Pathologic prognostic factors in esophageal squamous cell carcinoma: A follow-up study of 74 patients with or without preoperative chemoradiation therapy

One of the primary goals of pathologic examination of esophageal squamous c ell carcinoma resection specimens is to provide information regarding morph ologic features which can help prognosticate and guide management of affect ed patients. The purpose of this study was to determine the prognostic util ity of a variety of histopathologic prognostic factors in patients with eso phageal squamous cell carcinoma with and without preoperative chemotherapy and radiotherapy (chemrad), Multiple clinical and histologic features such as peri-tumoral lymphocytic infiltrate, Crohn's-Like lymphoid reaction, deg ree of residual tumor, mitosis per 1000 cells, tumor differentiation, lymph atic/vascular invasion, perineural invasion, desmoplastic reaction, and tum or growth pattern were evaluated in patients with (53) and without (21) pre operative chemrad and correlated with survival (mean follow-up, 25 mo). Dat a were analyzed for the entire cohort and for each separate treatment group by univariate and multivariate analysis. Patients who received chemrad sho wed no significant survival benefit (hazard ratio = 2.5, P = .10). In the w hole cohort of patients, higher pathologic stage (P = .04), poor tumor diff erentiation (P = .003), increased mitotic count (P = .005), perineural inva sion (P = .01), lymphatic/vascular invasion (P = .002), tumor size (P = .05 ), and absence of a Crohn's-like lymphoid reaction (P = .05) were significa ntly associated with poor survival by univariate analysis. In multivariate analysis, poor tumor differentiation (P = .005), high mitotic count (P = .0 1), and vascular invasion (P = .03) were important prognostic features, ind ependent of pathologic stage, for the entire cohort, In the chemrad group o nly, tumor size (in patients with macroscopic residual tumor) (P = .05), ly mph node metastasis (P = .03), mitotic count (P = .01), and lymphatic/vascu lar invasion (P = .02) were significant prognostic indicators by univariate analysis. Upon multivariate analysis, only lymphatic/vascular invasion (P = .02) and mitotic rate (P = .01) were independent predictors of survival, In the nonchemrad group, only turner differentiation was significant by bot h univariate (P = .008) and multivariate analysis (P = .03). The difference s in pathologic prognostic factors between chemrad and nonchemrad treated c ases suggests that chemrad has a significant effect on the biologic propert ies of these tumors.