What type of study is this?

September 10, 2025

Outcomes of Surgery in Patients With a Non-Clinical Complete Response After NCRT for Esophageal Cancer

Puntos clave

Three-year survival was 48% overall, with 41% for NCCR patients and 61% for CCR patients, indicating significant prognosis differences.
The study included 758 patients, of whom 274 were CCR and randomized between active surveillance and surgery, highlighting diverse treatment approaches.
Timing of surgery for NCCR patients at 6 or 12 weeks post-nCRT showed comparable overall survival outcomes, underscoring evaluation strategies.
Postoperative complications did not differ between NCCR subgroups, suggesting surgical safety is maintained regardless of response timing.

Resumen

Abstract Background The SANO trial showed non-inferior two-year overall survival for active surveillance versus standard surgery in patients with a clinical complete response (CCR) after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. However, the impact of delaying surgery to perform response evaluations and select patients for active surveillance has been questioned and detailed outcomes for patients with a non-clinical complete response (NCCR) are unknown. This study evaluates overall survival in the entire SANO cohort including patients with NCCR detected early or later after nCRT. Methods Patients with locoregional advanced esophageal cancer from the prospective multicenter SANO study were classified as CCR or NCCR based on clinical response evaluations at 6 (CRE-I) and 12 weeks (CRE-II) after nCRT. Patients with a CCR at CRE-II underwent active surveillance or standard surgery. Patients with a NCCR at CRE-I or II were scheduled for esophagectomy if no distant dissemination was detected. The primary outcome was overall survival (OS) at a minimum follow-up of three years according to response after nCRT. Secondary outcomes were OS according to tumor regression grade (TRG) and postoperative complications. Results A total of 758 patients were included: 274 (36%) had a CCR and were randomized between active surveillance and standard surgery, while 484 patients (64%) had a NCCR (292 CRE-I and 192 at CRE-II). Median follow-up was 49 months (IQR 44–57). Three-year survival for all patients was 48%: 41% for patients with NCCR, and 61% for patients with CCR (OS: HR 1.77, 95%CI 1.44—2.18). OS was comparable for patients with NCCR at CRE-I and CRE-II (HR 1.22, 95%CI 0.98–1.53) and did not differ within TRG subgroups. Postoperative complications were comparable for the CRE-I and CRE-II groups. Conclusion Overall survival was better in the CCR group than in the NCCR group, reflecting the prognostic value of clinical response after nCRT. The timing of surgery within the NCCR group, whether performed after tumor detection 6 or 12 weeks after nCRT, did not affect survival or postoperative outcomes.

Me gusta

Guardar