While most resection specimens from patients with neoadjuvantly treated esophageal squamous cell carcinoma show therapy-related changes in the form of inflammation and fibrosis, others harbor a florid foreign body-type giant cell response to keratin debris. The purpose of our study was to perform a detailed clinicopathologic analysis of these histologic types of treatment responses and correlate these findings with patient outcome. Clinical and pathologic parameters from 110 esophagogastrectomies were recorded and analyzed. Two main types of histologic responses were observed: inflammatory-predominant response (59%) and florid foreign body-type giant cell response to keratin (41%). Irrespective of cG, cTNM, and amount of residual cancer, florid foreign body-type giant cell reaction was predominantly noted deep within the esophageal wall, while the inflammatory response was restricted to the mucosa, submucosa, and inner half of muscularis propria. Patients with foreign body-type giant cell response showed significantly better overall survival compared with the inflammatory response group (log-rank test P=0.015). Florid foreign body-type giant cell response was the only factor associated with improved survival in a multivariable analysis for overall survival (hazard ratio=0.5; 95% confidence interval=0.3-1.0; P=0.038), but not in the model for disease-specific survival, whereas ypTNM stage II was the only significant risk factor for disease-specific survival in multivariable analysis (hazard ratio=3.4; 95% confidence interval=1.0-11.2; P=0.047). Our results suggest that in addition to the College of American Pathologists Tumor Regression Score and ypTNM stage, subtype of histologic response to therapy may represent another prognostic marker for neoadjuvantly treated esophageal squamous cell carcinoma.

中文翻译：

---

对角蛋白的华丽异物型巨细胞反应与接受食管鳞状细胞癌术前治疗的患者总体生存率的提高有关。

虽然大多数接受新辅助治疗的食管鳞状细胞癌患者的切除标本显示出与治疗相关的炎症和纤维化变化，但其他标本则对角蛋白碎片表现出强烈的异物型巨细胞反应。我们研究的目的是对这些治疗反应的组织学类型进行详细的临床病理学分析，并将这些结果与患者的结果相关联。记录并分析了 110 例食管胃切除术的临床和病理参数。观察到两种主要类型的组织学反应：炎症为主的反应（59%）和对角蛋白的异物型巨细胞反应（41%）。无论cG、cTNM和残留癌的数量如何，食管壁深处主要观察到强烈的异物型巨细胞反应，而炎症反应仅限于粘膜、粘膜下层和固有肌层的内半部分。与炎症反应组相比，异物型巨细胞反应组患者的总生存率显着提高（时序检验 P=0.015）。在总体生存的多变量分析中，丰富的异物型巨细胞反应是与生存改善相关的唯一因素（风险比=0.5；95%置信区间=0.3-1.0；P=0.038），但在疾病模型中则不然- 特异性生存，而 ypTNM II 期是多变量分析中疾病特异性生存的唯一显着风险因素（风险比=3.4；95% 置信区间=1.0-11.2；P=0.047）。我们的结果表明，除了美国病理学家学会肿瘤消退评分和 ypTNM 分期之外，治疗的组织学反应亚型可能代表新辅助治疗的食管鳞状细胞癌的另一个预后标志物。