Morphomic Factors Associated With Complete Response to Neoadjuvant Therapy in Esophageal Carcinoma

Ann Thorac Surg. 2020 Jan;109(1):241-248. doi: 10.1016/j.athoracsur.2019.08.031. Epub 2019 Sep 21.


Background: In patients undergoing neoadjuvant chemoradiotherapy (nCRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC), patients with a pathologic complete response (pCR) have the greatest benefit. The purpose of this study was to identify morphomic factors obtained from pretreatment computed tomography scans associated with a pCR in ESCC.

Methods: We retrospectively analyzed patients with ESCC treated with nCRT who underwent esophagectomy between 2006 and 2016. Clinical and morphomic characteristics pre-nCRT were analyzed to identify factors associated with pCR using univariate and multivariable analyses.

Results: There were 183 patients with ESCC included in this study, and 45 (24.6%) patients achieved pCR. The overall survival in patients with pCR was better than that in patients without pCR (5.8 years vs 1.2 years; P < .001). On univariate analysis, increased age, radiation dose greater than or equal to 4000 cGy, and larger subcutaneous adipose tissue area were correlated with pCR. On multivariable logistic regression, increased age (odds ratio, 1.53; P = .03), radiation dose greater than or equal to 4000 cGy (odds ratio, 2.19; P = .04), and larger dorsal muscle group normal-density area (odds ratio, 1.59; P = .03) were independently associated with pCR.

Conclusions: Increased age, radiation dose greater than or equal to 4000 cGy, and larger dorsal muscle group normal-density area were significantly associated with pCR. These factors may be useful in determining which patients are most likely to benefit from nCRT followed by esophagectomy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Back Muscles / anatomy & histology
  • Back Muscles / diagnostic imaging
  • Body Weights and Measures
  • Bone Density
  • Chemoradiotherapy, Adjuvant
  • Esophageal Squamous Cell Carcinoma / therapy*
  • Esophagectomy
  • Female
  • Humans
  • Intra-Abdominal Fat / anatomy & histology
  • Intra-Abdominal Fat / diagnostic imaging
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Remission Induction
  • Retrospective Studies
  • Tomography, X-Ray Computed