Clinicopathological features and pathological evaluation of preoperative treatment of patients with resectable esophageal carcinosarcoma

Abstract

Background

Because esophageal carcinosarcoma (ECS) is rare, a treatment strategy similar to that employed in esophageal cancer is usually applied. However, the clinicopathological features and the treatment effects of preoperative chemotherapy or chemoradiotherapy (CT/CRT) are not well known.

Methods

We retrospectively evaluated clinical and pathological characteristics of consecutive patients with pathologically confirmed ECS who underwent esophagectomy from 1996 to 2011 in our institution, and assessed their pathological response to preoperative CT/CRT in surgically resected specimens.

Results

We identified 19 patients with a final diagnosis of ECS who had then undergone curative surgery. In 6 of these, the preoperative pathological diagnosis by biopsy had been squamous cell carcinoma. In 7 of 13 patients treated by surgery alone, clinical T factors were overdiagnosed compared with pathological findings. Of patients who received preoperative CT (5-fluorouracil plus cisplatin) with (n = 2) and without (n = 4) concurrent RT (41.4–50.4 Gy), two had a partial response, in three, the disease remained stable, and one patient had progressive disease. Histopathological evaluation showed a limited pathological response in the sarcomatous component. Median overall survival of patients with and without preoperative treatment was 28.0 and 47.2 months, respectively [HR = 1.55 (95% CI 0.36–6.56)], and median relapse free survival was 13.4 months versus not achieved [HR = 2.06 (95% CI 0.54–7.76)].

Conclusion

The problems associated with clinical T stage diagnosis as well as the lack of evidence for an effect of preoperative treatment, especially on the sarcomatous component, mean that treatment strategies for ECS should be considered with care.

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