1. Utility of Initial Tumor Reduction as a Prognostic Factor in Esophageal Squamous Cell Cancer Patients Undergoing Neoadjuvant Chemotherapy Followed by Surgery : A Retrospective Cohort Study.
- Author
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Hagi T, Shiraishi O, Nakanishi T, Kohda M, Hiraki Y, Kato H, Yasuda A, Shinkai M, Imano M, and Yasuda T
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Survival Rate, Aged, Prognosis, Follow-Up Studies, Adult, Esophageal Squamous Cell Carcinoma pathology, Esophageal Squamous Cell Carcinoma surgery, Esophageal Squamous Cell Carcinoma therapy, Esophageal Squamous Cell Carcinoma drug therapy, Esophageal Squamous Cell Carcinoma mortality, Aged, 80 and over, Neoadjuvant Therapy mortality, Esophageal Neoplasms pathology, Esophageal Neoplasms drug therapy, Esophageal Neoplasms surgery, Esophageal Neoplasms mortality, Esophageal Neoplasms therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Cisplatin administration & dosage, Docetaxel administration & dosage, Esophagectomy mortality, Fluorouracil administration & dosage
- Abstract
Background: While a neoadjuvant chemotherapy regimen using docetaxel, cisplatin, and 5-fluorouracil (NAC-DCF) is considered the standard treatment for locally advanced esophageal cancer (EC) in Japan, a reliable marker for early prediction of treatment efficacy remains unclear. We investigated the utility of the tumor response after a first course of NAC-DCF as a post-surgery survival predictor in patients with EC., Methods: We enrolled 150 consecutive patients who underwent NAC-DCF followed by surgery for EC between September 2009 and January 2019. The initial tumor reduction (ITR), defined as the percentage decrease in the shorter diameter of the tumor after the first course of NAC-DCF, was evaluated using computed tomography. We analyzed the relationship between ITR, clinicopathological parameters, and survival., Results: The median ITR was 21.07% (range -11.45 to 50.13%). The optimal cut-off value for ITR for predicting prognosis was 10% (hazard ratio [HR] 3.30, 95% confidence interval [CI] 1.98-5.51), based on univariate logistic regression analyses for recurrence-free survival (RFS). Compared with patients with ITR <10%, patients with ITR ≥10% showed a significantly higher proportion of ypM0 (80.0% vs. 92.5%) and responders in terms of overall clinical response (50.0% vs. 80.8%). Multivariate analysis for RFS revealed that ypN2-3 (HR 2.78, 95% CI 1.67-4.62), non-response in terms of overall clinical response (HR 1.87, 95% CI 1.10-3.18), and ITR <10% (HR 2.48, 95% CI 1.42-4.32) were independent prognostic factors., Conclusions: Tumor response after the first course of NAC-DCF may be a good predictor of survival in patients with EC who underwent NAC-DCF plus surgery., (© 2024. Society of Surgical Oncology.)
- Published
- 2024
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