• Erin M Bayley, Megan L Ivy, Jitesh B Shewale, Phillip S Ge, Mara B Antonoff, Ashleigh M Francis, Wayne L Hofstetter, Reza J Mehran, Ravi Rajaram, David C Rice, Jack A Roth, Boris Sepesi, Ara A Vaporciyan, Garrett L Walsh, J Jack Lee, Brian E Louie, and Stephen G Swisher.
• Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX.
• Ann. Surg. 2023 May 1; 277 (5): 721726721-726.

ObjectiveClinical predictors of pathological complete response have not reliably identified patients for whom an organ-sparing approach following neoadjuvant chemoradiation be undertaken for esophageal cancer patients. We sought to identify high-risk predictors of residual carcinoma that may preclude patients from a selective surgical approach.BackgroundPatients treated with neoadjuvant chemoradiation followed by esophagectomy for esophageal adenocarcinoma were identified.Patients And MethodsCorrelation between clinical and pathologic complete responses were examined. Regression models and recursive partitioning were utilized to identify features associated with residual carcinoma. External validation of these high-risk factors was performed on a data set from an independent institution.ResultsA total of 326 patients were identified, in whom clinical complete response was noted in 104/326 (32%). Pathologic complete response was noted in only 33/104 (32%) of these clinical complete responders. Multivariable analysis identified that the presence of stricture ( P =0.011), positive biopsy ( P =0.010), and signet ring cell histology ( P =0.019) were associated with residual cancer. Recursive partitioning corroborated a 94% probability of residual disease, or greater, for each of these features. The positive predictive value was >90% for these characteristics. A SUV max >5.4 at the esophageal primary in the absence of esophagitis was also a high-risk factor for residual carcinoma. External validation confirmed these high-risk factors to be implicated in the finding of residual carcinoma.ConclusionsClinical parameters of response are poor predictors of complete pathologic response leading to challenges in selecting candidates for active surveillance. However, we characterize several high-risk features for residual carcinoma which indicate that esophagectomy should not be delayed.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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