Serum squamous cell carcinoma antigen is a predictive factor of outcomes in patients with locally advanced unresectable esophageal squamous cell carcinoma treated by definitive chemoradiotherapy

Aim:Definitive chemoradiotherapy(dCRT)is the standard treatment for locally advanced unresectable esophageal squamous cell carcinoma(LU-ESCC).This study aimed to describe the results of dCRT for T4 ESCC and evaluate the pretherapeutic predictive factors of the outcomes.Methods:A total of 133 patients with T4 ESCC who received dCRT were grouped into those who achieved a complete response(CR)or those who had residual disease(RD).The clinicopathologic variables were compared between the groups and the overall survival(OS)was evaluated.The predictive factor of RD was assessed and the prognostic factor for OS was identified.Results:Among the 133 patients,31(23%)achieved CR.The CR group had a significantly better OS than the RD group(89.9 months vs.10.7 months;hazard ratio=0.096;95%confidence interval:0.05-0.19;P<0.001).Multivariate analysis showed that a supracarinal tumor(OR=3.21;P=0.016),higher pretherapeutic serum SCC-Ag level(>1.6 ng/mL)(OR=2.86;P=0.018),and metastatic node invasion(OR=3.19;P=0.048)were independent predictors of RD.The increased level of pretherapeutic serum squamous cell carcinoma antigen(>1.6 ng/mL)(OR=1.61;P=0.022)was an independent predictor of poor survival.Conclusions:Among the patients who underwent dCRT for LU-ESCC,23%achieved CR,and the long-term outcome of these patients was favorable.Increased levels of pretherapeutic serum squamous cell carcinoma antigen were also found to be predictive of treatment failure.

Recent updates of therapeutic strategy of esophagogastric junction adenocarcinoma

The incidence of esophagogastric junction(EGJ)adenocarcinoma has been increasing in Asian countries.Despite the recent advances in multidisciplinary treatments,EGJ adenocarcinoma remains aggressive with unfavorable outcomes.Regarding surgical strategy,EGJ adenocarcinoma arises between the esophagus and the stomach,and thus tumor cells spread through the lymphatic system both upward to the mediastinum and downward to the abdomen.Nevertheless,an optimal extent of lymphadenectomy remains controversial.Regarding drug therapy,the latest topic in gastric and EGJ adenocarcinoma is trastuzumab deruxtecan,which is an antibody-drug conjugate consisting of an anti-HER2 antibody.In addition,many clinical trials have recently demonstrated the efficacy of immune checkpoint inhibitors.Meanwhile,recent advances in sequencing technology have revealed that gastroesophageal adenocarcinoma could be categorized into four molecular subtypes:epstein-Barr virus-associated,high-level microsatellite instability,genomically stable,and chromosomal instability tumors.Furthermore,these subtypes show distinct clinical phenotypes and molecular alterations.We review the current surgical strategy and drug treatment such as molecular-targeted agents,immune checkpoint inhibitors,and molecular-subtype-based therapeutic strategies in EGJ adenocarcinoma.Clinical and molecular characteristics and response to immune checkpoint inhibitors differ among molecular subtypes.Treatment strategies based on molecular subtypes may be clinically beneficial for patients with EGJ adenocarcinoma.