Singh Pranit, Choo Sylvia, Adams Jacob, Adams Matthew, Lima Pereira Allan A, Baldonado Jobelle J A, Fontaine Jacques P, Sandoval Maria L, Frakes Jessica M, Pimiento Jose M, Hoffe Sarah E, Sinnamon Andrew J
USF Health Morsani College of Medicine, Tampa, FL, USA.
Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA.
Cancer Control. 2025 Jan-Dec;32:10732748251382635. doi: 10.1177/10732748251382635. Epub 2025 Sep 24.
IntroductionNeoadjuvant chemoradiation (CRT) is commonly used for esophageal cancer (EC), with pathologic complete response (pCR) linked to improved prognosis. pCR rates range from 25%-30% for adenocarcinoma to 50% for squamous cell carcinoma (SCC). High-volume centers (HVCs) often yield favorable outcomes across various cancers. This study examines whether CRT delivery at an HVC impacts pCR and ypN0 rates in EC patients undergoing esophagectomy.MethodsIn this retrospective cohort analysis, we identified patients with clinical stage T2+/N+ EC who received neoadjuvant CRT and esophagectomy from a prospectively maintained database (1996-2019). CRT was delivered at the HVC or a community center (CC), while all surgeries occurred at the HVC. Primary outcomes were pCR and ypN0.ResultsAmong 708 patients, median age was 65 years, with 83.6% male and 95.3% white. Most had adenocarcinoma (87.9%) in the distal esophagus or gastroesophageal junction. CRT was delivered at CCs in 64.8% and at HVC in 35.2%. Radiation dose was higher at the HVC (mean 5195 vs 4944 cGy, < 0.001), with similar intensity-modulated radiation therapy use (83% vs 79%, = 0.12). Overall pCR rate was 37.7%, without significant difference between HVC and CC (40.6% vs 36.2%, = 0.25, multivariable adjusted OR 0.88, = 0.47). SCC histology was associated with higher pCR (OR 2.39, = 0.002). Among SCC patients, pCR rate was higher at HVC than CC (75.0% vs 50.0%, = 0.03) but not significant in multivariable analysis (OR = 2.65, = 0.11). Conversely, minimal histopathologic response (TRG3) was higher at CCs, not statistically different (17.9% vs 14.5%, = 0.24). Rate of ypN0 was similar (HVC 70.7% vs CC 68.0%, = 0.71) with no difference in ratio of positive to resected nodes ( = 0.94).ConclusionThere were no significant differences in pCR or ypN0 rates by CRT delivery site. pCR was higher for SCC histology at HVC, but did not reach statistical significance. Further research is warranted for SCC specifically.
引言
新辅助放化疗（CRT）常用于食管癌（EC），病理完全缓解（pCR）与预后改善相关。腺癌的pCR率为25%-30%，鳞状细胞癌（SCC）为50%。高容量中心（HVC）在各种癌症治疗中往往能取得良好效果。本研究探讨在HVC进行CRT治疗对接受食管切除术的EC患者的pCR率和ypN0率是否有影响。
方法
在这项回顾性队列分析中，我们从一个前瞻性维护的数据库（1996 - 2019年）中识别出临床分期为T2+/N+的EC患者，这些患者接受了新辅助CRT和食管切除术。CRT在HVC或社区中心（CC）进行，而所有手术均在HVC进行。主要结局指标为pCR和ypN0。
结果
708例患者中，中位年龄为65岁，男性占83.6%，白人占95.3%。大多数患者为远端食管或胃食管交界处的腺癌（87.9%）。64.8%的患者在CC接受CRT治疗，35.2%在HVC接受治疗。HVC的放射剂量更高（平均5195 cGy vs 4944 cGy，<0.001），调强放疗的使用比例相似（83% vs 79%，P = 0.12）。总体pCR率为37.7%，HVC和CC之间无显著差异（40.6% vs 36.2%，P = 0.25，多变量调整OR 0.88，P = 0.47）。SCC组织学类型与较高的pCR相关（OR 2.39，P = 0.002）。在SCC患者中，HVC的pCR率高于CC（75.0% vs 50.0%，P = 0.03），但在多变量分析中无显著性差异（OR = 2.65，P = 0.11）。相反，CC的最小组织病理学反应（TRG3）较高，但无统计学差异（17.9% vs 14.5%，P = 0.24）。ypN0率相似（HVC为70.7%，CC为68.0%，P = 0.71），阳性淋巴结与切除淋巴结的比例无差异（P = 0.94）。
结论
CRT治疗地点对pCR率或ypN0率无显著差异。HVC中SCC组织学类型的pCR率较高，但未达到统计学显著性。有必要对SCC进行进一步研究。
