From CROSS to SANO: Evidence-based breakthroughs and clinical practice challenges in organ-preservation strategies for esophageal cancer in the era of neoadjuvant therapy
- VernacularTitle:从CROSS到SANO：新辅助治疗时代食管癌器官保留策略的循证突破与临床实践挑战
- Author:
Hui LI
1
,
2
Author Information
1. Department of Thoracic Surgery, Hebei Yanda Hospital, Langfang, 065201, Hebei, P. R. China
2. Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, P. R. China
- Publication Type:Journal Article
- Keywords:
Esophageal cancer organ preservation;
neoadjuvant chemoradiotherapy;
squamous cell carcinoma;
clinical complete response;
active surveillance strategy;
salvage surgery;
immunotherapy
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(03):347-352
- CountryChina
- Language:Chinese
-
Abstract:
Organ preservation after neoadjuvant therapy for esophageal cancer has gained significant attention. While the CROSS trial established neoadjuvant chemoradiotherapy (nCRT) followed by surgery as standard care, approximately 30% of patients achieve pathological complete response (pCR), prompting exploration of active surveillance (AS). The landmark SANO phase Ⅲ trial (2025) demonstrated non-inferior 2-year overall survival (74% AS vs. 71% surgery), with 31% of patients avoiding surgery. Multimodal assessment (endoscopic deep biopsy+endoscopic ultrasound+PET-CT) reduced residual disease misdiagnosis to 10%. The Asian-led NEEDS trial is evaluating definitive chemoradiotherapy with salvage surgery. Although immunotherapy boosts pCR rates to 40%-55%, challenges persist, including 8%-12% false-negative cCR assessments, limited long-term data, and East-West histological disparities. The 2024 NCCN guidelines conditionally recommend AS (Category 2B, prioritized for squamous cell carcinoma), emphasizing centralized implementation. Future directions involve circulating tumor DNA and radiomics for risk stratification to advance precise organ-preserving strategies.
