P189. Recurrence and Metastasis Patterns in Esophageal Cancer Following Neoadjuvant Chemoradiotherapy and Esophagectomy
Banner/University of Arizona
tucson, AZ
United States - Contact Me
Ahmed Elkamel, MD
Post-Doctoral Research Fellow, Cardiothoracic Surgery
University of Arizona, Tucson, AZ
Dr. Ahmed Elkamel is a Post-Doctoral Research Fellow in Cardiothoracic Surgery at the University of Arizona. Originally from Sudan, Dr. Elkamel earned his medical degree and began his career with a focus on surgery and medical education. Since moving to the United States, he has focused on advancing his expertise in surgery and research.
Dr. Elkamel completed a research traineeship in vascular surgery at the Mayo Clinic in Jacksonville, Florida, where he contributed to projects involving innovative vascular techniques and outcomes. Following this, he joined the University of Arizona as a preliminary general surgery resident, gaining extensive clinical experience and refining his surgical skills in a fast-paced academic environment. He progressed through his training to hold a PGY-2 position before transitioning to his current role in thoracic surgical research. His research interests include esophageal cancer outcomes, perioperative management, and innovations in thoracic surgery, particularly minimally invasive techniques.
Description
Neoadjuvant therapy followed by esophagectomy is the standard treatment for esophageal cancer. Achieving a pathological complete response (pCR) after neoadjuvant chemoradiation therapy (nCRT) improves outcomes, but recurrence and metastasis patterns in pCR versus residual disease patients are unclear. This study compares these patterns in patients who achieved pCR versus those with residual disease.
Methods:
This retrospective multi-institutional study included esophageal cancer patients treated with nCRT followed by esophagectomy between 2008 and 2023. Patients were divided into two groups: those who achieved pCR and those with residual disease. Data on patient characteristics, metastatic patterns, adjuvant therapy, and perioperative outcomes were collected.
Results:
Recurrence occurred in 41% of patients (95/232), with 13% (5/39) in the pCR group and 47% (90/193) in the residual disease group. Metastasis patterns differed significantly: liver metastasis was most common in residual disease patients (34% vs. 10%, p=0.035), thoracic metastasis occurred in 23% of the residual disease group and 7% of the pCR group (p=0.047), and peritoneal metastases were more frequent in patients with residual disease (12% vs. rare in pCR group, p=0.042). Patients with residual disease also experienced a higher rate of metastasis to multiple sites.Immunotherapy was more frequently administered to patients with residual disease (42% vs. 18%, p<0.001). Patients receiving immunotherapy had lower recurrence rates (27.3% vs. 45.7%, p=0.014). Logistic regression identified immunotherapy as a significant protective factor against recurrence (OR=0.159, 95% CI [0.035–0.712], p=0.016).Logistic regression also showed that residual disease was a strong predictor of metastasis (OR=2.65, 95% CI [1.12–6.28], p=0.027). Immunotherapy significantly reduced the risk of metastasis (OR=0.16, 95% CI [0.035–0.71], p=0.016), and greater nodal involvement was associated with an increased risk of metastasis (OR=1.82, 95% CI [1.05–3.16], p=0.033).
Conclusion:
Patients with residual disease after nCRT are at higher risk of developing distant metastases,particularly to the liver, thorax, and peritoneum.Immunotherapy is associated with reduced recurrence and better outcomes. Further research is needed to optimize treatment strategies, especially for patients with residual disease following nCRT.
Authors
Ahmed Elkamel (1), Shamele Battan-Wraith (2), Kevin Wang (3), Timothy Harris (3), Anthony Maltagliati (3), Evelyn Alexander (3), Mazin Abdalgadir (3), Praveen Sridhar (4), Stephanie Worrell (3)
Institutions
(1) Banner/University of Arizona, tucson, AZ, (2) Banner/University of Arizona, Toronto, ON, (3) University of Arizona, Tucson, AZ, (4) University of Arizona Department of Surgery, Tucson, AZ