracycline-based chemotherapy; 42% also received taxane-based therapy. The relationship of distant metastasis with clinicopathologic factors was evaluated, and Cox regression analysis was performed to identify independent predictors of development of distant metastasis. Results Median follow-up was 63 months. There were 31 distant metastases. Ten-year distant metastasis-free rate was 82%. Multivariate Cox regression analysis using combined stage revealed that clinical stages IIIB, IIIC, and IBC (hazard ratio [HR], 4.24; 95% CI, 1.96 to 9.18; P < .0001), identification of ≤ 10 lymph nodes (HR, 2.94; 95% CI, 1.40 to 6.15; P = .004), and premenopausal status (HR, 3.08; 95% CI, 1.25 to 7.59; P = .015) predicted for distant metastasis. Freedom from distant metastasis at 10 years was 97% for no factors, 88% for one factor, 77% for two factors, and 31% for three factors (P < .0001). Conclusion A small percentage of breast cancer patients with pCR experience recurrence. We identified factors that independently predicted for distant metastasis development. Our data suggest that premenopausal patients with advanced local disease and suboptimal axillary node evaluation may be candidates for clinical trials to determine whether more aggressive or investigational adjuvant therapy will be of benefit.

O30 NON-RADICAL ESOPHAGECTOMY FOR ESOPHAGEAL CANCER; A NATIONWIDE STUDY ON INCIDENCE, RISK FACTORS AND OUTCOMES IN SWEDEN

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
David Edholm ◽  
Petter Hollertz ◽  
Per Sandström ◽  
Bergthor Björnsson ◽  
Dennis Björk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Esophageal Cancer ◽  
Cox Regression ◽  
Regional Lymph Node ◽  
Neoadjuvant Treatment ◽  
Resected Specimen ◽  
Radical Esophagectomy ◽  
Term Survival ◽  
R1 Resection ◽  
Independent Risk Factors

Abstract Aim To identify potential risk factors for a microscopically non-radical esophageal cancer resection (R1) and investigate how such a resection affects long-term survival. Background & Methods Esophageal cancer resections that are considered R1 have been associated with worse survival. The Swedish National Register for Esophageal and Gastric Cancer includes information on all esophageal cancer resections in Sweden. All patients having undergone esophageal resection with curative intent 2006-2017 were included. Risk factors for R1 resection were assessed through logistic regression. Factors predicting five-year survival were assessed through Cox-regression, adjusted for T-stage, N-stage, age and R-status. Results The study included 1,504 patients. The margins were microscopically involved in 146 patients (10%). Of these the circumferential margin was involved in 115 (8%). The proximal margin was involved in 55 patients (4%) and the distal in 30 (2%). In 54 (4%) specimens two margins were involved. Independent risk factors for R1-resection were absence of neoadjuvant treatment and clinical T3 stage or higher. The 5-year survival for the entire cohort was 41%, but only 19% for those with an R1 resection. Independent risk factors for death within 5-year from resection were regional lymph node metastasis (Hazard Ratio (HR) 2.6 (95% CI 2.2-3.1), histopathological stage T3 or higher (HR 1.2 95% CI 1.1-1.5), age above 60 years and R1-resection (HR 1.6 95% CI 1.4-2.0) Conclusion Involved margin in the resected specimen is an independent risk factor predicting worse 5-year survival. Besides striving for adequate surgical margins, the rate of R1-resections could be decreased through neoadjuvant treatment in fit patients.

Does endoscopy accurately predict response to chemoradiation in patients undergoing esophagectomy?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4024-4024 ◽  
Author(s):  
I. S. Sarkaria ◽  
N. Rizk ◽  
M. Bains ◽  
R. Flores ◽  
B. Park ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Squamous Cell ◽  
Residual Disease ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Endoscopic Biopsy ◽  
Response To Treatment ◽  
Cancer Center ◽  
Local Disease ◽  
Mean Time

4024 Background: Endoscopic biopsy after chemoradiation therapy (CRT) for esophageal cancer has been used to determine response to treatment. To test the validity of this methodology, we conducted a study to determine if endoscopic biopsy can accurately establish evidence of local pathologic complete response (pCR), defined as no residual local disease in the esophagus, in patients undergoing esophagectomy after CRT. Methods: We retrospectively queried a prospectively maintained database for patients seen at Memorial Sloan-Kettering Cancer Center from 1996 to the present who underwent, 1) CRT for esophageal cancer with the intent to proceed to esophagectomy post-treatment, and 2) post-CRT endoscopic biopsy. Data points included the pathology of the post-CRT endoscopy and resected surgical specimens, tumor histology, mean time from end of CRT to endoscopic biopsy, and mean time from endoscopic biopsy to surgery. Correlations were analyzed by the chi-square test and one way analysis of variance. Results: One-hundred thirty seven patients meeting our search criteria were identified. Ninety-percent of patients received cisplatin based chemotherapy and 5040 cGy of radiation. One-hundred four patients had a negative pathology on endoscopic biopsy. A negative pathology at endoscopic biopsy was a poor predictor of pCR (Positive Predictive Value = 37.5%), with 65% of these patients having residual local disease at esophagectomy. This result was not influenced by mean time from completion of CRT to endoscopy (p=0.5), or by mean time from endoscopy to surgery (p=0.47). A positive pathology at endoscopic biopsy was highly predictive of residual disease (p<0.001). When analyzed by histology, a negative endoscopic biopsy better predicted response for squamous cell carcinomas versus adenocarcinomas (p<0.001). Conclusions: Although improved for squamous cell cancers versus adenocarcinomas, a disease free endoscopic biopsy does not appear to be a useful predictor of a complete pathologic response after CRT. Neither the time to endoscopy after CRT, nor the time to surgery after endoscopy, influence this finding. No significant financial relationships to disclose.

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