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Clinical model predicted pathCR with higher probability
A logistic regression model predicted pathologic complete response with a high probability in patients with esophageal cancer, according to study results.
Esophageal cancer often is diagnosed in late stages, but approximately 50% of patients have potentially curable diseases. Surgery alone results in a cure rate of less than 20% for patients with esophageal cancer, according to background information in the study.
Preoperative radiation is favored over preoperative chemotherapy due to higher efficacy, and approximately 25% of patients with esophageal cancer who undergo preoperative chemoradiation achieve a pathologic complete response (pathCR), the researchers said.
Jaffer A. Ajani, MD, a professor in the division of cancer medicine at The University of Texas MD Anderson Cancer Center, and colleagues hypothesized that a model based on clinical parameters could predict pathCR with a probability of at least 60%.
The researchers analyzed 322 patients with esophageal cancer who underwent preoperative chemoradiation. All patients received baseline and post-chemoradiation PET, as well as pre- and post-chemoradiation endoscopic biopsy.
Researchers monitored patients periodically until at least 5 years after surgery or until death.
At the time of data collection, 26.1% of pathCR patients and 40.9% of non-pathCR patients had died.
Of the 322 patients, 70 (21.7%) achieved pathCR.
Median OS was significantly higher in patients who achieved pathCR (79.77 months; 95% CI, 56.40-77.53) compared with patients who did not (39.73 months; 95% CI, 41.89-53.33).
According to the study, 32.8% of patients who achieved pathCR suffered recurrence and/or disease-specific death compared with 47.5% of patients who did not achieve pathCR.
The median DFS for patients who achieved pathCR was 79.76 months (95% CI, 53.27-75.14) compared with 30.4 months for non-pathCR patients (95% CI, 38.26-49.98).
Ajani and colleagues created a predictive model by combining the variables associated with pathCR: post-chemotherapy radiation PET, post-chemotherapy radiation biopsy, sex, histologic tumor grade and baseline endoscopic ultrasonography T stage.
Researchers found that the combination of the five variables increased the probability of predicting pathCR to as high as 80% if a patient scored >160 points on a nomogram graph.
The addition of relevant biomarkers to a practical model may improve its usefulness after proper validation, according to researchers.
“Our practical model for predicting pathCR in patients with [esophageal cancer] is a preliminary step toward the development of an esophagus preservation strategy,” Ajani and colleagues concluded. “The presented model needs to be replicated and the prospectively validated before it can be implemented in clinical practice.”
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Ajani JA. Ann Oncol. 2012;doi:10.1093/annonc/mds210.