448. THE PRIMARY TUMOR BURDEN SCORE: A NOVEL CLINICOPATHOLOGICAL STAGING TOOL FOR PATIENTS WITH ESOPHAGEAL CARCINOMA RECEIVING NEOADJUVANT CHEMORADIOTHERAPY PLUS SURGERY. (24th September 2022)

• Record Type: Journal Article
• Authors: Huang, Xu; Tang, Han; Tan, Lijie; Hou, Yingyong
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.448
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: The AJCC TNM staging system (8th edition) contains a ypTNM stage classification for patients with EC receiving neoadjuvant therapy prior to surgery. However, the ypTNM staging system may be unable to represent tumor changes occurring during the treatment. This study was to develop a prognostic model for esophageal carcinoma (EC) describing both the pretreatment pathological state of the tumor and its change after neoadjuvant chemoradiotherapy (nCRT) plus surgery. 187 patients with esophageal carcinoma treated with nCRT plus surgery were identified from two medical centers. The Primary Tumor Burden Score (PTBS) was calculated by multiplying the percentage of residual primary cancer cells and the pretreatment pathological T stage (prepT-stage). Univariate and multivariate Cox regression was used to determine the relationships between clinicopathological parameters and prognosis. The discriminatory power of the model was evaluated using the area under the curve (AUC) and goodness-of-fit Akaike information criterion (ΔAIC). The revised TNM stage was compared with the ypTNM stage using the AIC and the C-index. The PTBS model (AUC:0.727) outperformed to the residual tumor ratio (AUC:0.588) and the pretreatment T stage (AUC:0.6) in OS prediction (P < 0.05). High PTBS scores were associated with significantly worse outcomes: five-year OS of stage 1, 2, and 3 were 73.1%, 42.0%, and 11.4%, respectively, P < 0.001. The PTBS model was more accurate in predicting patient prognosis than cT-stage or ypT-stage (ΔAIC: PTBS vs cT-stage and pT-stage, 30.38 vs −1.87 and 7.61). Multivariate analysis indicated that PTBS independently predicted OS and DFS, The PTBS-based revised TNM stage showed superior prognostic strength to the 8th AJCC ypTNM stage. The PTBS model showed superior prognostic discriminatory ability than cT-stage or ypT-satge and may thus be useful for describing the influence of the primary tumor burden on survival in patients who had received neoadjuvant CRT before surgery. A revised TNM stage based on PTBS showed superior prognostic capability to the 8th AJCC ypTNM stage.