October 15, 2025

Pathological Evaluation of Post Nact/Nacrt Changes in Oesophagectomy Specimen in a Tertiary Care Cancer Center

Key Points

A significant 40% of cases showed pathological complete response following neoadjuvant therapy.
Key evidence demonstrated that perineural invasion correlated with incomplete pathological response (p=0.001).
The prospective study evaluated 60 patients with esophageal carcinoma, assessing tumor response using the modified Ryan score.
Results suggest squamous cell carcinoma has better prognosis compared to adenocarcinoma, with p-value indicating significance.

Abstract

Esophageal carcinoma is an aggressive malignancy with multifactorial etiology. Even with radical surgery, a signicant percentage of patients with esophageal cancer can experience residual disease the impact of which can be determined by pathological evaluation of resected specimen. Aims: 1. To observe the pathological changes both macroscopically and microscopically in oesophagectomy specimen receiving NACT/NACRT. 2. To determine the proportion of PCR (Pathological Complete Response) in post NACT/NACRT (Neoadjuvant chemotherapy/Neoadjuvant chemoradiotherapy) oesophagectomy cases. Materials and Methods: A prospective study of 60 patients with esophageal carcinoma, operated between January 2024 and December 2024 is included. Clinical parameters such as tumour length, thickness, tumour site and histopathological parameters such as tumour grade, Lymphovascular invasion (LVI), Perineural invasion(PNI) is studied in relationship to the post NACT/NACRT oesophagectomy cases. Evaluation of tumour regression is done using Modied Ryan Score (Tumour Response Grade, TRG). The study has s Results: howed a male to female ratio of 1:5:1, with age ranging from 40 yrs to 74 yrs (median age is 57 yrs). The most common site involved is mid thoracic oesophagus with squamous cell carcinoma as the most common histology type. Also, it has been observed that PCR is not associated with tumour size, since in this study the largest tumour size is 6.5X2X0.1 cm but it is associated with PCR. LVI, PNI, was also noted in the study. Association of LVI doesnot any show any correlation with PCR, whereas PNI has seen to be associated with incomplete pathological response with a p value of 0.001. Also, patient having squamous cell carcinoma histological type has good prognosis than adenocarcinoma with a p-value of 0.0002. Preoperative Conclusions: CT/CTRT followed by surgery currently represents the standard approach for esophageal carcinoma. Assessment of tumor response to neoadjuvant treatment followed by surgery is done by using parameters like tumour site, length, thickness, LVI,PNI, ENE, grade. In our present study 40% cases showed complete pathological response.

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