Characterization of residual tumours at the primary site in patients with a near pathological complete response after neoadjuvant chemoradiotherapy for oesophageal cancer.
BACKGROUND
A 'surgery as needed' strategy has been proposed for patients with oesophageal cancer who truly achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). However, the ability to detect residual disease remains problematic. This study investigated the anatomical locations and pathological characteristics of residual cancer in patients with oesophageal squamous cell carcinoma (SCC) who achieved a near pCR following nCRT.


METHODS
Patients with oesophageal SCC who achieved a near pCR after nCRT were eligible. Near pCR was defined as residual cancer in the resection specimen representing less than 10 per cent of the apparent original tumour area.


RESULTS
Detailed histopathological reassessment of 76 consecutive patients (mean age 54·4 years) with a near pCR was undertaken. Some 32 patients (42 per cent) with a near pCR had no detectable mucosal lesions. Residual tumour was identified most frequently in the submucosal layer (54, 71 per cent), followed by the mucosa (44, 58 per cent), muscle layer (36, 47 per cent) and adventitia (22, 29 per cent) (P < 0·001). Among patients without ypT1a disease, increasing depth of tumour invasion correlated negatively with the likelihood of mucosal involvement. Of patients with ypT3 disease, 16 of 22 had no detectable cancer located in the mucosa, compared with six of 29 with ypT1b disease (P < 0·001).


CONCLUSIONS
Better tools for predicting pCR are required before considering a 'surgery as needed' approach in the management of oesophageal cancer.
Division of Thoracic Surgery, Chang Gung University, Taoyuan, Taiwan.
Y-K
YK
Chao
Department of Surgery, Chang Gung University, Taoyuan, Taiwan.
Y
Y
Chang
Department of Pathology, Chang Gung University, Taoyuan, Taiwan.
C-J
CJ
Yeh
Division of Haematology/Oncology, Chang Gung University, Taoyuan, Taiwan.
H-K
HK
Chang
Department of Radiation Oncology, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan.
C-K
CK
Tseng
Department of Pathology, Chang Gung University, Taoyuan, Taiwan.
W-Y
WY
Chuang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000379:methods; D004938:Esophageal Neoplasms / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome