Prognostic value of endoscopic biopsy findings after induction chemoradiotherapy with and without surgery for esophageal cancer

Objective: To investigate the value of endoscopic biopsy in predicting the clinicopathological response and survival in patients with esophageal cancers who received chemoradiotherapy (CRT) alone or CRT followed by surgery. Background: Endoscopic biopsy examination after CRT for esophageal cancer has been used to confirm the presence of residual tumor before surgery, but there is little or no information on the clinical significance of the results of endoscopic biopsy in neoadjuvant or definitive CRT. Methods: We studied 189 patients who underwent endoscopic biopsy after induction CRT (40 Gy) for esophageal cancer, consisting of 123 patients who received neoadjuvant CRT (40 Gy) followed by surgery and 66 patients who underwent definitive CRT (mostly more than 60 Gy). The correlations between the results of endoscopic biopsy and clinicopathological factors, including response to CRT and survival, were examined. Results: For neoadjuvant CRT, endoscopic biopsy findings correlated significantly with pathological tumor regression and lymph node involvement, although the majority of cases with negative biopsy (64%) displayed residual tumor cells in the surgical specimen. The 5-year survival rate was significantly higher in patients with negative biopsy (48.3%) than in those with positive biopsy (21.8%, P = 0.006). For definitive CRT, patients with negative biopsy at the time of 40 Gy showed clinical complete response to CRT (P = 0.002) and had significantly better 3-year survival (57.0%) than those with positive biopsy (22.5%, P = 0.0008). Conclusions: The results of endoscopic biopsy examination after induction CRT can predict the response to CRT and prognosis of patients who receive CRT with and without surgery.