Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 1380–1387 | Cite as

CT Signs Can Predict Treatment Response and Long-Term Survival: A Study in Locally Advanced Esophageal Cancer with Preoperative Chemotherapy

  • Xiao-Yan Zhang
  • Wan-Pu Yan
  • Yu Sun
  • Xiao-Ting Li
  • Ying Chen
  • Meng-Ying Fan
  • Ying Wu
  • Zhen Liang
  • Hong-Chao Xiong
  • Zhi-Long Wang
  • Ying-Shi Sun
  • Ke-Neng Chen
Thoracic Oncology

Abstract

Background

Accurate prediction of treatment response and prognosis before surgery allows prompt therapy adjustment. This study aimed to evaluate the efficacy of computed tomography (CT) signs in predicting treatment response and survival for advanced esophageal squamous cell carcinoma patients who received preoperative chemotherapy.

Methods

This study retrospectively enrolled 135 consecutive patients with preoperative chemotherapy from September 2005 to December 2011. A logistic regression model was used to evaluate the association between pathologic response and CT signs. Overall survival (OS) and disease-free survival (DFS) were estimated using the Kaplan–Meier method, and a Cox proportional hazards model was constructed to determine associations between CT signs after neoadjuvant chemotherapy and survival outcomes.

Results

Logistic regression showed that the significant predictors of a poor response were the total number of lymph nodes (LNs) (>6) at baseline [odds ratio (OR) 5.07; 95 % confidence interval (CI) 1.86–13.81; P = 0.002] and the CT value change rate (≤17 %) (OR 2.35; 95 % CI 1.05–5.23; P = 0.037). In the Cox analyses, the significant predictors of OS were preoperative tumor thickness (>10 mm) [hazard ratio (HR) 2.33; 95 % CI 1.36–4; P = 0.002), total number of LNs (>6) (HR 1.88; 95 % CI 1.12–3.17; P = 0.017), and short diameter of the largest LN (>10 mm) (HR 1.87; 95 % CI 1.07–3.28; P = 0.028), whereas only the short diameter of the largest LN was a significant predictor of DFS (HR 2.36; 95 % CI 1.23–4.54; P = 0.01).

Conclusions

CT signs can predict therapeutic efficacy and survival outcomes and provide an opportunity to offer additional treatment options before surgery.

Keywords

Overall Survival Esophageal Cancer Preoperative Chemotherapy Esophageal Squamous Cell Carcinoma Patient Large Lymph Node 

Notes

Acknowledgment

This work was supported by the National Basic Research Program of China (973 Program) (Grant No. 2011CB707705, 2011CB504300), National Natural Science Foundation of China (Grant No. 81471640, 81301748), the Capital Health Research and Development of Special Foundation (Grant No. 2011-2015-02), Specialized Research Fund for the Doctoral Program of Higher Education (Grant No. 20130001110108), Beijing Health System High Level Health Technical Personnel Training Plan (Grant No. 2013-3-083), Education Ministry Innovative Research Team in University (Grant No.IRT13003), Beijing Academic Leaders Program (Grant No. 2009-2-17), Beijing Natural Science Foundation (Grant No. 7102029), Capital Medical Developed Research Found (Grant No. 2007-1023), New Scholar Star Program of Ministry of Education.

Conflict of interest

There are no conflict of interest.

Supplementary material

10434_2015_4531_MOESM1_ESM.tif (833 kb)
Supplementary Fig. 1. Flow chart of patient enrollment (TIFF 832 kb)
10434_2015_4531_MOESM2_ESM.tif (971 kb)
Supplementary Fig. 2. (A) Kaplan–Meier curves of pathological response on overall survival (OS); (B) Kaplan–Meier analysis of pathological response on disease-free survival (DFS) (TIFF 970 kb)
10434_2015_4531_MOESM3_ESM.docx (21 kb)
Supplementary material 3 (DOCX 20 kb)

References

  1. 1.
    van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BPL, Richel DJ, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, Cuesta MA, Blaisse RJB, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074–84.PubMedCrossRefGoogle Scholar
  2. 2.
    Oppedijk V, van der Gaast A, van Lanschot JJ, van Hagen P, van Os R, van Rij CM, van der Sangen MJ, Beukema JC, Rütten H, Spruit PH, Reinders JG, Richel DJ, van Berge Henegouwen MI, Hulshof MC. Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol. 2014;32:385–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Berger AC, Farma J, Scott WJ, Freedman G, Weiner L, Cheng JD, Wang H, Goldberg M. Complete response to neoadjuvant chemoradiotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol. 2005;23:4330–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Arnott SJ, Duncan W, Gignoux M, Hansen HS, Launois B, Nygaard K, Parmar MKB, Rousell A, Spilopoulos G, Stewart G, Tierney JF, Wang M, et al. Preoperative radiotherapy for esophageal carcinoma. Cochrane Database Syst Rev. 2005;19:CD001799.Google Scholar
  5. 5.
    Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J, Estes N, Haller DG, Ajani J, Kocha W, Minsky BD, Roth RA. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med. 1998;339:1979–84.PubMedCrossRefGoogle Scholar
  6. 6.
    Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–33.CrossRefGoogle Scholar
  7. 7.
    Gebski V, Burmeister B, Smithers BM, Foo K, Zalcberg J, Simes J. Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol. 2007;8:226–34.PubMedCrossRefGoogle Scholar
  8. 8.
    Mariette C, Dahan L, Mornex F, Maillard E, Thomas PA, Meunier B, Boige V, Pezet D, Robb WB, Le Brun-Ly V, Bosset JF, Mabrut JY, et al. Surgery alone versus chemoradiotherapy followed by surgery for stage I and II esophageal cancer: final analysis of randomized controlled phase III trial FFCD 9901. J Clin Oncol. 2014;32(23):2416–22.PubMedCrossRefGoogle Scholar
  9. 9.
    Hermann RM, Horstmann O, Haller F, Perske C, Christiansen H, Hille A, Schmidberger H, Füzesi L. Histomorphological tumor regression grading of esophageal carcinoma after neoadjuvant radiochemotherapy: which score to use? Dis Esophagus. 2006;19:329–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Swisher SG, Maish M, Erasmus JJ, Correa AM, Ajani JA, Bresalier R, Komaki R, Macapinlac H, Munden RF, Putnam JB, Rice D, Smythe WR, Vaporciyan AA, Walsh GL, Wu TT, Roth JA. Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer. Ann Thorac Surg. 2004;78:1152–60.PubMedCrossRefGoogle Scholar
  11. 11.
    Rosch T. Endosonographic staging of esophageal cancer: a review of literature results. Gastrointest Endosc Clin North Am. 1995;5:537–47.Google Scholar
  12. 12.
    Lightdale CJ, Kulkarni KG. Role of endoscopic ultrasonography in the staging and follow-up of esophageal cancer. J Clin Oncol. 2005;23:4483–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Crabtree TD, Kosinski AS, Puri V, Burfeind W, Bharat A, Patterson GA, Hofstetter W, Meyers BF. Evaluation of the reliability of clinical staging of T2 N0 esophageal cancer: a review of the society of thoracic surgeons database. Ann Thorac Surg. 2013;96:382–90.PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Hofstetter WL. Surgery alone or preoperative therapy in cT2N0 esphageal cancer. 2014 AATS annual meeting. Abstract Book 2014:151–152.Google Scholar
  15. 15.
    Rice TW, Blackstone EH, Rusch VW. 7th edition of the AJCC Cancer Staging Manual: esophagus and esophagogastric junction. Ann Surg Oncol. 2010;17:1721–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Swisher SG, Ajani JA, Komaki R, Nesbitt CJ, Correa AM, Cox JD, Lahoti S, Martin F, Putnam JB, Smythe WR, Vaporciyan AA, Walsh GL, et al. Long-term outcome of phase II trial evaluating chemotherapy, chemoradiotherapy, and surgery for locoregionally advanced esophageal cancer. Int J Radiat Oncol Biol Phys. 2003;57:120–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Konieczny A, Meyer P, Schnider A, Komminoth P, Schmid M, Lombriser N, Weishaupt D. Accuracy of multidetector-row CT for restaging after neoadjuvant treatment in patients with oesophageal cancer. Eur Radiol. 2013;23:2492–502.PubMedCrossRefGoogle Scholar
  18. 18.
    Sun F, Chen T, Han J, Ye P, Hu J. Staging accuracy of endoscopic ultrasound for esophageal cancer after neoadjuvant chemotherapy: a meta-analysis and systematic review. Dis Esophagus. 2014. doi: 10.1111/dote.12274.Google Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Xiao-Yan Zhang
    • 1
  • Wan-Pu Yan
    • 2
  • Yu Sun
    • 3
  • Xiao-Ting Li
    • 1
  • Ying Chen
    • 1
  • Meng-Ying Fan
    • 2
  • Ying Wu
    • 3
  • Zhen Liang
    • 2
  • Hong-Chao Xiong
    • 2
  • Zhi-Long Wang
    • 1
  • Ying-Shi Sun
    • 1
  • Ke-Neng Chen
    • 2
  1. 1.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of RadiologyPeking University Cancer Hospital and InstituteBeijingChina
  2. 2.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), The First Department of Thoracic SurgeryPeking University Cancer Hospital and InstituteBeijingChina
  3. 3.Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of PathologyPeking University Cancer Hospital and InstituteBeijingChina

Personalised recommendations