Nodal Response to Neoadjuvant Therapy Predictive of Survival in Esophageal Cancer

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Findings on the predictive nature of nodal response to neoadjuvant therapy from the American Association for Thoracic Surgery 98th Annual Meeting.
Findings on the predictive nature of nodal response to neoadjuvant therapy from the American Association for Thoracic Surgery 98th Annual Meeting.

Survival outcomes are determined by nodal response to neoadjuvant therapy more so than primary tumor response among patients with locally advanced esophageal adenocarcinoma, according to findings presented at the American Association for Thoracic Surgery 98th Annual Meeting in San Diego, California.1

For this retrospective study, researchers assessed the outcomes of 2870 patients with esophageal adenocarcinoma who underwent margin-negative esophagectomy after completing neoadjuvant chemoradiation or chemotherapy. Investigators sought to determine whether neoadjuvant chemoradiation or chemotherapy led to a more complete pathologic response, and if nodal versus primary tumor response had implications for survival.

Of study participants, 17.3% and 34.5% of patients achieved complete response and partial response, respectively.

Patients who received neoadjuvant chemotherapy had a lower primary tumor response rate of 21.3% compared with 33.9% among patients in the chemoradiation arm (P < .001), as well as a poorer nodal response rate of 32.7% compared with 55.9% in the chemoradiation arm (P < .001). Neoadjuvant chemotherapy was also less likely to lead to partial or complete response, while neoadjuvant chemoradiation was significantly associated with completeness of response and overall risk of death.

Primary tumor and nodal response were both associated with a reduced risk of death, but patients who only had a primary tumor response saw a reduced survival benefit. Patients who only had a nodal response however, experienced no such drop-off in survival outcomes.

The authors concluded that results of the study suggest “a need to optimize neoadjuvant strategies associated with more complete nodal response rates or to consider more aggressive adjuvant treatment for patients with residual nodal disease after a margin-negative esophagectomy.”

Reference

  1. Groth SS, Burt BM, Farjah F, et al. Prognostic value of neoadjuvant treatment response in locally advanced esophageal adenocarcinoma. Presentation at: 2018 American Association for Thoracic Surgery 98th Annual Meeting; April 28-May 1, 2018; San Diego, CA.

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