Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer

Joel Shapiro, Katharina Biermann, David van Klaveren, G. Johan A Offerhaus, Fiebo J W ten Kate, Sybren L. Meijer, Mark I. van Berge Henegouwen, Ewout W. Steyerberg, Bas P L Wijnhoven, J. Jan B Van Lanschot

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: We aimed to determine pretreatment pathological tumor extent in the resection specimen after neoadjuvant chemoradiotherapy (nCRT) and to assess its prognostic value in patients with esophageal cancer. METHODS:: Patients with esophageal cancer, treated with nCRT plus surgery were included (2003–2011). Pretreatment pathological T-stage (prepT-stage) and N-stage (prepN-stage) were estimated based on the extent of regressional changes and residual tumor cells in the resection specimen. Interobserver agreement was determined between 3 pathologists. The prognostic performance of prepT-stage and prepN-stage was scored using the difference in Akaike information criterion (ΔAIC). PrepN-stage and posttreatment pathological N-stage (ypN-stage) were combined to determine the effect of nodal sterilization on prognosis. RESULTS:: Overall concordance for prepT-stage and prepN-stage was 0.69 and 0.84, respectively. Prognostic strength of prepT-stage was similar to clinical T-stage and worse compared with ypT-stage (ΔAIC 1.3 versus 2.0 and 8.9, respectively). In contrast, prognostic strength of prepN-stage was better than cN-stage and similar to ypN-stage (ΔAIC 17.9 versus 6.2 and 17.2, respectively). PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients, with a five year overall survival of 51% versus 68%, P = 0.019, respectively. CONCLUSIONS:: PrepT-stage and prepN-stage can be estimated reproducibly. Prognostic strength of prepT-stage is comparable with clinical T-stage, whereas prepN-stage is better than cN-stage. PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients. Pretreatment pathological staging should be considered useful as a new staging parameter for esophageal cancer and could also be of interest for other tumor types.

Original languageEnglish (US)
JournalAnnals of Surgery
DOIs
StateAccepted/In press - Jan 14 2016
Externally publishedYes

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Chemoradiotherapy
Esophageal Neoplasms
Neoplasms
Survival
Residual Neoplasm

ASJC Scopus subject areas

  • Surgery

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Shapiro, J., Biermann, K., van Klaveren, D., Offerhaus, G. J. A., ten Kate, F. J. W., Meijer, S. L., ... Lanschot, J. J. B. V. (Accepted/In press). Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001630

Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer. / Shapiro, Joel; Biermann, Katharina; van Klaveren, David; Offerhaus, G. Johan A; ten Kate, Fiebo J W; Meijer, Sybren L.; van Berge Henegouwen, Mark I.; Steyerberg, Ewout W.; Wijnhoven, Bas P L; Lanschot, J. Jan B Van.

In: Annals of Surgery, 14.01.2016.

Research output: Contribution to journalArticle

Shapiro, J, Biermann, K, van Klaveren, D, Offerhaus, GJA, ten Kate, FJW, Meijer, SL, van Berge Henegouwen, MI, Steyerberg, EW, Wijnhoven, BPL & Lanschot, JJBV 2016, 'Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000001630
Shapiro, Joel ; Biermann, Katharina ; van Klaveren, David ; Offerhaus, G. Johan A ; ten Kate, Fiebo J W ; Meijer, Sybren L. ; van Berge Henegouwen, Mark I. ; Steyerberg, Ewout W. ; Wijnhoven, Bas P L ; Lanschot, J. Jan B Van. / Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer. In: Annals of Surgery. 2016.
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abstract = "OBJECTIVE:: We aimed to determine pretreatment pathological tumor extent in the resection specimen after neoadjuvant chemoradiotherapy (nCRT) and to assess its prognostic value in patients with esophageal cancer. METHODS:: Patients with esophageal cancer, treated with nCRT plus surgery were included (2003–2011). Pretreatment pathological T-stage (prepT-stage) and N-stage (prepN-stage) were estimated based on the extent of regressional changes and residual tumor cells in the resection specimen. Interobserver agreement was determined between 3 pathologists. The prognostic performance of prepT-stage and prepN-stage was scored using the difference in Akaike information criterion (ΔAIC). PrepN-stage and posttreatment pathological N-stage (ypN-stage) were combined to determine the effect of nodal sterilization on prognosis. RESULTS:: Overall concordance for prepT-stage and prepN-stage was 0.69 and 0.84, respectively. Prognostic strength of prepT-stage was similar to clinical T-stage and worse compared with ypT-stage (ΔAIC 1.3 versus 2.0 and 8.9, respectively). In contrast, prognostic strength of prepN-stage was better than cN-stage and similar to ypN-stage (ΔAIC 17.9 versus 6.2 and 17.2, respectively). PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients, with a five year overall survival of 51{\%} versus 68{\%}, P = 0.019, respectively. CONCLUSIONS:: PrepT-stage and prepN-stage can be estimated reproducibly. Prognostic strength of prepT-stage is comparable with clinical T-stage, whereas prepN-stage is better than cN-stage. PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients. Pretreatment pathological staging should be considered useful as a new staging parameter for esophageal cancer and could also be of interest for other tumor types.",
author = "Joel Shapiro and Katharina Biermann and {van Klaveren}, David and Offerhaus, {G. Johan A} and {ten Kate}, {Fiebo J W} and Meijer, {Sybren L.} and {van Berge Henegouwen}, {Mark I.} and Steyerberg, {Ewout W.} and Wijnhoven, {Bas P L} and Lanschot, {J. Jan B Van}",
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T1 - Prognostic Value of Pretreatment Pathological Tumor Extent in Patients Treated With Neoadjuvant Chemoradiotherapy Plus Surgery for Esophageal or Junctional Cancer

AU - Shapiro, Joel

AU - Biermann, Katharina

AU - van Klaveren, David

AU - Offerhaus, G. Johan A

AU - ten Kate, Fiebo J W

AU - Meijer, Sybren L.

AU - van Berge Henegouwen, Mark I.

AU - Steyerberg, Ewout W.

AU - Wijnhoven, Bas P L

AU - Lanschot, J. Jan B Van

PY - 2016/1/14

Y1 - 2016/1/14

N2 - OBJECTIVE:: We aimed to determine pretreatment pathological tumor extent in the resection specimen after neoadjuvant chemoradiotherapy (nCRT) and to assess its prognostic value in patients with esophageal cancer. METHODS:: Patients with esophageal cancer, treated with nCRT plus surgery were included (2003–2011). Pretreatment pathological T-stage (prepT-stage) and N-stage (prepN-stage) were estimated based on the extent of regressional changes and residual tumor cells in the resection specimen. Interobserver agreement was determined between 3 pathologists. The prognostic performance of prepT-stage and prepN-stage was scored using the difference in Akaike information criterion (ΔAIC). PrepN-stage and posttreatment pathological N-stage (ypN-stage) were combined to determine the effect of nodal sterilization on prognosis. RESULTS:: Overall concordance for prepT-stage and prepN-stage was 0.69 and 0.84, respectively. Prognostic strength of prepT-stage was similar to clinical T-stage and worse compared with ypT-stage (ΔAIC 1.3 versus 2.0 and 8.9, respectively). In contrast, prognostic strength of prepN-stage was better than cN-stage and similar to ypN-stage (ΔAIC 17.9 versus 6.2 and 17.2, respectively). PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients, with a five year overall survival of 51% versus 68%, P = 0.019, respectively. CONCLUSIONS:: PrepT-stage and prepN-stage can be estimated reproducibly. Prognostic strength of prepT-stage is comparable with clinical T-stage, whereas prepN-stage is better than cN-stage. PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients. Pretreatment pathological staging should be considered useful as a new staging parameter for esophageal cancer and could also be of interest for other tumor types.

AB - OBJECTIVE:: We aimed to determine pretreatment pathological tumor extent in the resection specimen after neoadjuvant chemoradiotherapy (nCRT) and to assess its prognostic value in patients with esophageal cancer. METHODS:: Patients with esophageal cancer, treated with nCRT plus surgery were included (2003–2011). Pretreatment pathological T-stage (prepT-stage) and N-stage (prepN-stage) were estimated based on the extent of regressional changes and residual tumor cells in the resection specimen. Interobserver agreement was determined between 3 pathologists. The prognostic performance of prepT-stage and prepN-stage was scored using the difference in Akaike information criterion (ΔAIC). PrepN-stage and posttreatment pathological N-stage (ypN-stage) were combined to determine the effect of nodal sterilization on prognosis. RESULTS:: Overall concordance for prepT-stage and prepN-stage was 0.69 and 0.84, respectively. Prognostic strength of prepT-stage was similar to clinical T-stage and worse compared with ypT-stage (ΔAIC 1.3 versus 2.0 and 8.9, respectively). In contrast, prognostic strength of prepN-stage was better than cN-stage and similar to ypN-stage (ΔAIC 17.9 versus 6.2 and 17.2, respectively). PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients, with a five year overall survival of 51% versus 68%, P = 0.019, respectively. CONCLUSIONS:: PrepT-stage and prepN-stage can be estimated reproducibly. Prognostic strength of prepT-stage is comparable with clinical T-stage, whereas prepN-stage is better than cN-stage. PrepN+ patients who become ypN0 after nCRT have a worse survival compared with prepN0 patients. Pretreatment pathological staging should be considered useful as a new staging parameter for esophageal cancer and could also be of interest for other tumor types.

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