Dataset Information

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.

ABSTRACT:

Introduction

We aimed to elucidate the prognostic value of tumor regression grade (TRG) combined with lymph node status compared with the 8th edition of the ypTNM staging system in patients with advanced esophageal squamous cell cancer (ESCC) after neoadjuvant chemoradiotherapy (nCRT).

Methods

We enrolled 325 patients with ESCC who underwent nCRT followed by complete resection. We adopted the modified Schneider TRG system, with high (ypT0N0), mid (ypT0N+ or ypT + N0), and low (ypT + N+). After developing a multivariable Cox model, the discrimination ability of the ypStage and TRG systems was evaluated using the Akaike Information Criterion (AIC) and R² measure.

Results

The mean duration of follow-up was 56.7 ± 43.3 months. The survival curves between the adjacent groups of TRG were significantly different for both overall survival (OS) and recurrence-free survival (RFS). However, there were no significant differences between ypStages II and III for OS (p = 0.683) or RFS (p = 0.760). The TRG system also had a discrimination ability in patients with ypStage I (p < 0.001 for both OS and RFS) and ypStage III (p = 0.045 for OS and 0.042 for RFS). Compared with the ypTNM staging system, the modified TRG had a lower AIC value (1835.99 vs. 1852.02) and a higher R² (0.256 vs. 0.177), indicating better discrimination ability and prediction accuracy.

Conclusions

For patients with ESCC who underwent esophagectomy following nCRT, the modified Schneider TRG system may complement the ypStage and help clinicians select the most appropriate postoperative treatment and surveillance.

SUBMITTER: Yun JK

PROVIDER: S-EPMC9554450 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.

Yun Jae Kwang JK Kim Youngwoong Y Lee Geun Dong GD Choi Sehoon S Kim Yong-Hee YH Kim Dong Kwan DK Park Seung-Il SI Kim Hyeong Ryul HR

Cancer medicine 20220417 19

<h4>Introduction</h4>We aimed to elucidate the prognostic value of tumor regression grade (TRG) combined with lymph node status compared with the 8th edition of the ypTNM staging system in patients with advanced esophageal squamous cell cancer (ESCC) after neoadjuvant chemoradiotherapy (nCRT).<h4>Methods</h4>We enrolled 325 patients with ESCC who underwent nCRT followed by complete resection. We adopted the modified Schneider TRG system, with high (ypT0N0), mid (ypT0N+ or ypT + N0), and low (ypT ...[more]

PMID: 35434935

Similar Datasets

Project description:BackgroundThe status of lymph node (LN) metastases in esophageal squamous cell carcinoma (ESCC) following neoadjuvant chemoradiation (NCRT) is not well understood but significantly affects patient prognosis and treatment options. We conducted this study to evaluate the distribution of LN metastases in patients with ESCC who received NCRT combined minimally invasive esophagectomy (MIE).MethodsFrom March 2019 to September 2023, patients with middle- and lower-third ESCC received NCRT, followed by MIE with two-field lymphadenectomy, were included in this study. The primary outcome was to examine the distribution of LN metastases and their correlation with the radiation fields. Secondary outcomes included identifying risk factors for LN metastases and their impact on long-term survival.ResultsOne hundred consecutive patients were included, and 4.11% had LN metastases. The median number of positive LN and the rate of LN metastases in the thoracic LN stations was lower than that of the abdominal region (1.5 and 2.84% vs. 2 and 5.94%, respectively). Over half of the patients had LN metastases within the radiation field. The multivariate analysis found that the LN metastases were associated with the ycN-stage [hazard ratio (HR) =2.03, 95% confidence interval (CI): 1.02-4.04, P=0.04]. Although the LN metastases were not significantly associated with either overall survival (OS) or disease-free survival (DFS) (P=0.89 and P=0.65, respectively), the number of LN removal ≥15 LN removals was significantly improved both OS and DFS (P=0.040 and P=0.049, respectively).ConclusionsIn patients with middle- and lower-third ESCC who underwent NCRT followed by MIE, the rate of LN metastases in the abdominal region is higher than in the thoracic region. The majority of patients had LN metastases within the radiation field. Therefore, NCRT does not justify minimizing lymphadenectomy in ESCC; furthermore, a higher ycN-stage correlated with a higher incidence of LN metastases; higher ycN-stage correlates with higher LN metastases.

Project description:BackgroundEsophageal cancer is a highly invasive malignancy. Neoadjuvant chemoradiotherapy not only increases the rate of complete resection but also improves the median survival. However, a sensitive biomarker is urgently needed in clinical practice.Methods60 esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemoradiotherapy (NCRT) were enrolled at the People's Hospital Affiliated to Jiangsu University. Patients were grouped according to tumor regression grade (TRG) criteria from the College of American Pathologists (CAP). The correlation between TRG groups, clinicopathologic characteristics, and prognosis was analyzed. Differential gene expression analysis was performed on ESCC patients before and after NCRT using the public database (GSE43519). MMP9, NFIX, and GPR56 were identified as candidate genes, and their expression and correlation with prognosis were evaluated by immunohistochemical analysis.ResultsAmong 60 ESCC patients who underwent surgery after NCRT, the pathological complete response (pCR) rate was 35.0% (21/60), and the major pathological response (MPR) rate was 60.0% (36/60). Poor tumor differentiation and neural or vascular invasion were associated with inadequate tumor regression grade and were independent factors influencing TRG. ESCC patients were divided into effective (TRG 0 + 1) and ineffective (TRG 2 + 3) groups. Higher TRG was significantly associated with shorter overall survival (OS). Our study also identified TRG as an independent prognostic factor through univariate and multivariate Cox regression analyses (P < 0.05). The differentially expressed genes GPR56, MMP9, and NFIX selected from the GSE43519 dataset were significantly downregulated after NCRT (P < 0.001). Immunohistochemistry showed that GPR56 was highly expressed in ESCC, while it was negatively expressed in paracancerous tissues. There was a significant difference in expression between cancerous and paracancerous tissues. GPR56 expression was consistent with the public dataset, and patients with high GPR56 expression had significantly shorter OS (P < 0.05). In addition, patients with inadequate MPR and high GPR56 expression had shorter OS (P < 0.05).ConclusionsThe findings suggest that TRG serves as an independent prognostic factor for ESCC following NCRT. High GPR56 expression is found to be associated with a poor prognosis of ESCC. Downregulation of GPR56 suggests a potential significant predictive value in conjunction with MPR analysis.

Project description:BackgroundMultiple clinical trials were conducted to evaluate the efficacy of neoadjuvant therapy in esophageal cancer but exhibited mixed results, indicating that the efficacy of neoadjuvant therapy remains controversial in the treatment of esophageal cancer. Our study was conducted to investigate the value of neoadjuvant therapy in patients with esophageal cancer with supraclavicular lymph node metastases.MethodsWe retrospectively enrolled 231 patients who had resectable esophageal squamous cell carcinoma (ESCC) with supraclavicular lymph node metastases from June 2008 to November 2018. All patients were divided into three groups: the neoadjuvant therapy combined with surgery (Neo + S) group, the radical chemoradiotherapy (CRT) group, and the single radiotherapy (RT) group. Propensity score matching (PSM) was conducted to exclude the impact of potential interferences. Kaplan-Meier analysis, the log-rank test, and competitive risk model analysis were used to assess the efficacy of different therapeutic methods.ResultsPatients in the Neo + S group had a better 3-year survival rate (72.0% vs. 35.8%; P=0.005), progression-free survival (PFS) (24 vs. 14 months; P<0.0001), and lower 3-year tumor-specific mortality risk (25.1% vs. 53.7%; P=0.005) than those in the CRT group. Furthermore, patients in the CRT group had a better 3-year survival (30.1% vs. 18.6%; P=0.012) and lower 3-year tumor-specific mortality risk (57.9% vs. 76.8%; P=0.011) than those in the RT group. Additionally, the supraclavicular lymph node metastasis rate was higher than the mediastinal lymph node metastasis rate in patients with upper esophageal cancer compared to middle and lower esophageal cancer.ConclusionsNeoadjuvant chemotherapy combined with surgery showed better efficacy than radical CRT in patients who had resectable ESCC with supraclavicular lymph nodes metastasis. Supraclavicular lymph nodes are more likely to be regional lymph nodes for upper and middle esophageal cancer.

Project description:BackgroundProgrammed death 1 (PD-1) inhibitor demonstrated durable antitumor activity in advanced esophageal squamous cell carcinoma (ESCC), but the clinical benefit of perioperative immunotherapy in ESCC remains unclear. This study evaluated the efficacy and safety of neoadjuvant chemoradiotherapy (nCRT) combined with the PD-1 inhibitor toripalimab in patients with resectable ESCC.MethodsFrom July 2020 to July 2022, 21 patients with histopathologically confirmed thoracic ESCC and clinical staged as cT1-4aN1-2M0/cT3-4aN0M0 were enrolled. Eligible patients received radiotherapy (23 fractions of 1.8 Gy, 5 fractions a week) with concurrent chemotherapy of paclitaxel/cisplatin (paclitaxel 45 mg/m2 and cisplatin 25 mg/m2) on days 1, 8, 15, 22, 29 and two cycles of toripalimab 240 mg every 3 weeks after nCRT for neoadjuvant therapy before surgery, four cycles of toripalimab 240 mg every 3 weeks for adjuvant therapy after surgery. The primary endpoint was the major pathological response (MPR) rate. The secondary endpoints were safety and survival outcomes.ResultsA total of 21 patients were included, of whom 20 patients underwent surgery, 1 patient refused surgery and another patient was confirmed adenocarcinoma after surgery. The MPR and pathological complete response (pCR) rates were 78.9% (15/19) and 47.4% (9/19) for surgery ESCC patients. 21 patients (100.0%) had any-grade treatment-related adverse events, with the most common being lymphopenia (100.0%), leukopenia (85.7%), neutropenia (52.4%). 14 patients (66.7%) had adverse events of grade 3 with the most common being lymphopenia (66.7%). The maximum standardized uptake value and total lesion glycolysis of positron emission tomography/CT after neoadjuvant therapy well predicted the pathological response. The peripheral CD4+%, CD3+HLA-DR+/CD3+%, CD8+HLA-DR+/CD8+%, and IL-6 were significant differences between pCR and non-pCR groups at different times during neoadjuvant therapy. Three patients had tumor relapse and patients with MPR have longer disease-free survival than non-MPR patients.ConclusionsnCRT combined with perioperative toripalimab is effective and safe for locally advanced resectable ESCC. Long-term survival outcomes remain to be determined.Trial registration numberNCT04437212.

Dataset Information

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.

Introduction

Methods

Results

Conclusions

Publications

Tumor regression grade combined with lymph node status in esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets