Prediction of Tracheobronchial Invasion in ycT3 Esophageal Cancer Using Contact Angle on Preoperative CT Images: A Multicenter Analysis.

Abstract

If esophageal cancer extensively contacts the tracheobronchus (TB), a pathologic resection margin (pRM) cannot be reliably predicted. An objective diagnosis based on preoperative computed tomography (CT) is challenging because TB deformity is not necessarily caused by tumor invasion. It also may result from external compression by the tumor itself. Across three institutions, 100 esophageal cancer patients with a diagnosis of ycT3, characterized by contact with the TB without apparent invasion, were enrolled. This study evaluated the relationship between the degree of contact angle (CA) and the pathologic outcomes of curative resection. Patients with positive resection margins (pRM1) had a significantly larger CA than those with negative margins (pRM0) (130° vs. 93°; P = 0.0002). Receiver operating characteristic (ROC) curve analysis identified an optimal CA cutoff of 125° for predicting pRM1 (sensitivity, 63%; specificity, 87%; area under the curve [AUC], 0.76). In all patients, CA ≥ 125° cases had a poorer prognosis (median survival time [MST]: CA ≥ 125° cases [11.0 months] vs CA < 125° cases [33.0 months]; hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.05-3.20; P = 0.03). In neoadjuvant chemotherapy (NAC) cases, CA ≥ 125° had a poorer prognosis than < 125° cases (MST, 6.5 vs. 32.0 months; HR, 2.50; 95 % CI, 1.19-5.23; P = 0.02). The CA measured on preoperative CT may serve as a useful predictive indicator for curative pathologic resection in ycT3 esophageal cancer.