Introduction Neoadjuvant chemoradiation (CRT) is commonly used for esophageal cancer (EC), with pathologic complete response (pCR) linked to improved prognosis. pCR rates range from 25%-30% for adenocarcinoma to 50% for squamous cell carcinoma (SCC). High-volume centers (HVCs) often yield favorable outcomes across various cancers. This study examines whether CRT delivery at an HVC impacts pCR and ypN0 rates in EC patients undergoing esophagectomy. Methods In this retrospective cohort analysis, we identified patients with clinical stage T2+/N+ EC who received neoadjuvant CRT and esophagectomy from a prospectively maintained database (1996-2019). CRT was delivered at the HVC or a community center (CC), while all surgeries occurred at the HVC. Primary outcomes were pCR and ypN0. Results Among 708 patients, median age was 65 years, with 83.6% male and 95.3% white. Most had adenocarcinoma (87.9%) in the distal esophagus or gastroesophageal junction. CRT was delivered at CCs in 64.8% and at HVC in 35.2%. Radiation dose was higher at the HVC (mean 5195 vs 4944 cGy, P < 0.001), with similar intensity-modulated radiation therapy use (83% vs 79%, P = 0.12). Overall pCR rate was 37.7%, without significant difference between HVC and CC (40.6% vs 36.2%, P = 0.25, multivariable adjusted OR 0.88, P = 0.47). SCC histology was associated with higher pCR (OR 2.39, P = 0.002). Among SCC patients, pCR rate was higher at HVC than CC (75.0% vs 50.0%, P = 0.03) but not significant in multivariable analysis (OR = 2.65, P = 0.11). Conversely, minimal histopathologic response (TRG3) was higher at CCs, not statistically different (17.9% vs 14.5%, P = 0.24). Rate of ypN0 was similar (HVC 70.7% vs CC 68.0%, P = 0.71) with no difference in ratio of positive to resected nodes ( P = 0.94). Conclusion There were no significant differences in pCR or ypN0 rates by CRT delivery site. pCR was higher for SCC histology at HVC, but did not reach statistical significance. Further research is warranted for SCC specifically.
Singh et al. (Mon,) studied this question.