Post-esophagectomy Adjuvant Chemotherapy Benefits Esophageal Cancer Patients

Sohda, Makoto; Saya, Hideyuki; Kuriyama, Kinya; Yoshida, Tatsushi; Kumakura, Yuji; Honjyo, Hiroaki; Hara, Keigo; Ozawa, Daigo; Suzuki, Shigemasa; Tanaka, Naritaka; Sakai, Makoto; Miyazaki, Tatsuya; Fukuchi, Minoru; Kuwano, Hiroyuki

doi:10.21873/invivo.11502

“…Li et al [ 15 ] showed that POCT, relative to SA, increased the 3-year DFS from 19.9% to 41.6% and the 3-year OS from 30.8% to 53.7% in patients with stage pN2/3 ESCC, but this treatment did not improve outcomes for patients with pN1 ESCC. Sohda et al and our previous study also showed that POCT improved OS compared with SA [ 16 , 17 ]. A meta-analysis by Zhao et al [ 18 ] identified POCT as an independent factor associated with favorable prognosis in patients with ESCC, because it improved OS and DFS.…”

Section: Discussionmentioning

confidence: 70%

Postoperative Adjuvant Therapy for Patients with pN+ Esophageal Squamous Cell Carcinoma

Li

¹

,

Qiu

²

,

Hu

³

et al. 2021

BioMed Research International

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Esophageal squamous cell carcinoma (ESCC) is the most common pathological type of esophageal cancer in China. However, patient survival time after surgery remains unsatisfactory, especially in those who are pN+. This retrospective study determined the value of postoperative adjuvant therapy for patients with pN+ ESCC. From Jan 2008 to Sep 2011, 453 pN+ ESCC patients who underwent R0 resection and survived for at least 1 month were retrospectively enrolled. All patients received surgery. Some patients received surgery alone (SA, n = 131 ), and others received postoperative chemotherapy (POCT, n = 222 ), radiotherapy (PORT, n = 57 ), or sequential chemoradiotherapy (POCRT, n = 43 ). The follow-up ended on 1 Dec 2019. The 5-year overall survival (OS), disease-free survival (DFS), and locoregional recurrence (LR) were significantly worse in the SA group (15.2%, 13.1%, and 71.6%, all p < 0.05 ) than in the POCT group (28.0%, 20.8%, and 66.5%), the PORT group (27.4%, 24.4%, and 46.9%), and the POCRT group (42.8%, 35.5%, and 43.0%). Furthermore, compared with the SA group, the median OS and DFS were significantly longer in the POCT, PORT, and POCRT groups (all p < 0.05 ). PORT and POCRT (but not POCT) also significantly reduced the LR ( p < 0.01 ). Multivariate Cox analysis showed that each type of postoperative therapy was independently associated with improvements in OS, DFS, and LR. Postoperative adjuvant therapy—either POCT, PORT, or POCRT—significantly improved OS and DFS in patients with pN+ ESCC after R0 surgery. PORT and PORCT significantly reduced LR in these patients.

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“…The use of this treatment is based solely on the experience of the physicians and even the wishes of the patients. Few studies have focused on postoperative adjuvant chemotherapy versus surgery alone, and the results are controversial 9–11 . Hence, we conducted a retrospective study to investigate the effect of POCT on the OS of patients and to further analyze which subgroups of patients were most suitable for POCT.…”

Section: Introductionmentioning

confidence: 99%

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

Zhu

¹

,

Ren

²

,

Yang

³

et al. 2021

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Background The efficacy of postoperative treatment of squamous cell carcinoma of the esophagus has not yet been determined. In this retrospective study, we investigated whether postoperative adjuvant chemotherapy (POCT) confers a survival benefit on patients who undergo curative esophagectomy. Methods A total of 782 patients were enrolled in our study. The patients were divided into surgery alone (S) and surgery plus postoperative chemotherapy (S + POCT) groups. Propensity score matching (PSM) was used to eliminate the differences in baseline characteristics. The primary endpoint was overall survival (OS), which was calculated by the Kaplan–Meier method and compared with the log‐rank test. A Cox proportional hazards model was used to identify factors influencing the prognosis. Results Of 782 patients, 343 (43.9%) underwent S alone, and 439 (56.1%) underwent S + POCT before PSM. The five‐year OS rates were 42.3% and 47.8% in the S and S + POCT groups (p = 0.080), respectively. After PSM (296 patients per group), the five‐year OS rates were 48.7% and 56.2% in the S and S + POCT groups (p = 0.025), respectively. For different cycles of POCT, patients with more than three cycles had a better survival than those with less than three cycles. The significant predictive factors for OS were pN stage (HR = 1.861, 95% CI: 1.310–2.645, p = 0.001), number of dissected nodes (HR = 0.621, 95% CI: 0.494–0.781, p < 0.001) and POCT received (HR = 0.699, 95% CI: 0.559–0.875, p = 0.002), which were identified by multivariate Cox regression analyses in the matched samples. Conclusions POCT appears to improve the OS rate of patients with ESCC after resection, and at least four chemotherapy cycles are necessary. These conclusions warrant further confirmation in large‐scale multicenter randomized controlled trials.

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“…We also observed an association between pTNM and LRFS in pN + ESCC patients. Sohda et al [ 33 ] also found a significant correlation of recurrence with pT and pN.…”

Section: Discussionmentioning

confidence: 95%

Correlates of Long-Term Survival of Patients with pN+ Esophageal Squamous Cell Carcinoma after Esophagectomy

He

¹

,

Zhan

²

,

Qiu

³

et al. 2021

Journal of Oncology

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Esophageal squamous cell carcinoma (ESCC) is the most common pathological type of esophageal cancer in China. Patients with ESCC have poor long-term survival, especially those with lymphatic metastasis (pN + ESCC). In this retrospective study, we evaluated the correlates of long-term survival time of patients with pN + ESCC. A total of 453 patients with pN + ESCC who underwent surgical R0 resection between Jan 2008 and Sep 2011 were enrolled. The follow-up ended on December 2019. The clinical, pathological, inflammation-related factors and general survival data of these patients were analyzed using SPSS 22.0 software. The 1-, 3-, and 5-year overall survival (OS) rates were 73.7%, 34.6%, and 25.6%, respectively; the 1-, 3-, and 5-year disease-free survival (DFS) rates were 45.0%, 26.3%, and 20.4%, respectively. The median OS and DFS were 23 and 14 months, respectively. On multivariate analyses, gender, site of lesion, number of dissected lymph nodes, stage pTNM, adjuvant therapy, and neutrophil lymphocyte ratio were independent predictors of OS. Site of lesion, stage pTNM, and adjuvant therapy were independent predictors of DFS. Recursive partitioning analysis (RPA) scores of each patient were calculated based on the independent predictors of OS, and the patients were divided into 3 classes: low-risk, medium-risk, and high-risk. The OS, DFS, and local recurrence-free survival were significantly different among these three RPA classes P < 0.001 . Several factors showed an independent association with long-term postoperative survival of pN + ESCC patients after radical surgery. RPA scores can potentially be used to predict the prognosis of ESCC.

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Post-esophagectomy Adjuvant Chemotherapy Benefits Esophageal Cancer Patients

Cited by 13 publications

References 18 publications

Postoperative Adjuvant Therapy for Patients with pN+ Esophageal Squamous Cell Carcinoma

Postoperative Adjuvant Therapy for Patients with pN+ Esophageal Squamous Cell Carcinoma

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

Correlates of Long-Term Survival of Patients with pN+ Esophageal Squamous Cell Carcinoma after Esophagectomy

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