ArticleEuropean journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery2025
Real-world applications of postneoadjuvant stage I of the staging system for oesophageal squamous cell cancer: what is beyond a pathological complete response?
Article in European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThe 8th edition of the American Joint Committee on Cancer classification system defines the postneoadjuvant pathological T0-2N0M0 (ypT0-2N0M0) stage as ypI for oesophageal cancer. This study was designed to explore the possible differences in survival among patients with yp stage I.
methodsThe records of patients with oesophageal squamous cell cancer staged ypI who underwent a radical oesophagectomy between July 2009 and July 2022 at the Sun Yat-sen University Cancer Center were reviewed. The survival differences were compared between ypT0, ypTis, ypT1a, ypT1b and ypT2.
resultsA total of 355 patients (65 deaths and 34 recurrences) were reviewed. Overall survival (OS) and disease-free survival (DFS) differed significantly between patients in the total population staged as ypT0-1a and ypT1b-2 [5-year OS (5-OS): 81.5% vs 70.2%, P = 0.043; 5-year DFS (5-DFS): 80.8% vs 71.9%, P = 0.016) in the neoadjuvant chemoradiotherapy (NCRT) group (5-OS: 82.0% vs 67.5%, P = 0.032; 5-DFS: 84.6% vs 71.2%, P = 0.027), but not in the neoadjuvant chemotherapy±I group (5-OS: 80.3% vs 72.9%, P = 0.34; 5-DFS: 66.5% vs 72.4%, P = 0.41). The OS and DFS of patients with ypT0 stage (pathological complete response) disease were similar to those of patients with ypTis-1a disease in the total population (P = 0.16 and 0.94) and the NCRT group (P = 0.40 and 0.57). Cox regression analysis revealed that ypT1b-2 was an independent prognostic factor for survival in the total population (hazard ratio = 1.760, 95% confidence interval = 1.056-2.933; P = 0.030).
conclusionsPatients with ypIa-new (ypT0-1aN0M0) disease had significantly better survival than those with ypIb-new (ypT1b-2N0M0) disease among patients who received NCRT. Patients with ypIa-new (pathological complete response and ypTis-1aN0M0) disease had similar survival data. Adjuvant immunotherapy might not be required for patients with ypTis-1aN0M0 stage disease.
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