Prognostic significance of tumor regression grade in esophageal squamous cell carcinoma after neoadjuvant chemoradiation

Chi Zhang; Fei Xu; Yong Qiang; Zhuang-Zhuang Cong; Qin Wang; Zheng Zhang; Chao Luo; Bing-Mei Qiu; Li-Wen Hu; Yi Shen

doi:10.3389/fsurg.2022.1029575

Prognostic significance of tumor regression grade in esophageal squamous cell carcinoma after neoadjuvant chemoradiation

Front Surg. 2023 Jan 6:9:1029575. doi: 10.3389/fsurg.2022.1029575. eCollection 2022.

Authors

Chi Zhang¹, Fei Xu², Yong Qiang³, Zhuang-Zhuang Cong¹, Qin Wang¹, Zheng Zhang², Chao Luo⁴, Bing-Mei Qiu⁵, Li-Wen Hu¹, Yi Shen^{1

2

3

4

5}

Affiliations

¹ Department of Cardiothoracic Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
² Department of Cardiothoracic Surgery, Jinling Hospital, School of Clinical Medicine, Nanjing Medical University, Nanjing, China.
³ Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.
⁴ Department of Cardiothoracic Surgery, Jinling Hospital, School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁵ Department of Cardiothoracic Surgery, Jinling Hospital, Nanjing, China.

Abstract

Backgrounds: Trimodal therapy (neoadjuvant chemoradiotherapy followed by esophagectomy) for locally advanced esophageal squamous cell carcinoma (ESCC) is associated with a significant survival benefit. Modified Ryan score is an effective tool to evaluated the tumor regression grade (TRG) after neoadjuvant therapy. The aim of this study was to evaluate the prognostic value of TRG for overall survival (OS) and disease-free survival (DFS) in ESCC patients undergoing neoadjuvant chemoradiation.

Methods: The study retrospectively reviewed 523 ESCC patients who underwent neoadjuvant chemoradiotherapy and radical esophagectomy at Jinling Hospital from January 2014 to July 2020. Kaplan-Meier curves with log-rank test and Cox regression model were used to evaluate the prognostic factor of TRG based on modified Ryan scoring system on OS and DFS.

Results: After application of inclusion and exclusion criteria, 494 patients with ESCC following neoadjuvant chemoradiotherapy and radical esophagectomy were available for analysis. The TRG scores are significantly associated with smoke history (p = 0.02), lymphovascular invasion (LVI) and/or peripheral nerve invasion (PNI) (p < 0.01), and postoperative adjuvant therapy (p < 0.01). Meanwhile, tumor characteristics including tumor length (p < 0.01) and tumor differentiation grade (p < 0.01) are also significantly associated with TRG score. The results of multivariable Cox regression modal showed that TRG is not an independently prognostic factor for OS (p = 0.922) or DFS (p = 0.526) but tumor length is an independently prognostic factor for DFS (p = 0.046).

Conclusions: This study evaluated the prognostic value of modified Ryan scoring system for ESCC after trimodal therapy and concluded that modified Ryan scoring system can predict survival and recurrence rates but is not an independently prognostic factor for OS and DFS.

Keywords: esophageal squamous cell carcinoma; esophagectomy; modified ryan scoring system; neoadjuvant chemoradiotherapy; tumor regression grade.