Hipp, Julian;
Kuvendjiska, Jasmina;
Hillebrecht, Hans Christian;
Herrmann, Stephan;
Timme-Bronsert, Sylvia;
Fichtner-Feigl, Stefan;
Hoeppner, Jens;
Diener, Markus K.
Oncological recurrence following pathological complete response after neoadjuvant treatment in patients with esophageal cancer — a retrospective cohort study
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Media type:
E-Article
Title:
Oncological recurrence following pathological complete response after neoadjuvant treatment in patients with esophageal cancer — a retrospective cohort study
Contributor:
Hipp, Julian;
Kuvendjiska, Jasmina;
Hillebrecht, Hans Christian;
Herrmann, Stephan;
Timme-Bronsert, Sylvia;
Fichtner-Feigl, Stefan;
Hoeppner, Jens;
Diener, Markus K.
imprint:
Springer Science and Business Media LLC, 2023
Description:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>To evaluate recurrence in patients with post-neoadjuvant pathological complete response (pCR) and in patients with complete response of primary tumor but persisting lymphatic spread of disease (non-pCR, ypT0ypN +) of esophageal cancer.</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>Seventy-five patients (63 pCR, 12 non-pCR) were analyzed retrospectively. Pattern and incidence of local and distant recurrence as well as the impact on overall (OS) and disease-free survival (DFS) were evaluated. The efficacy of neoadjuvant chemotherapy according to FLOT protocol was compared to neoadjuvant chemoradiation according to CROSS protocol.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>In the pCR group, isolated local recurrence was diagnosed in 3%, while no isolated local recurrence was observed in the non-pCR group due to the high incidence of distant recurrence. Distant recurrence was most common in both cohorts (isolated distant recurrence: pCR group 10% to non-pCR group 55%; simultaneous distant and local recurrence: pCR group 3% to non-pCR group 18%). Median time to distant recurrence was 5.5 months, and median time to local recurrence was 8.0 months. Cumulative incidence of distant recurrence (with and without simultaneous local recurrence) was 16% (± 6%) in pCR patients and 79% (± 13%) in non-pCR patients (hazard ratio (HR) 0.123) estimated by Kaplan–Meier method. OS (HR 0.231) and DFS (HR 0.226) were significantly improved in patients with pCR compared to patients with non-pCR. Advantages for FLOT protocol compared to CROSS protocol, especially with regard to distant control of disease (HR 0.278), were observed (OS (HR 0.361), DFS (HR 0.226)).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Distant recurrence is the predominant site of treatment failure in patients with pCR and non-pCR grade 1a regression, whereby recurrence rates are much higher in patients with non-pCR.</jats:p>
</jats:sec>