Article Figures & Data
Figures
- Fig. 1
Histopathology of adenocarcinoma of esophagus and EGJ treated with chemoradiation followed by esophagogastrectomy. The treated primary site has signet-ring cell and mucinous histology. A and B, residual carcinoma characterized by rare individual carcinoma cell with signet-ring features present in mucin pools at the primary site. C, acellular mucin pools extending through the layers of the esophageal wall without residual carcinoma.
- Fig. 2
Kaplan-Meier curves of overall survival among patients with carcinoma of the esophagus and EGJ treated with surgery alone and patients treated with preoperative neoadjuvant chemoradiation followed by esophagectomy. A, patients treated with surgery alone who had adenocarcinoma of the usual type in the esophagus or EGJ have a better overall survival than patients with signet-ring cell or mucinous histology in the post-treatment surgical specimens. B, in contrast to the patients treated with surgery alone, the overall survival rate for the patients treated with chemoradiation followed by surgery was significantly worse for patients who had adenocarcinoma of the usual type than it was for patients with signet-ring cell or mucinous histology in the post-treatment surgical specimens.
- Fig. 3
Kaplan-Meier curves of overall survival among patients with carcinoma of the esophagus and EGJ treated with preoperative neoadjuvant chemoradiation followed by esophagectomy. A, patients with acellular mucin pools have a better overall survival in specimens with no residual carcinoma. B and C, mucin pools in the post-treatment surgical specimens do not confer a survival advantage in the group with 1-10% residual carcinoma or the group with 11-50% residual carcinoma.
Tables
- Table 1
Characteristics of the patients according to the therapy group
Characteristics Chemoradiation followed by surgery (n = 193) Surgery alone (n = 219) Gender, n (%) Male 180 (93.3) 194 (88.6) Female 13 (6.7) 25 (11.4) Age (y) Mean 59.68 62.54 Median (range) 60 (32-79) 65 (28-84) Primary location, n (%) Cervical/upper/middle 3 (1.6) 15 (6.8) Lower/EGJ 190 (98.4) 204 (93.2) Type of esophagogastrectomy, n (%) Transthoracic (Ivor-Lewis) 114 (59.1) 105 (47.9) Transhiatal 53 (27.5) 86 (39.3) Total (three-field technique) 25 (13.0) 16 (7.3) Two-stage procedure 1 (0.5) 12 (5.5) Positive margin, n (%)* 16 (8.3) 80 (36.5) NOTE. Because of rounding, not all percentages total 100.
↵* A specimen with at least one of the proximal, radial, or distal resection margins involved by carcinoma.
- Table 2
Characteristics of the patients with adenocarcinoma of the esophagus treated with surgery alone according to the presence of signet-ring cell or mucinous histology
Characteristics Adenocarcinoma with signet-ring cell or mucin (n = 40) Adenocarcinoma of the regular type (n = 179) P Gender, n (%) Male 34 (85.0) 160 (89.4) 0.42 Female 6 (15.0) 19 (10.6) Age (y) Mean 59.38 63.25 0.04 Median (range) 62 (32-81) 65 (28-84) Tumor location, n (%) Cervical/upper/middle 1 (2.5) 14 (7.8) 0.32 Lower/EGJ 39 (97.5) 165 (92.2) Pathologic stage, n (%) I 3 (7.5) 33 (18.4) 0.10 II 9 (22.5) 52 (29.1) III 19 (47.5) 74 (41.3) IV 9 (22.5) 20 (11.2) Positive margin, n (%)* Radial, proximal, distal 21 (51.2) 60 (33.5) 0.03 NOTE. Because of rounding, not all percentages total 100.
↵* A specimen with at least one of the proximal, radial, or distal resection margins involved by carcinoma.
- Table 3
Characteristics of the patients with adenocarcinoma of the esophagus treated with chemoradiation followed by surgery according to the presence of signet-ring cell or mucinous histology
Characteristics Pretreatment biopsy Post-treatment surgical specimen Carcinoma with signet-ring cell or mucin (n = 32) Carcinoma of the regular type (n = 161) P Carcinoma with signet-ring cell or mucin (n = 33) Carcinoma of the regular type (n = 160) P Gender, n (%) Male 30 (93.7) 150 (93.1) 1.00 30 (90.9) 150 (93.7) 0.47 Female 2 (6.2) 11 (6.8) 3 (9.1) 10 (6.2) Age (y) Mean 61.22 59.38 0.34 61.30 59.35 0.30 Median (range) 64 (37-79) 59 (32-79) 64 (37-79) 59 (32-79) Tumor location, n (%) Cervical/upper/middle 0 (0) 3 (1.8) 1.00 0 (0) 3 (1.8) 1.00 Lower/EGJ 32 (100) 158 (98.1) 33 (100) 157 (98.1) Pathologic stage, n (%) 0 9 (28.1) 47 (29.1) 0.84 13 (39.3) 43 (26.8) 0.32 I 2 (6.2) 19 (11.8) 1 (3.0) 20 (12.5) II 13 (40.6) 52 (32.2) 12 (36.3) 53 (33.1) III 6 (18.7) 35 (21.7) 5 (15.1) 36 (22.5) IVA 2 (6.2) 8 (4.9) 2 (6.0) 8 (5) Residual carcinoma, n (%) 0% 9 (28.1) 53 (32.9) 0.61 13 (39.3) 49 (30.6) 0.19 1-10% 10 (31.2) 42 (26.0) 12 (36.3) 40 (25) 11-50% 4 (12.5) 32 (19.8) 4 (12.1) 32 (20) >50% 9 (28.1) 34 (21.1) 4 (12.1) 39 (24.3) Positive margin, n (%)* 5 (15.6) 11 (6.8) 0.15 6 (18.1) 10 (6.2) 0.04 ↵* A specimen with at least one of the proximal, radial, or distal resection margins involved by carcinoma.
- Table 4
Correlation between pretreatment biopsy and post-treatment specimen evaluation in patients treated with chemoradiation followed by surgery
Biopsy findings Post-treatment specimen findings, n (%)* P† Carcinoma with signet-ring cell or mucin (n = 33)‡ Carcinoma of the regular type (n = 117) Carcinoma with signet-ring cell or mucinous histology 25 (80.6) 6 (19.4) 0.67 Carcinoma of the regular type 8 (6.7) 111 (93.2) ↵* All 43 cases with no residual tumor and no mucin pools (complete pathologic response) were excluded from the correlation because there is no information available regarding the cell type (signet-ring or regular).
↵† Wilcoxon matched-pairs signed-rank test for paired comparison between pretreatment biopsy and post-treatment specimen findings.
↵‡ This group includes 13 patients with complete pathologic response and presence of acellular mucin pools in the resected pathology specimen.
- Table 5
Univariate analysis of overall survival in relation to pathologic characteristics
Characteristics Chemoradiation followed by surgery Surgery alone Patients, n (%)* (n = 193) Hazard ratio (95% confidence interval) P Patients, n (%)* (n = 219) Hazard ratio (95% confidence interval) P Age 193 (100) 1.018 (1.00-1.04) 0.10 219 (100) 1.002 (0.99-1.02) 0.83 Pathologic tumor-node-metastasis stage 0† (reference) 56 (29) 1 <0.001 — — <0.001 I 21 (11) 1.30 (0.56-3.04) 0.55 36 (16) 1 — II 65 (34) 2.31 (1.24-4.32) 0.01 61 (28) 2.99 (1.44-6.20) 0.003 III 41 (21) 4.37 (2.36-8.11) <0.001 93 (42) 9.19 (4.59-18.42) <0.001 IV 10 (5) 4.44 (1.82-10.86) 0.001 29 (13) 10.96 (5.09-23.60) <0.001 Residual carcinoma 0% (reference) 62 (32) 1 <0.00 1-10% 52 (27) 2.10 (1.14-3.90) 0.02 11-50% 36 (19) 2.26 (1.14-4.46) 0.02 >50% 43 (22) 4.50 (2.49-8.16) <0.001 Signet-ring cell or mucinous histology in surgery specimen No (reference) 160 (83) 1 0.02 179 (82) 1 0.04 Yes 33 (17) 0.45 (0.23-0.90) 40 (18) 1.45 (1.00-2.12) Signet-ring cell or mucinous histology in biopsy specimen No (reference) 161 (83) 1 Yes 32 (17) 0.53 (0.27-1.03) 0.06 - Table 6
Results of multivariate Cox regression analysis of overall survival among the 193 patients with carcinoma of the esophagus and EGJ treated with chemoradiation followed by surgery
Characteristic Patients, n (%) Hazard ratio (95% confidence interval) P Mean age (y) 59.68 1.029 (1.01-1.05) 0.02 Pathologic tumor-node-metastasis stage 0 56 (29) 1 0.03 I 21 (11) 0.46 (0.08-2.50) 0.37 II 65 (34) 1.01 (0.23-4.42) 0.99 III 41 (21) 1.59 (0.33-7.70) 0.56 IV 10 (5) 2.25 (0.40-12.50) 0.36 Residual carcinoma 0% (reference) 62 (32) 1 0.19 1-10% 52 (27) 2.36 (0.53-10.43) 0.26 11-50% 36 (19) 1.95 (0.43-8.79) 0.39 >50% 43 (22) 3.32 (0.76-14.54) 0.11 Signet-ring cell or mucin in surgery specimen 33 (17) 0.479 (0.23-0.98) 0.04
Volume 11, Issue 6
