Why is endosonography insufficient for residual diagnosis after neoadjuvant therapy for esophageal cancer? Solutions using muscle layer evaluation

Table 1 Patients’ characteristics

	All population (n = 23)	NAC (n = 15)	CRT (n = 8)
Age (yr)
Median (range)	72 (43-81)	72 (43-78)	72 (49-81)
Sex
Male	19	12	7
Female	4	3	1
Tumor location
Ut	2	2	0
Mt	15	8	7
Lt	4	4	0
Ae	2	1	1
Clinical T stage
cT1b	1	1	0
cT2	3	3	0
cT3	11	11	0
cT4a	1	0	1
cT4b	7	0	7
Chemotherapy regimen
CF	21	13	8
DCF	2	2
Total irradiation dose
38-40Gy	6		6
60Gy	2		2
Time of surgery after therapy (d)
Median (range)	37 (31-61)	36 (31-61)	40 (35-57)
Pathological T stage
pT0	3	1	2
pT1a	3	1	2
pT1b	6	6	0
pT2	3	1	2
pT3	8	6	2
Pathological response
Grade1	13	11	2
Grade2	7	3	4
Grade3	3	1	2

Ut: Upper thoracic esophagus; Mt: Middle thoracic esophagus; Lt: Lower thoracic esophagus; Ae: Abdominal esophagus; CF: Cisplatin plus 5-fluorouracil; DCF: Docetaxel plus cisplatin plus 5-fluorouracil; NAC: Neoadjuvant chemotherapy; CRT: Chemoradiotherapy.

Table 2 Comparison Ultrasound for specimens uT stage to histological pT stage

Ultrasound T stages	pT0	pT1a	pT1b	pT2	pT3	Total
	Pathological T stages after NAC and CRT
uT0	0	1	1	0	0	2
uT1a	0	0	0	0	0	0
uT1b	0	0	4	0	0	4
uT2	1	1	1	2	0	5
uT3	2	1	0	1	8	12
Total	3	3	6	3	8	23
Accuracy (%)	0	0	67	67	100	61
Overstaging (%)	100	67	17	33	0	30
Understaging (%)		33	16	0	0	9
	Pathological T stages after NAC
uT0	0	1	1	0	0	2
uT1a	0	0	0	0	0	0
uT1b	0	0	4	0	0	4
uT2	1	0	1	1	0	3
uT3	0	0	0	0	6	6
Total	1	1	6	1	6	15
Accuracy (%)	0	0	67	100	100	73
Overstaging (%)	100	0	17	0	0	13
Understaging (%)		100	17	0	0	13
	Pathological T stages after CRT
uT0	0	0	0	0	0	0
uT1a	0	0	0	0	0	0
uT1b	0	0	0	0	0	0
uT2	0	1	0	1	0	2
uT3	2	1	0	1	2	6
Total	2	2	0	2	2	8
Accuracy (%)	0	0	0	50	100	38
Overstaging (%)	100	100	0	50	0	62
Understaging (%)		0	0	0	0	0

NAC: Neoadjuvant chemotherapy; CRT: Chemoradiotherapy.

Table 3 Relationship between detection of residual tumor and clinicopathological factors

	Detection of residual tumor
	Possible	Impossible	P
All, n (%)	15 (75)	5 (25)
Preoperative treatment, n (%)
NAC	11 (79)	3 (21)
CRT	4 (67)	2 (33)	0.613
Macroscopic type after neoadjuvant therapy, n (%)
Ulcerative and protruding type	11 (100)	0 (0)
Superficial and SMT type	4 (44)	5 (56)	0.008
Pathologic tumor size (mm)
Median (range)	42 (5-65)	4 (2-34)	0.008
Pathological T stage, n (%)
pT1a/1b	5 (56)	4 (44)
pT2/3	10 (91)	1 (9)	0.127
Pathological response, n (%)
Grade1	12 (92)	1 (8)
Grade2	3 (43)	4 (57)	0.031

NAC: Neoadjuvant chemotherapy; CRT: Chemoradiotherapy.

Table 4 Echoic characteristics of the detected residual tumor

	All population (n = 15)	NAC (n = 11)	CRT (n = 4)	P
Border
Regular	10	10	0
Irregular	5	1	4	0.004
Echogenicity
Hypoechoic	5	5	0
Hypo and isoechoic (mixed)	10	6	4	0.231

NAC: Neoadjuvant chemotherapy; CRT: Chemoradiotherapy.

Table 5 Patients’ characteristics in study 2

	pT0/1 (n = 10)	pT2/3 (n = 10)	P
Age (yr)
Median (range)	73 (52-79)	72 (43-81)	0.94
Sex
Male/Female	9/1	7/3	0.582
Tumor location
Ut, Mt, Lt/Ae	10/0	8/2	0.473
Clinical T stage
cT2, 3/cT4a, b	6/4	6/4	1
Preoperative treatment
NAC/CRT	6/4	6/4	1
Chemo regimen
CF/DCF	9/1	9/1	1
Total irradiation dose
38-40Gy/60Gy	2/2	4/0	0.429
Time of EUS after therapy (d)
Median (range)	37 (21-49)	29 (14-50)	0.172
Time of surgery after therapy (d)
Median (range)	41 (34-57)	37 (31-61)	0.471

Ut: Upper thoracic esophagus; Mt: Middle thoracic esophagus; Lt: Lower thoracic esophagus; Ae: Abdominal esophagus; CF: Cisplatin plus 5-fluorouracil; DCF: Docetaxel plus cisplatin plus 5-fluorouracil; NAC: Neoadjuvant chemotherapy; CRT: Chemoradiotherapy.