2124 - Impact of the Integrated Pathologic Score on Clinical Outcomes in Resected Esophageal Cancer following Neoadjuvant Chemoradiation
Presenter(s)
J. J. Lee1, T. Jacobsen2, S. Saeed3, K. Avaiya3, S. Hoffe4, J. M. Frakes4, A. L. Pereira3, A. Sinnamon5, S. Dooley4, M. L. Sandoval6, L. N. Silverman4, L. Portelance4, J. Baldonado7, J. Fontaine7, and J. Pimiento5; 1University of South Florida Morsani College of Medicine, Tampa, FL, 2Lake Erie College of Osteopathic Medicine - Bradenton, Tampa, FL, 3Moffitt Cancer Center, Tampa, FL, 4H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, Tampa, FL, 5H. Lee Moffitt Cancer Center and Research Institute, Department of Surgical Oncology, Tampa, FL, 6Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, 7Department of Thoracic Surgery, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
Purpose/Objective(s): Our group previously reported that the Integrated Pathologic Score of the College of American Pathologists (IPSCAP) independently predicted overall survival (OS) in patients with initially borderline resectable pancreatic cancer who underwent surgery after chemotherapy and ablative radiation therapy (RT). We have also previously shown that pathologic complete response is associated with improved OS in esophageal cancer (EC) patients receiving neoadjuvant therapy. This study extends IPSCAP to EC patients, assessing its association with OS and evaluating its prognostic value beyond individual pathologic features.
Materials/Methods: This IRB-approved retrospective study evaluated EC patients treated between 2010 and 2022. Demographics and tumor characteristics were collected. IPSCAP was calculated by summing tumor regression grade (TRG), ypT, and ypN stage in cases with at least 12 lymph nodes examined. Scores were then categorized as Group 1 (0-3), Group 2 (4-6), or Group 3 (7-10). OS was analyzed using the Kaplan-Meier method with log-rank testing. Univariate and multivariate Cox regression models were used to evaluate the association between IPSCAP groups and other clinical variables.
Results: Among 370 eligible patients, the median age at diagnosis was 64 years, and 84.1% were male. The median follow-up time was 68.69 months. IPSCAP distribution was 58.4% (n = 216) in Group 1, 27.3% (n = 101) in Group 2, and 14.3% (n = 53) in Group 3. Lymphovascular invasion (LVI) increased across groups (4.6% in Group 1, 47.5% in Group 2, and 77.4% in Group 3). Perineural invasion (PNI) was most frequent in Group 2 (38.6%), followed by Group 3 (22.6%) and Group 1 (1.4%). While R0 resection was achieved in 94.3% of patients, the rate was substantially lower in Group 3 (77.4%). Median OS was significantly lower in Group 3 (19.64 months) than in Group 1 (76.22 months) and Group 2 (73.56 months) (p < 0.001). In univariate Cox analysis, Group 3 was significantly associated with worse OS (HR: 2.49, 95% CI: 1.70-3.66, p < 0.001), while Group 2 was not (HR: 1.14, 95% CI: 0.81-1.59, p = 0.451). In multivariate Cox regression adjusting for age, gender, radiation dose, LVI, PNI, R0 resection, and stratifying by pre-therapy clinical stage, Group 3 remained independently associated with survival (HR: 2.39, 95% CI: 1.12-5.10, p = 0.025).
Conclusion: In EC patients undergoing resection after neoadjuvant chemoradiation, higher IPSCAP scores correlated with adverse pathologic features, reduced R0 resection rates, and worse OS. IPSCAP may refine prognostication and may help individualize adjuvant treatment strategies in this patient population.