期刊
ANNALS OF ONCOLOGY
卷 24, 期 5, 页码 1262-1266出版社
ELSEVIER
DOI: 10.1093/annonc/mds617
关键词
clinical complete response; esophageal cancer; multimodality therapy; pathologic complete response; prediction
类别
资金
- Dallas family fund
- Park family fund
- Smith family fund
- Cantu family fund
- Kevin Fund
- Sultan Fund
- River Creek Foundation
- Aaron and Martha Schecter Private Foundation
- Multidisciplinary Research Program at The University of Texas MD Anderson Cancer Center
- National Institutes of Health through MD Anderson Cancer Center [CA016672]
Background: Chemoradiation followed by surgery is the preferred treatment of localized gastroesophageal cancer (GEC). Surgery causes considerable life-altering consequences and achievement of clinical complete response (clinCR; defined as postchemoradiation [but presurgery] endoscopic biopsy negative for cancer and positron emission tomographic (PET) scan showing physiologic uptake) is an enticement to avoid/delay surgery. We examined the association between clinCR and pathologic complete response (pathCR). Patients and methods: Two hundred eighty-four patients with GEC underwent chemoradiation and esophagectomy. The chi-square test, Fisher exact test, t-test, Kaplan-Meier method, and log-rank test were used. Results: Of 284 patients, 218 (77%) achieved clinCR. However, only 67 (31%) of the 218 achieved pathCR. The sensitivity of clinCR for pathCR was 97.1% (67/69), but the specificity was low (29.8%; 64/215). Of the 66 patients who had less than a clinCR, only 2 (3%) had a pathCR. Thus, the rate of pathCR was significantly different in patients with clinCR than in those with less than a clinCR (P < 0.001). Conclusions: clinCR is not highly associated with pathCR; the specificity of clinCR for pathCR is too low to be used for clinical decision making on delaying/avoiding surgery. Surgery-eligible GEC patients should be encouraged to undergo surgery following chemoradiation despite achieving a clinCR.
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