Page 64 - ARNM-2-3

Advances in Radiotherapy
& Nuclear Medicine NCRT for T3N0M0 ESCC

Table 5. Failure patterns in the entire population independent prognostic factors for OS, which has been
reported in earlier research. 27,28
Variables Total Surgery NCRT+S P‑value
(n=443) (n=343) (n=100) Previous research 29,30 suggests that among patients
Total failure, n (%) <0.001 undergoing NCRT + S, those achieving pCR have a
significant survival advantage over patients with non-
None 215 (48.5) 151 (44.0) 64 (64.0) pCR. To better identify beneficiaries in the NCRT + S
Yes 228 (51.5) 192 (56.0) 36 (36.0) group, the patients were divided into pCR and non-pCR
Failure patterns, n (%) 0.002* groups, and their prognosis was compared with that of the
None 215 (48.5) 151 (44.0) 64 (64.0) surgery group. It was found that compared with surgery
LR 103 (23.3) 89 (25.9) 14 (14.0) alone, the pCR group showed improved OS; however, the
DM 52 (11.7) 41 (12.0) 11 (11.0) non-pCR group did not. This result has not been reported
LR+DM 13 (2.9) 9 (2.6) 4 (4.0) previously. This study suggests that NCRT + S should be
recommended for patients likely to achieve pCR after
Others 60 (13.5) 53 (15.5) 7 (7.0) NCRT. Direct surgery might be advised if pCR cannot
LR, n (%) 0.013 be achieved because the survival rates are similar. This
Absent 340 (76.7) 254 (74.1) 86 (86.0) is crucial for patients intolerant to chemoradiotherapy.
Present 103 (23.3) 89 (25.9) 14 (14.0) Moreover, although NCRT + S treatment is relatively
DM, n (%) 0.794 expensive for patients, it is still recommended for those who
Absent 391 (88.3) 302 (88.0) 89 (89.0) can benefit from NCRT, despite the high cost. For patients
who cannot benefit from NCRT, opting for surgery alone can
Present 52 (11.7) 41 (12.0) 11 (11.0)
LR and DM, n (%) 0.502* help avoid the high expenses, making it a better option for
those with financial constraints. Nonetheless, there remains
Absent 430 (97.1) 334 (97.4) 96 (96.0) an urgent need for non-invasive pretreatment methods to
Present 13 (2.9) 9 (2.6) 4 (4.0) predict whether patients can achieve a pCR after undergoing
Others, n (%) 0.030 NCRT. At present, potential biomarkers for predicting NCRT
Absent 383 (86.5) 290 (84.5) 93 (93.0) treatment response in esophageal cancer include genetic
Present 60 (13.5) 53 (15.5) 7 (7.0) markers and metabolic markers such as levels of lactic acid
Notes: *Fisher’s exact test; P<0.05 indicates statistically significant and glucose metabolism-related substances, which can reflect
differences. changes in tumor metabolic status and thus predict treatment
Abbreviations: DM: Distant metastasis; LR: Local recurrences. response. In addition, imaging markers such as tumor volume
changes obtained through imaging studies or tumor features
indicated that NCRT + S could provide survival benefits extracted through radiomics methods to predict treatment
to true LN-negative patients. It was suspected that the response can be further researched in the future.
inconsistency in the results of these two studies stems from Considering the lack of significant benefit of NCRT +
inaccurate clinical staging. Although some researchers S on DFS in patients with pre-T3N0M0 disease, the failure
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found that NCRT + S significantly improved DFS and OS patterns in the entire cohort were further analyzed. The
in patients with cT3N0M0 compared to surgery alone, results showed that NCRT + S significantly reduced the local
they relied on clinical staging, and the N staging of patients recurrence rate. Previous studies 13,14 found that surgery alone
in the surgery group was inconsistent with post-operative significantly increased the local recurrence rate compared
pathological staging, leading to controversial results. This to post-operative adjuvant therapy. Similarly, the research
study accurately identified patients with a true LN-negative confirmed that surgery alone significantly increased the
status before treatment through pathological assessment,
making the findings more reliable. Furthermore, this local recurrence rate compared to NCRT + S. Therefore,
local treatment is crucial for patients with pre-T3N0M0
study also confirmed that patients with pre-T3N0M0 esophageal cancer to reduce the risk of local recurrence.
stage disease who underwent NCRT + S had superior OS
outcomes, and even after PSM analysis, these patients still This study had some limitations. First, being a single-
demonstrated similar survival outcomes. In addition, the center retrospective study, the findings require validation
survival rate in this study surpassed previous results, 4,5,7,22-25 through multicenter prospective studies. Second, the status
likely due to the selection of patients accurately staged as of the LNs that were not excised during surgery could
pre-T3N0M0. However, the survival rate of the surgery not be assessed. Moreover, since NCRT + S treatment for
group was in line with findings from other studies. 26,27 Age T3N0M0 has only recently been widely adopted in clinical
and the number of LNs removed were also identified as practice, the follow-up period for these patients remains

Volume 2 Issue 3 (2024) 9 doi: 10.36922/arnm.3821