Clinical Predictors of Locally Advanced Pathology in Esophageal Adenocarcinoma

Juan David Gomez Cifuentes; Mahnur Haider; Madhusudhan R Sanaka; Prabhat Kumar; James Bena; John McMichael; Davendra P Sohal; Siva Raja; Sudish Murthy; Prashanthi N Thota

doi:10.7759/cureus.18991

Clinical Predictors of Locally Advanced Pathology in Esophageal Adenocarcinoma

Cureus. 2021 Oct 23;13(10):e18991. doi: 10.7759/cureus.18991. eCollection 2021 Oct.

Authors

Affiliations

¹ Department of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, USA.
² Section of General Internal Medicine, Tulane Medical Center, New Orleans, USA.
³ Center of Excellence for Barrett's Esophagus, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, USA.
⁴ Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, USA.
⁵ Department of General Surgery, Cleveland Clinic Foundation, Cleveland, USA.
⁶ Department of Hematology and Oncology, University of Cincinnati, Cincinnati, USA.
⁷ Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA.

Abstract

Background In patients with resectable esophageal adenocarcinoma (EAC), the decision for neoadjuvant treatment depends on clinical staging with endoscopic ultrasound (EUS) and positron-emission tomography (PET) scan. Patients with locally advanced EAC pathology misclassified as early EAC by clinical staging are missing the opportunity to receive neoadjuvant therapy. We aim to identify predictors of locally advanced pathology in EAC to determine more accurately those who benefit from neoadjuvant therapy. Methods Retrospective study of patients who underwent upfront endoscopic or surgical resection for EAC without neoadjuvant therapy from January 2011 to December 2017 was performed. Clinical characteristics, EUS, PET scan and histologic findings were analyzed. Multivariable analysis of predictors of locally advanced stage was performed and a risk prediction score was developed. Results A total of 97 patients were included; 68 patients were staged as early EAC (pT1 or pT2 and pN0) and 29 patients were staged as locally advanced EAC (pT1 or pT2 with pN1 and pT3 or pT4 irrespective of N status). In a predictive model of EAC, patients presenting with dysphagia, tumor size >2 cm, exophytic mass appearance on endoscopy and absence of hiatal hernia were more likely to be have locally advanced pathology with a probability of 70% (C-statistic 0.766). Conclusions A risk prediction model based on the presence of dysphagia, tumor size >2 cm, exophytic mass appearance and absence of hiatal hernia can be used to identify locally advanced pathology in EAC patients.

Keywords: endoscopic ultrasound; esophageal adenocarcinoma; esophageal cancer; neoadjuvant chemotherapy; pathology staging.