Expression molecular subtype as a predictor of outcomes of chemoradiotherapy for esophageal cancer.

Authors

null

Manabu Muto

Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Manabu Muto , Keiko Minashi , Tomonori Yano , Yusuke Amanuma , Ryu Ishihara , Akinori Watanabe , Chikatoshi Katada , Tomoki Yamatsuji , Kayoko Matsushima , Hisashi Doyama , Takayuki Ando , Yasumasa Nishimura , Katsuyuki Sakanaka , Shigeru Tsunoda , Shinya Ohashi , Juko Shimizu , Harue Tada , Ryuji Uozumi , Kengo Nagashima , Hiroki Sasaki

Organizations

Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan, Clinical Trial Promotion Department, Chiba Cancer Center, Chiba City, Chiba, Japan, Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Kashiwa, Japan, Department of Clinical Trial Promotion, Chiba Cancer Center, Chiba, Japan, Osaka International Cancer Institute, Osaka, Japan, Kitasato University, Sagamihara, Japan, Kyoto University, Department of Therepeutic Oncology, Kyoto, Japan, Kawasaki Medical School, Okayama, Japan, Nagasaki University, Nagasaki, Japan, Ishikawa Prefectual Central Hospital, Kanazawa, Japan, Third Department of Internal Medicine, University of Toyama, Toyama, Japan, Kindai University Faculty of Medicine, Osaka-Sayama, Japan, Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan, Department of Surgery, Kyoto University, Kyoto, Japan, Department ofTherapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan, Kyoto University, Kyoto, Japan, Translational Research Center,Kyoto University Hospital, Kyoto, Japan, Tokyo Insitute of Technology, Meguro-Ku, Japan, Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan, Department of Translational Oncology, National Cancer Center Research Institute, Tokyo, Japan

Research Funding

Other Government Agency
AMED Foundation in Japan

Background: The standard treatment for advanced esophageal cancer is preoperative chemoradiotherapy (CRT) followed by surgery or definitive CRT (NCCN Guideline 2022 ver5). CRT has the advantage of preserving organs and functions and the prognosis for patients achieved complete response by CRT is good. However, it is currently impossible to predict the outcomes of CRT before treatment. We have performed RNA expression analysis of pre-treatment biopsy specimens of esophageal cancer and identified several intrinsic molecular subtypes, as well as E-type (high expression of squamous markers) with good prognosis for CRT and M2-type (high expression of stromal markers) with poor prognosis for CRT (US patent No 10,969,390 B2). Herein, we performed an integrated analysis to confirm the relationship between intrinsic expression molecular subtype classification and prognosis in the pooled population from two prospective cohort studies (UMIN000043637). Methods: Two cohort studies were as follows; 1) single institute prospective cohort study conducted at National Cancer Center Hospital East (n=157, UMIN-C000000459), 2) multicenter prospective cohort study conducted at 10 institutions (n=226, UMIN000016141). A total 383 cases met inclusion criteria and the Affymetrix U331Plus 2 panel (47,104 transcripts, 38,572 genes) was used to identify E-type and M2-type. The clinical course and outcome were blinded for subtype classification. Treatment was performed as usual at each institution, and treatment details and outcomes were examined by subtype. Results: Among 383 patients, 181 and 164 patients were treated by CRT and surgery, respectively. Ninety-nine percent (n=342) were squamous cell carcinoma. Stage I/II/III/IV were 13/61/86/21 and 17/63/81/3 in CRT group and surgery group, respectively. Among them, 76 (22%), 100 (29%), 169 (49%) patients were classified as E, M2 and others, respectively. Among the patients treated by CRT, CR rate of E-type and M2-type were 62.8% (95% CI, 47.8-75.7) and 33.3% (95% CI, 21.9-47.1) (p=0.006). The 5-year progression free survival (PFS) and overall survival (OS) rates of CRT group was 50.5% (95% CI, 34.7-64.4) and 59.8% (95% CI, 42.6-73.3) for E-type vs. 23.0% (95% CI, 12.0-36.2) and 29.0% (95%CI, 16.8-42.4) for M2-type, with statistically significant difference (p=0.011, p=0.003). Cox regression analysis showed that crude HR for PFS and OS of E vs M2 were 0.50 (95% CI, 0.296-0.859, p=0.012) and 0.41 (95% CI, 0.226-0750, p=0.004), respectively. In contrast, E and M2-type did not show the survival difference in surgery group. Conclusions: For the first time in the world, we confirmed that expression molecular subtype of esophageal cancer has the potential to predict the outcomes of CRT. The results may provide precision medicine in the selection of treatment for esophageal cancer.

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Track

Gastrointestinal Cancer—Gastroesophageal, Pancreatic, and Hepatobiliary

Sub Track

Esophageal or Gastric Cancer - Advanced/Metastatic Disease

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 4030)

DOI

10.1200/JCO.2023.41.16_suppl.4030

Abstract #

4030

Poster Bd #

351

Abstract Disclosures