Is Tumor Regression Grade Sufficient to Predict Survival in Esophageal Cancer with Trimodal Therapy?

Abstract

Background

This study aimed to assess the predictive value of tumor regression grade (TRG) and nodal status on survival in esophageal carcinoma with neoadjuvant chemoradiotherapy (nCRT).

Methods

Tumor pathologic regression and nodal status were assessed. Differences in survival stratified by TRG or nodal status were analyzed using the Kaplan–Meier method and log–rank test. The prognostic value of TRG and nodal status were analyzed using univariate and multivariate Cox proportional hazards methods.

Results

From July 2016 to June 2019, 253 patients with esophageal cancer underwent nCRT followed by surgery. Significant differences were presented in survival according to nodal status but not TRG. Multivariate analysis showed that nodal status and not TRG was the only independent predicter for overall survival (HR: 3.550, 95% CI: 2.264–5.566, P < 0.001) and disease-free survival (HR: 2.801, 95% CI: 1.874–4.187, P < 0.001). The modified TRG system combining tumor regression with nodal status stratified patients survival with good discrimination.

Conclusions

Lymph node status impacts more importantly than TRG on survival for patients with esophageal cancer undergoing nCRT plus esophagectomy. The modified TRG system may facilitate postoperative treatment decisions and survival surveillance.

Keywords:

• esophageal cancer
• neoadjuvant chemoradiotherapy
• tumor regression grade
• survival
• nodal status

View addendum:

Predictive Survival Power of Combined Tumor Regression Grade (TRG) and Lymph Node Status in Patients with Esophageal Cancer

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by National Natural Science Foundation of China (82000514), Key Projects of Sichuan Provincial Department of Science and Technology (2021YFS0222), 1•3•5 project for disciplines of excellence–Clinical Research Incubation Project, West China Hospital, Sichuan University (2018HXFH020), Regional Innovation and Collaboration projects of Sichuan Provincial Department of Science and Technology (2021YFQ0026), National Natural Science Foundation Regional Innovation and Development (U20A20394) and did not receive any commercial interest support.