title: Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation.
abstract: BACKGROUND
  In patients with locoregional carcinoma of the esophagus or esophagogastric junction who underwent preoperative chemoradiation, it is unclear whether survival was better predicted by pretherapy clinical stage or by posttherapy pathologic stage.
  
  
  METHODS
  The authors studied 235 consecutive patients with pretherapy clinical Stage II, III, or IVA (according to American Joint Committee on Cancer criteria) carcinoma of the esophagus or esophagogastric junction who were treated with chemoradiation followed by esophagectomy. Posttherapy cancer status was classified using pathologic stage and semiquantitative assessment of residual carcinoma. Clinicopathologic features, residual carcinoma status, and pretherapy and posttherapy stage were compared with disease-free and overall survival.
  
  
  RESULTS
  Posttherapy pathologic stage was Stage 0 in 29% of patients, Stage I in 11% of patients, Stage II in 34% of patients, Stage III in 20% of patients, and Stage IV in 6% of patients. Cancer downstaging occurred in 56% of patients. In univariate analysis, disease-free and overall survival were predicted by posttherapy pathologic stage (both with P < 0.001), margin status (P = 0.002 and P = 0.01, respectively), extent of residual carcinoma (both with P < 0.001), and downstaging (both with P = 0.001), but not by age, gender, type of cancer, pretherapy clinical stage, or preoperative regimen. However, in multivariate analysis, disease-free and overall survival were independently predicted by posttherapy pathologic stage (both with P = 0.02). Extent of residual carcinoma was a marginally significant predictor of overall survival (P = 0.04).
  
  
  CONCLUSIONS
  Posttherapy pathologic stage was the best available predictor of outcome for patients with locoregional carcinoma of the esophagus or esophagogastric junction who underwent chemoradiation therapy followed by esophagectomy. The findings in the current study supported the concept of downstaging by preoperative therapy.
authors.affiliation: Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Lucian R
authors.initials: LR
authors.lastname: Chirieac
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Ritsuko R
authors.initials: RR
authors.lastname: Komaki
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Morris
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Asif
authors.initials: A
authors.lastname: Rashid
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Hamilton
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
mesh_terms: D002277:Carcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate