Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer

Analysis in a large cohort

N. K.S. Cheedella, A. Suzuki, L. Xiao, W. L. Hofstetter, D. M. Maru, T. Taketa, K. Sudo, M. A. Blum, S. H. Lin, J. Welch, J. H. Lee, M. S. Bhutani, D. C. Rice, A. A. Vaporciyan, S. G. Swisher, J. A. Ajani

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Article numbermds617
Pages (from-to)1262-1266
Number of pages5
JournalAnnals of Oncology
Volume24
Issue number5
DOIs
StatePublished - May 1 2013

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Neoplasms
Esophagectomy
Kaplan-Meier Estimate
Chi-Square Distribution
Electrons
Biopsy
Therapeutics
Clinical Decision-Making

Keywords

  • Clinical complete response
  • Esophageal cancer
  • Multimodality therapy
  • Pathologic complete response
  • Prediction

ASJC Scopus subject areas

  • Hematology
  • Oncology

Cite this

Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer : Analysis in a large cohort. / Cheedella, N. K.S.; Suzuki, A.; Xiao, L.; Hofstetter, W. L.; Maru, D. M.; Taketa, T.; Sudo, K.; Blum, M. A.; Lin, S. H.; Welch, J.; Lee, J. H.; Bhutani, M. S.; Rice, D. C.; Vaporciyan, A. A.; Swisher, S. G.; Ajani, J. A.

In: Annals of Oncology, Vol. 24, No. 5, mds617, 01.05.2013, p. 1262-1266.

Research output: Contribution to journalArticle

Cheedella, NKS, Suzuki, A, Xiao, L, Hofstetter, WL, Maru, DM, Taketa, T, Sudo, K, Blum, MA, Lin, SH, Welch, J, Lee, JH, Bhutani, MS, Rice, DC, Vaporciyan, AA, Swisher, SG & Ajani, JA 2013, 'Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: Analysis in a large cohort', Annals of Oncology, vol. 24, no. 5, mds617, pp. 1262-1266. https://doi.org/10.1093/annonc/mds617
Cheedella, N. K.S. ; Suzuki, A. ; Xiao, L. ; Hofstetter, W. L. ; Maru, D. M. ; Taketa, T. ; Sudo, K. ; Blum, M. A. ; Lin, S. H. ; Welch, J. ; Lee, J. H. ; Bhutani, M. S. ; Rice, D. C. ; Vaporciyan, A. A. ; Swisher, S. G. ; Ajani, J. A. / Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer : Analysis in a large cohort. In: Annals of Oncology. 2013 ; Vol. 24, No. 5. pp. 1262-1266.
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abstract = "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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T1 - Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer

T2 - Analysis in a large cohort

AU - Cheedella, N. K.S.

AU - Suzuki, A.

AU - Xiao, L.

AU - Hofstetter, W. L.

AU - Maru, D. M.

AU - Taketa, T.

AU - Sudo, K.

AU - Blum, M. A.

AU - Lin, S. H.

AU - Welch, J.

AU - Lee, J. H.

AU - Bhutani, M. S.

AU - Rice, D. C.

AU - Vaporciyan, A. A.

AU - Swisher, S. G.

AU - Ajani, J. A.

PY - 2013/5/1

Y1 - 2013/5/1

N2 - 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.

AB - 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.

KW - Clinical complete response

KW - Esophageal cancer

KW - Multimodality therapy

KW - Pathologic complete response

KW - Prediction

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