Predictive Value of Preoperative Endoscopic Ultrasound (EUS) After Neoadjuvant Chemotherapy in Locally Advanced Esophagogastric Cancer – Data From a Randomized German Phase II Trial

Abstract

Purpose The role of EUS before or after neoadjuvant chemotherapy (nCTX) in advanced esophagogastric cancer (EGC) is still unclear. The phase II NEOPECX trial evaluated perioperative chemotherapy with or without panitumumab in this setting. The aim of this sub-study was to investigate the prognostic value of EUS-guided preoperative staging before and after nCTX.

Materials and Methods Preoperative yuT/yuN stages by EUS were compared with histopathological ypT/ypN stages after curative resection. Reduction in T-stage from baseline to preoperative EUS was defined as downstaging (DS+) and compared to progression-free (PFS) and overall survival (OS) of patients without downstaging (DS-). In addition, preoperative EUS N-stages (positive N+ or negative N-) were correlated with clinical data.

Results The preoperative yuT-stage correlated with the ypT-stage in 48% of cases (sensitivity 48%, specificity 52%), while the preoperative yuN-stage correlated with the ypN-stage in 64% (sensitivity 76%, specificity 52%). Within DS+ patients who were downstaged by ≥ 2 T-categories, a trend towards improved OS was detected (median OS DS+: not reached (NR), median OS DS-: 38.5 months (M), p=0.21). Patients with yuN+ at preoperative EUS had a worse outcome than yuN- patients (median OS yuN-: NR, median OS yuN+: 38.5 M, p = 0.013).

Conclusion The diagnostic accuracy of EUS to predict the response after nCTX in patients with advanced EGC is limited. In the current study the endosonographic detection of lymph node metastasis after nCTX indicates a poor prognosis. In the future, preoperative EUS with sectional imaging procedures may be used to tailor treatment for patients with advanced EGC.

Zusammenfassung

Ziel Die Rolle des endoskopischen Ultraschalls (EUS) vor oder nach neoadjuvanter Chemotherapie (nCTX) bei fortgeschrittenem ösophagogastrischem Karzinom (EGC) ist noch unklar. Die Phase-II-Studie NEOPECX untersuchte die perioperative Chemotherapie mit und ohne Panitumumab in diesem Zusammenhang. Ziel dieser Teilstudie war es, den prognostischen Wert des EUS-gestützten präoperativen Stagings vor und nach nCTX zu untersuchen.

Material und Methoden Das präoperative yuT/yuN-Stadium mittels EUS wurde mit dem histopathologischen ypT/ypN-Stadium nach kurativer Resektion verglichen. Die Reduktion des T-Stadiums vom Ausgangswert bis zum präoperativen EUS wurde als Downstaging (DS+) definiert und mit dem progressionsfreien Überleben (PFS) und dem Gesamtüberleben (OS) von Patienten ohne Downstaging (DS-) verglichen. Darüber hinaus wurden die präoperativen EUS-N-Stadien (positives N+ oder negatives N-) mit den klinischen Daten korreliert.

Ergebnisse Das präoperative yuT-Stadium korrelierte in 48% mit dem ypT-Stadium (Sensitivität 48%, Spezifität 52%), während das präoperative yuN-Stadium in 64% mit dem ypN-Stadium korrelierte (Sensitivität 76%, Spezifität 52%). Bei DS+-Patienten mit Downstaging um ≥2 T-Kategorien wurde ein Trend zu einem verbesserten OS festgestellt (medianes OS DS+: nicht erreicht (NR), medianes OS DS-: 38,5 Monate (M), p=0,21). Patienten mit yuN+ beim präoperativen EUS hatten einen schlechteren Outcome als yuN-Patienten (medianes OS yuN-: NR, medianes OS yuN+: 38,5 M, p=0,013).

Schlussfolgerung Die diagnostische Genauigkeit des EUS zur Vorhersage des Ansprechens nach nCTX bei Patienten mit fortgeschrittenem EGC ist begrenzt. In der aktuellen Studie deutet der endosonografische Nachweis von Lymphknotenmetastasen nach nCTX auf eine schlechte Prognose hin. In Zukunft könnte der präoperative EUS mit Schnittbildverfahren dazu dienen, die Behandlung von Patienten mit fortgeschrittenem EGC abzustimmen.

Keywords

Mortality - Locally advanced esophagogastric cancer - Endosonography - THEMES - staging

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