Timing after neoadjuvant therapy predicts mortality in patients undergoing esophagectomy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 157-157
Author(s):  
Taylor Maramara ◽  
Jamie Huston ◽  
Ravi Shridhar ◽  
Kenneth L Meredith
Keyword(s):  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Pathologic Response ◽  
Chi Square ◽  
Surgery Timing ◽  
Improvement In Survival ◽  
The Impact

157 Background: Neoadjuvant therapy (NT) prior to esophagectomy has dramatically improved survival in patients with esophageal cancer. Currently, most surgeons will allow 6-12 weeks after NT prior to recommending esophagectomy. Given that complete pathologic response (pCR) correlates to an improvement in survival, some have advocated a longer interval should be entertained to increase the pathologic response. The impact of an expanded NT-surgery timing is not currently well understood. Methods: Utilizing the National Cancer Database, we identified patients with esophageal cancer who underwent NT followed by esophagectomy. Patients were divided into 4 time intervals: < 6 wks, 6-12 wks, 3-6 mo, and > 6 mo. Mann-Whitney U, Kruskal Wallis, and Pearson’s Chi-square test were used as appropriate. Survival analyses were performed using the Kaplan-Meier method and p < 0.05 was considered significant. Results: We identified 9,256 patients who received NT followed by esophagectomy. There were 8,053 (87%) adenocarcinomas and N = 1203 (13%) squamous cell carcinomas. 7,858 (84.9%) were male and 1,398 (15.1%) female with a median age was 62 (24-88). R0 resections decreased as the NT-Surgery interval increased: < 6 wks, 6-12 wks, 2-6 mos, and > 6 mos at 93%, 94.1%, 94.1%, and 86.2% respectfully p = 0.004. Additionally, the median lymph nodes harvested decreased as timing increased: 12, 12, 10, and 9 p < 0.001 and the median nodes positive decreased as timing increased 1.5, 1.3, 1.1, and 2.4 p = 0.01. The complete response rates increased as timing increased 15.5%, 20.1%, 22.7%, and 25.8% p < 0.001. However, this improvement in pCR did not translate into an increase in median survival: < 6 wks 40.9 mos, 6-12 weeks 38.5 mos, 3-6 mos 34.8 mos, and > 6 mos 39.8 mos of survival, p = 0.94 90-day mortality increased as the timing from neoadjuvant therapy increased: 6.4%, 7.9%, 9.4%, and 16.0%, respectively p = 0.001. Conclusions: Our data demonstrates that patients who have a prolonged NT- esophagectomy interval will have a substantial increase in 90-day mortality. While there was an increase in pathologic complete response rates, this did not translate into an improvement in survival. The current recommendations of a NT-surgery timing of 6-12 weeks should remain.

scholarly journals Pathologic Complete Response Following Neoadjuvant Therapy for Gastric Adenocarcinoma: A National Cancer Database Analysis on Incidence, Predictors, and Outcomes

2020 ◽  
pp. 000313482097208
Author(s):  
Christof Kaltenmeier ◽  
Alison Althans ◽  
Maria Mascara ◽  
Ibrahim Nassour ◽  
Sidrah Khan ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Neoadjuvant Therapy ◽  
Gastric Adenocarcinoma ◽  
Survival Rates ◽  
Pathologic Complete Response ◽  
Tumor Grade ◽  
Complete Response ◽  
Neoadjuvant Chemoradiation ◽  
National Cancer Database ◽  
The Impact

Introduction With advances in multimodal therapy, survival rates in gastric cancer have significantly improved over the last two decades. Neoadjuvant therapy increases the likelihood of achieving negative margins and may even lead to pathologic complete response (pCR). However, the impact of pCR on survival in gastric cancer has been poorly described. We analyzed the rate and predictors of pCR in patients receiving neoadjuvant therapy as well as impact of pCR on survival. Methods We conducted a National Cancer Database (NCDB) analysis (2004-2016) of patients with gastric adenocarcinoma who received neoadjuvant chemotherapy followed by surgical resection. Results The pCR rate was 2.2%. Following adjustment, only neoadjuvant chemoradiation, non-signet histology, and tumor grade remained as significant factors predicting pCR. pCR was a statistically significant predictor of survival. Conclusion In this NCDB study, pCR was a predictor of survival. Though chemoradiation rather than chemotherapy alone was a predictor of pCR, it was not a predictor of survival. Further studies are needed to elucidate the role of radiation in the neoadjuvant setting and to discern the impact of pCR on survival.

Factors predictive of tumor recurrence and overall survival in patients with esophageal cancer who have pathologic complete response after neo-adjuvant therapy.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 170-170
Author(s):  
Alexandra Gangi ◽  
Sarah E. Hoffe ◽  
Jessica M. Frakes ◽  
Khaldoun Almhanna ◽  
Luis Pena ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Recurrent Disease ◽  
Systemic Disease ◽  
Cell Cancer ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Specific Information ◽  
Patient Demographics

170 Background: Pathologic complete response (pCR) to neoadjuvant therapy is presumably associated with favorable outcomes in patients (pts) with esophageal cancer, but reported survival rates vary. This study evaluates patterns of recurrence after curative esophagectomy and identifies factors predictive of recurrent disease and overall survival (OS) in patients with pCR. Methods: An IRB-approved, retrospective review of a prospective esophageal cancer database was conducted. Patient demographics, perioperative data, and outcomes were examined. Recurrences were classified as locoregional (LR) or systemic. Cox regression model and Kaplan–Meier (KM) plots were used for survival analysis. Results: 837 pts with invasive esophageal cancer treated at a single institution from 1994 to 2013 were identified. 176 pts underwent neoadjuvant therapy followed by surgery and had pCR. Of these, 93.7% had adenocarcinoma and 6.3% had squamous cell cancer. Mean age was 56.6 and most pts were white (96.6%) males (79.5%). Median follow up was 42.6 months. 95 pts were treated before 2007 and 81 after. Most pts (85%) underwent transthoracic esophagectomy. All 176 pts received chemotherapy and radiation; dose-specific information was available on 144 pts, of whom most received 50.4 Gy (45%). 170 pts had recurrence data available: 39 (22.9%) had recurrent disease at a mean of 18.3 months; 5 (2.9%) with LR and 34 (20%) with systemic disease. On multivariate analysis, when evaluating patient demographics, pretreatment stage, type of surgery, type of chemotherapy, and number of lymph nodes resected, only pretreatment stage was associated with recurrence (p = 0.04). Median time to recurrence was 26.3 months for LR disease and 10.9 months for systemic disease (p = 0.3). KM estimates determined that pre-treatment stage and time of treatment ( < 2007 or ≥ 2007) were predictive of improved OS (p < 0.01, = 0.03). Conclusions: The incidence of disease recurrence in pts who experience pCR is low. The pretreatment stage and time of treatment were independent predictors of improved OS. Enhancing treatment strategies to maximize pCR would improve outcomes in pts with esophageal cancer.

Association of specific gene expression profiles with a pathologic complete response to neoadjuvant therapy in esophageal adenocarcinoma.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 51-51
Author(s):  
Patrick James McLaren ◽  
Anthony P Barnes ◽  
Willy Z Terrell ◽  
Gina M. Vaccaro ◽  
Jack Wiedrick ◽  
...  
Keyword(s):  
Gene Expression ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Esophageal Adenocarcinoma ◽  
Expression Profiles ◽  
Pathologic Complete Response ◽  
Gene Expression Profiles ◽  
Complete Response ◽  
Specific Gene ◽  
Specific Gene Expression

51 Background: Predicting prognosis in esophageal cancer remains an unrealized goal despite studies linking constellations of genes to therapeutic response. In this study, we analyzed specific predictor genes expressed in tumor specimens from our institutional repository. Our aim was to determine if specific gene expression profiles are associated with pathologic complete response (pCR) after neoadjuvant chemo-radiotherapy (CRT). Methods: We investigated eleven genes identified from prior studies (CCL28, SPARC, S100A2, SPRR3, SIRT2, NOV, PERP, PAPSS2, DCK, DKK3, ALDH1) that have significant association with esophageal cancer progression. Patients with esophageal adenocarcinoma treated with neoadjuvant CRT followed by esophagectomy at our institution between January 2011 and July 2015 were included. Quantitative real-time polymerase chain reaction was conducted on pre-treatment biopsy specimens to determine gene expression. Patients were classified into two groups: 1) pCR and, 2) no or poor response (NR) after CRT based on final pathology report. An omnibus test using Mahalanobis distance was applied to evaluate overall genetic expression differences between groups. Log-rank tests compared the differential expression of individual genes. Results: 29 patients (11 pCR and 18 NR) were analyzed. Overall, gene expression profiles were significantly different between pCR and NR patients (p < 0.01). In particular, CCL28 was over-expressed in pCR (Log-HR: 1.53, 95%CI: 0.46-2.59, p = 0.005), and DKK3-was under-expressed in pCR patients (Log-HR: -1.03 95%CI: -1.97, -0.10, p = 0.031). Conclusions: Esophageal adenocarcinoma patients with a pCR after neoadjuvant therapy have genetic profiles that are significantly different from typical NR profiles. In our population, the genes CCL28 and DKK3 are potential predictors of treatment response.

scholarly journals Pathologic Response Rates for Breast Cancer Stages as a Predictor of Outcomes in Patients Receiving Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery

2020 ◽  
Author(s):  
Chang-Yun Lu ◽  
Ho-Min Chen ◽  
Szu-Yuan Wu
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Cox Regression ◽  
Ductal Carcinoma ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Pathologic Response ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract PURPOSE: To determine easy-to-use predictors of overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM) in patients with breast invasive ductal carcinoma (IDC) receiving neoadjuvant chemotherapy (NACT) followed by breast-conserving surgery (BCS), we obtained pathologic response rates (PRRs) for combined primary and nodal diseases (American Joint Committee on Cancer [AJCC] stages) from clinical and pathologic reports, and we used these as predictors.PATIENTS AND METHODS: We enrolled patients with IDC who had received NACT followed by BCS. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs) for the patients’ PRRs; other independent predictors were controlled for or stratified in the analysis.RESULTS: We analyzed 1047 patients with IDC (611, 260, and 176 patients in clinical stages IIB, IIIA, and IIIB-C, respectively) receiving NACT and BCS. After multivariate Cox regression analyses, the adjusted HRs (aHRs; 95% CI) in patients with pathologic complete response (ypT0N0) were 0.26 (0.13–0.56), 0.36 (0.15–0.85), and 0.15 (0.08–0.31) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with downstaging of AJCC stages were 0.55 (0.35–0.89), 0.91 (0.62–0.96), and 0.63 (0.43–0.91) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with upstaging of AJCC stages were 1.77 (1.06–2.24), 1.08 (1.03–1.82), and 1.19 (1.07–2.01) for all-cause mortality, LRR, and DM, respectively.CONCLUSION: The impacts of AJCC-stage PRRs are useful predictive tools and strong predictors for OS, LRR, and DM in patients with breast IDC receiving NACT followed by BCS.

scholarly journals Pathologic Response Rates for Breast Cancer Stages as a Predictor of Outcomes in Patients Receiving Neoadjuvant Chemotherapy Followed by Breast-Conserving Surgery

2020 ◽  
Author(s):  
jiaqiang Zhang ◽  
Chang-Yun Lu ◽  
Ho-Min Chen ◽  
Szu-Yuan Wu
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Cox Regression ◽  
Ductal Carcinoma ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Breast Conserving Surgery ◽  
Pathologic Response ◽  
Cox Regression Analysis ◽  
All Cause Mortality

Abstract PURPOSE: To determine easy-to-use predictors of overall survival (OS), locoregional recurrence (LRR), and distant metastasis (DM) in patients with breast invasive ductal carcinoma (IDC) receiving neoadjuvant chemotherapy (NACT) followed by breast-conserving surgery (BCS), we obtained pathologic response rates (PRRs) for combined primary and nodal diseases (American Joint Committee on Cancer [AJCC] stages) from clinical and pathologic reports, and we used these as predictors.PATIENTS AND METHODS: We enrolled patients with IDC who had received NACT followed by BCS. Cox regression analysis was used to calculate hazard ratios (HRs) and confidence intervals (CIs) for the patients’ PRRs; other independent predictors were controlled for or stratified in the analysis.RESULTS: We analyzed 1047 patients with IDC (611, 260, and 176 patients in clinical stages IIB, IIIA, and IIIB-C, respectively) receiving NACT and BCS. After multivariate Cox regression analyses, the adjusted HRs (aHRs; 95% CI) in patients with pathologic complete response (ypT0N0) were 0.26 (0.13–0.56), 0.36 (0.15–0.85), and 0.15 (0.08–0.31) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with downstaging of AJCC stages were 0.55 (0.35–0.89), 0.91 (0.62–0.96), and 0.63 (0.43–0.91) for all-cause mortality, LRR, and DM, respectively. The aHRs (95% CI) in patients with upstaging of AJCC stages were 1.77 (1.06–2.24), 1.08 (1.03–1.82), and 1.19 (1.07–2.01) for all-cause mortality, LRR, and DM, respectively.CONCLUSION: The impacts of AJCC-stage PRRs are useful predictive tools and strong predictors for OS, LRR, and DM in patients with breast IDC receiving NACT followed by BCS.

Pathologic response rates between gemcitabine-cisplatin (GC) and methotrexate, vinblastine, doxorubicin hydrochloride, and cisplatin (MVAC) neoadjuvant chemotherapy in muscle-invasive urothelial cell carcinoma of the bladder.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 267-267 ◽  
Author(s):  
Jonathan Lawrence Wright ◽  
Franklin Lee ◽  
William Proctor Harris ◽  
Heather H. Cheng ◽  
Song Zhao ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Cardiac Disease ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Response Rates ◽  
Complete Response ◽  
Pathologic Response ◽  
Bcg Therapy ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive

267 Background: Neoadjuvant chemotherapy for muscle invasive urothelial carcinoma (UC) of the bladder is associated with higher rates of pathologic complete response (CR) and improved disease-specific survival compared to those treated with radical cystectomy (RC) alone. Two standard regimens used are (1) gemcitabine and cisplatin (GC); and (2) methotrexate, vinblastine, adriamycin, and cisplatin (MVAC), with debate on whether there is a difference in clinical efficacy. In this analysis, we compare the pathologic outcomes at cystectomy between neoadjuvant GC and MVAC treatment. Methods: Data was retrospectively collected on patients with T2-T4 UC of the bladder who underwent RC between Sept 2003 and December 2011 at the University of Washington. Clinical and pathologic factors were recorded along with neoadjuvant chemotherapy and comorbidities. Pathologic outcomes included those with CR (pT0) and near CR (nCR = pT0/Ta/Tis). Odds ratio (OR) for CR and nCR were calculated using multivariate logistic regression adjusting for demographic (age, gender, race), medical (creatinine, diabetes mellitus, cardiac disease) and clinical factors (clinical T stage, prior BCG therapy, complete tumor debulking prior to chemotherapy). Results: A total of 78 patients received GC or MVAC neoadjuvant chemotherapy followed by RC, including 46 who received GC and 32 who received MVAC. There was no difference in gender, renal function, cardiac disease or clinical stage between the two groups. Patients over 70 years of age primarily received GC (17/18). CR was achieved in 30% and 25% (p = 0.15) of GC and MVAC patients, respectively (multivariate OR 0.42, 95% CI 0.11-1.63). nCR was more common in those receiving GC (50% vs. 38%, p = 0.04) although non-significant in the multivariate model (OR 0.30, 95% CI 0.07-1.16). Conclusions: We observed similar pathologic response rates for GC and MVAC neoadjuvant chemotherapy in this cohort of bladder cancer patients. These observations support the use of GC as an alternative regimen in the neoadjuvant setting.

177 CT RADIOMICS BASED ON MACHINE LEARNING PREDICTING PATHOLOGIC COMPLETE RESPONSE AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xue-Feng Leng ◽  
Qi-Feng Wang ◽  
Jin-Yi Lang ◽  
Tao Li ◽  
Yong-Tao Han ◽  
...  
Keyword(s):  
Machine Learning ◽  
Esophageal Cancer ◽  
Squamous Cell ◽  
Pathologic Complete Response ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Pathologic Response ◽  
Training Set ◽  
Term Survival ◽  
Training Cohort

Abstract   Neoadjuvant chemoradiotherapy (nCRT) has become the standard treatment for patients with locally advanced squamous cell esophageal cancer (LA-ESCC). Patients with the complete pathologic response (pCR) have significantly improved long-term survival. All efforts should be to improve the accuracy of predicting pCR. In this study, we investigate the use of radiomics based on machine learning to identify the pathologic complete response of patients with esophageal squamous cell carcinoma (ESCC) based on Computed Tomography (CT). Methods The study included 155 patients with pathologically confirmed LA-ESCC. All 155 patients underwent simulation CT before nCRT, Quantitative radiomics features were extracted from CT images of each patient. To explore the relationship between radiomics features and the pCR, we used five-fold cross validation to classify the training and the testing cohorts. The Least Absolute Shrinkage and Selectionator operator (Lasso) were used to select features useful for the grading of pCR in the training cohort. Different models were measured in the training cohort using accuracy, sensitivity, specificity, and area under the curve of the receiver operating characteristic curve (AUC). Results There were 155 patients. The pretreatment clinical stage was II in 16 patients (10.3%), III in 132 (85.2%), and IV in 7 (4.5%). Pathologic response was complete in 69 patients (44.5%), near-partial complete in 86 (55.5%). A total of 2193 radiomics features were extracted in the training set. After the use of statistical dimensionality reduction, five radiomics features were selected by Lasso to build radiomics signature. Prediction models for pCR were developed, and the model was able to predict pCR well in the training set(AUC = 0.902). In the testing cohorts, the model had a good performance in predicting pCR (AUC = 0.78). Conclusion This study showed that CT-based radiomics features could be used as biomarkers to predict the complete pathological response of esophageal cancer underwent Neoadjuvant chemoradiotherapy.

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