Applying post-neoadjuvant pathologic stage as prognostic tool in esophageal squamous cell carcinoma

Weiming Han; Wei Deng; Qifeng Wang; Wenjie Ni; Chen Li; Zongmei Zhou; Jun Liang; Dongfu Chen; Qinfu Feng; Nan Bi; Tao Zhang; Xin Wang; Lei Deng; Wenqing Wang; Wenyang Liu; Jianyang Wang; Qi Xue; Yousheng Mao; Xiangyang Liu; Dekang Fang; Jian Li; Dali Wang; Jun Zhao; Zefen Xiao

doi:10.3389/fonc.2022.998238

Applying post-neoadjuvant pathologic stage as prognostic tool in esophageal squamous cell carcinoma

Front Oncol. 2022 Nov 10:12:998238. doi: 10.3389/fonc.2022.998238. eCollection 2022.

Authors

Weiming Han¹, Wei Deng², Qifeng Wang³, Wenjie Ni⁴, Chen Li¹, Zongmei Zhou¹, Jun Liang¹, Dongfu Chen¹, Qinfu Feng¹, Nan Bi¹, Tao Zhang¹, Xin Wang¹, Lei Deng¹, Wenqing Wang¹, Wenyang Liu¹, Jianyang Wang¹, Qi Xue⁵, Yousheng Mao⁵, Xiangyang Liu⁵, Dekang Fang⁵, Jian Li⁵, Dali Wang⁵, Jun Zhao⁵, Zefen Xiao¹

Affiliations

¹ Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Radiation Oncology, Peking University School of Oncology, Beijing Cancer Hospital and Beijing Institute for Cancer Research, Beijing, China.
³ Radiation Oncology Key Laboratory of Sichuan Province, Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
⁴ Department of Radiation Oncology, Beijing Shijitan Hospital, Capital Medical University, Ninth School of Clinical Medicine, Peking University, School of Oncology, Capital Medical University, Beijing, China.
⁵ Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: It is still uncertain whether the newly released eighth American Joint Committee on Cancer (AJCC) post-neoadjuvant pathologic (yp) tumor-node-metastasis (TNM) stage for esophageal carcinoma can perform well regarding patient stratification. The current study aimed to assess the prognostication ability of the eighth AJCC ypTNM staging system and attempted to explore how to facilitate the staging system for more effective evaluation of prognosis.

Materials and methods: A total of 486 patients treated with neoadjuvant radiotherapy/chemoradiotherapy (nRT/CRT) were enrolled. ypN stage was reclassified by recursive partitioning. Prognostic performance, monotonicity, homogeneity, and discriminatory of yp and modified yp (myp) staging systems were assessed by time-dependent receiver operating characteristic (ROC), linear trend log-rank test, likelihood ratio χ2 test, Harrell's c statistic, and Akaike information criterion (AIC).

Results: The ypT stage, ypN stage, and pathologic response were significant prognostic factors of overall survival. Survival was not discriminated well using the eighth AJCC ypN stage and ypTNM stage. Recursive partitioning reclassified mypN0-N2 as metastasis in 0, 1-2, and ≥3 regional lymph nodes. Applying the ypT stage, mypN stage, and pathologic response to construct the myp staging system, the myp stage performed better in time-dependent ROC, linear trend log-rank test, likelihood ratio χ2 test, Harrell's c statistic, and AIC.

Conclusions: The eighth AJCC ypTNM staging system performed well in differentiating prognosis to some extent. By reclassifying the ypN stage and enrolling pathologic response as a staging element, the myp staging system holds significant potential for prognostic discrimination.

Keywords: AJCC staging; esophageal cancer; neoadjuvant chemoradiotherapy; neoadjuvant radiotherapy; prognostic model.