title: Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort.
abstract: BACKGROUND
  Chemoradiation followed by surgery is the preferred treatment of localized gastroesophageal cancer (GEC). Surgery causes considerable life-altering consequences and achievement of clinical complete response (clinCR; defined as postchemoradiation [but presurgery] endoscopic biopsy negative for cancer and positron emission tomographic (PET) scan showing physiologic uptake) is an enticement to avoid/delay surgery. We examined the association between clinCR and pathologic complete response (pathCR).
  
  
  METHODS
  Two hundred eighty-four patients with GEC underwent chemoradiation and esophagectomy. The chi-square test, Fisher exact test, t-test, Kaplan-Meier method, and log-rank test were used.
  
  
  RESULTS
  Of 284 patients, 218 (77%) achieved clinCR. However, only 67 (31%) of the 218 achieved pathCR. The sensitivity of clinCR for pathCR was 97.1% (67/69), but the specificity was low (29.8%; 64/215). Of the 66 patients who had less than a clinCR, only 2 (3%) had a pathCR. Thus, the rate of pathCR was significantly different in patients with clinCR than in those with less than a clinCR (P < 0.001).
  
  
  CONCLUSIONS
  clinCR is not highly associated with pathCR; the specificity of clinCR for pathCR is too low to be used for clinical decision making on delaying/avoiding surgery. Surgery-eligible GEC patients should be encouraged to undergo surgery following chemoradiation despite achieving a clinCR.
authors.affiliation: Department of Gastrointestinal Medical Oncology, Unit 426, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: N K S
authors.initials: NK
authors.lastname: Cheedella
authors.forename: A
authors.initials: A
authors.lastname: Suzuki
authors.forename: L
authors.initials: L
authors.lastname: Xiao
authors.forename: W L
authors.initials: WL
authors.lastname: Hofstetter
authors.forename: D M
authors.initials: DM
authors.lastname: Maru
authors.forename: T
authors.initials: T
authors.lastname: Taketa
authors.forename: K
authors.initials: K
authors.lastname: Sudo
authors.forename: M A
authors.initials: MA
authors.lastname: Blum
authors.forename: S H
authors.initials: SH
authors.lastname: Lin
authors.forename: J
authors.initials: J
authors.lastname: Welch
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: M S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: D C
authors.initials: DC
authors.lastname: Rice
authors.forename: A A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: S G
authors.initials: SG
authors.lastname: Swisher
authors.forename: J A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D059248:Chemoradiotherapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D012074:Remission Induction; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome