Docetaxel, cisplatin and 5-fluorouracil adjuvant chemotherapy following three-field lymph node dissection for stage II/III N1, 2 esophageal cancer

Abstract

To determine the efficacy of postoperative adjuvant chemotherapy with docetaxel + cisplatin + 5-fluorouracil (DCF) in lymph node metastasis-positive esophageal cancer, we retrospectively analyzed 139 patients with stage II/III (non-T4) esophageal cancer with lymph node metastasis (1-6 nodes), who did not receive preoperative treatment and underwent three-field lymph node dissection in the Juntendo University Hospital between December, 2004 and December, 2009. The tumors were histologically diagnossed as squamous cell carcinoma. The patients were divided into two groups, a surgery alone group (S group, 88 patients) and a group that received postoperative DCF therapy (DCF group, 51 patients). The disease-free and overall survival were compared between the groups and a multivariate analysis of prognostic factors was performed. The same analysis was performed for cases classified as N1 and N2, according to the TNM classification. There were no significant differences between the S and DCF groups regarding clinicopathological factors other than intramural metastasis and main tumor location. The presence of intramural metastasis, blood vessel invasion and the number of lymph nodes were identified as prognostic factors. The 5-year disease-free and overall survival were 55.8 and 57.3%, respectively, in the S group and 52.8 and 63.0%, respectively, in the DCF group. These differences were not considered to be statistically significant (P=0.789 and 0.479 for disease-free and overall survival, respectively). Although there were no significant differences in disease-free and overall survival between the S and DCF groups in N1 cases, both disease-free and overall survival were found to be better in the DCF group (54.2 and 61.4%, respectively) compared to the S group (29.6 and 28.8%, respectively) in N2 cases (P=0.029 and 0.020 for disease-free and overall survival, respectively). Therefore, postoperative adjuvant chemotherapy with DCF was shown to improve disease-free and overall survival in moderate lymph node metastasis-positive cases (N2), suggesting that the DCF regimen may be effective as postoperative adjuvant chemotherapy for patients with lymph node metastasis from esophageal cancer.

Role of chemotherapy after curative esophagectomy in squamous cell carcinoma of the thoracic esophagus: A propensity score‐matched analysis

“…Positive lymph node metastasis is often a factor indicating a poor prognosis, 27 and many trials on POCT versus surgery alone were limited to patients with lymph node positivity. Hashiguchi et al conducted a retrospective study to explore the efficacy of DCF regimens in patients with ESCC with lymph node metastasis, and the results suggested that OS could be significantly improved 28 29 .…”

Neoadjuvant chemotherapy followed by minimally invasive esophagectomy versus primary surgery for management of esophageal carcinoma: a retrospective study

“…The high pCR rate might be explained by the fact that the TP regime was adopted in this study, whereas in the past CF was mostly adopted. More and more studies have reported that paclitaxel cell toxicity is effective for treating squamous cell carcinoma (SCC) 20. Based on the retrospective data and clinical experience, weekly paclitaxel was tolerable, might have been related to the high pCR rate.…”

Efficacy of postoperative adjuvant chemotherapy for esophageal squamous cell carcinoma: A meta‐analysis

“…In 2014, Hashiguchi et al . from Japan evaluated the efficacy of postoperative docetaxel, cisplatin, and 5‐Fu (DCF) chemotherapy for 139 stage II/III N1/N2 ESCC patients, and showed that patients with lymph node metastasis could possibly benefit from postoperative chemotherapy . In the same year, Lyu et al .…”