Prognostic Factors for Patients With Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemotherapy Followed by Surgery

Abstract

Background/Aim: Neoadjuvant chemotherapy (NAC) followed by surgery is a standard treatment for patients with locally advanced esophageal cancer. This study aimed to identify patients who might be eligible for postoperative adjuvant therapy. Patients and Methods: We reviewed the surgical outcomes of 84 patients who received NAC followed by esophagectomy to treat esophageal squamous cell carcinoma (ESCC) and revealed prognostic factors associated with locally advanced ESCC. Results: Univariate and multivariate analyses revealed the pretreatment level of squamous cell carcinoma-related antigen [SCC-A; hazard ratio (HR)=1.50, p=0.01], ypT ≥3 (HR=2.51; p=0.04), ypN ≥1 (HR=5.87; p=0.01), ypM1 (HR=2.38; p=0.049), and lymphovascular invasion (HR=3.12, p=0.049) as significant independent covariates for recurrence-free survival (RFS). The 5-year RFS rates for patients with 0-1, 2-3, or 4-5 of these indicators of poor prognosis were 97.1%, 51.2%, and 6.7% (p≤0.001 for all). Recurrence rates among these groups also significantly differed at 2. 9%, 50.0%, and 93.3% (p<0.0001). Conclusion: Pretreatment SCC-A, ypT, ypN, ypM, and lymphovascular invasion were significantly associated with RFS in patients with ESCC who received NAC followed by surgery. The status of these prognostic factors in ESCC might indicate a need for postoperative adjuvant therapy after NAC followed by surgery.

Prognostic factors for esophageal squamous cell carcinoma without pathological lymph node metastasis after neoadjuvant therapy and surgery

“…10,13,14 NAC comprised the cisplatin/5FU, nedaplatin/5FU, or docetaxel/cisplatin/5FU regimens as previously described. [11][12][13]…”

“…Patients with a performance status of 0 or 1 according to the Eastern Cooperative Oncology Group criteria were treated with NAC or NACRT followed by esophagectomy based on the resectability of cancer in the thoracic esophagus or esophagogastric junction (EGJ), if tumor invasion was worse than cT2, positive for LNM (cNþ) or supraclavicular LNM was resectable. [10][11][12][13][14] The clinicopathological profiles of the tumors were based on the TNM Classification of Malignant Tumors, 8th edition. 15 The patients with clinically diagnosed Stage I (cT1 N1 M0) to IVB (supraclavicular LNM, M1) ESCC before initiating treatment were included in this study.…”

“…Common tumor markers for ESCC, such as carcinoembryonic antigen (CEA) 16 and SCC-related antigen (SCC), 11,17 as well as various blood parameters, such as neutrophil-to-lymphocyte ratio (NLR), 3,18 prognostic nutritional index (PNI), 4 and C-reactive protein/albumin ratio (CAR) 5 are predictive markers for the prognosis of esophageal cancer treated with neoadjuvant therapy followed by surgery. Therefore, in this study, we assessed the pretherapeutic values of these parameters as prognostic factors.…”

“…[3][4][5][6][7][8][9][10][11] Additionally, pathological lymph node metastasis (LNM) has been found to be a crucial factor closely associated with poor prognosis even after multimodal therapy. [6][7][8][9][10][11] However, recurrence may develop in some patients with esophageal cancer without pathological LNM after multimodal therapy: the 5-year survival rate in patients with ypN0 is 60%-85%. [6][7][8][9][10] To the best of our knowledge, the prognostic factors for esophageal cancer without pathological LNM after neoadjuvant therapy followed by surgery have not been sufficiently evaluated.…”

“…Neoadjuvant therapy and surgical resection represent a standard of care for locally advanced resectable esophageal cancer 1,2 . Various prognostic indicators after neoadjuvant chemotherapy (NAC) or chemoradiotherapy (NACRT) followed by surgery have been reported for esophageal cancer 3–11 . Additionally, pathological lymph node metastasis (LNM) has been found to be a crucial factor closely associated with poor prognosis even after multimodal therapy 6–11 …”