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Esophagus

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Prognostic significance of pathological tumor response and residual nodal metastasis in patients with esophageal squamous cell carcinoma after neoadjuvant chemotherapy followed by surgery

  • Junya Oguma
  • Soji OzawaEmail author
  • Kazuo Koyanagi
  • Akihito Kazuno
  • Miho Yamamoto
  • Yamato Ninomiya
  • Kentaro Yatabe
Original Article
  • 11 Downloads

Abstract

Background

The present study investigated prognostic factors in patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC) among various clinicopathological features related to neoadjuvant chemotherapy (NAC) and surgery, and the indications for additional treatment after surgery were considered.

Methods

A total of 113 patients with clinical stage II or III ESCC, who had undergone NAC followed by a thoracic esophagectomy with a three-field lymphadenectomy were retrospectively reviewed. NAC consisted of either two courses of cisplatin and 5-fluorouracil or three courses of docetaxel, cisplatin and 5-fluorouracil, with a new course beginning every 3 weeks.

Results

The overall survival (OS) rate was poorer in the pN-positive group than in the pN-negative group (P < 0.001). In terms of the histological therapeutic effect, the OS rate was poorer in the worse pathological responder group than in the better pathological responder group (P = 0.001). A multivariate analysis examining overall survival suggested that only pN (HR 3.204, P = 0.007) and worse pathological responder (HR 2.347, P = 0.041) were independent prognostic factors. The OS rate was compared among four groups classified according to the different combinations of pN and pathological response. A group of patients with pN-positive and worse pathological response had a significantly poorer outcome than the other groups.

Conclusions

The present study suggested that patients with resectable advanced ESCC undergoing NAC followed by surgery, who have both pN and worse pathological response, have a poor prognosis.

Keywords

Esophageal squamous cell carcinoma Neoadjuvant chemotherapy Prognostic factor Lymph node metastasis Histological therapeutic effect 

Notes

Compliance with ethical standards

Ethical Statement

The protocol for this retrospective study has been approved by the institutional review board of the Tokai University Hospital (Registration No.18R208). This work followed the guidelines set forth in the Helsinki Declaration of 1975, as revised in 2000, concerning Human and Animal Rights. This article does not contain human or animal subjects performed by any authors.

Conflict of interest

Authors declare no conflict of interest for this article.

References

  1. 1.
    Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group—JCOG9204. J Clin Oncol. 2003;21:4592–6.CrossRefGoogle Scholar
  2. 2.
    Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.CrossRefGoogle Scholar
  3. 3.
    Nakamura K, Kato K, Igaki H, et al. Three-arm phase III trial comparing cisplatin plus 5-FU (CF) versus docetaxel, cisplatin plus 5-FU (DCF) versus radiotherapy with CF (CF-RT) as preoperative therapy for locally advanced esophageal cancer (JCOG 1109, NExT study). Jpn J Clin Oncol. 2013;43:752–5.CrossRefGoogle Scholar
  4. 4.
    Japan Esophageal Society. Japanese Classification of Esophageal Cancer, 11th edition: part I. Esophagus. 2017;14:1–36.CrossRefGoogle Scholar
  5. 5.
    Schneider PM, Baldus SE, Metzger R, et al. Histopathologic tumor regression and lymph node metastases determine prognosis following neoadjuvant radiochemotherapy for esophageal cancer. Ann Surg. 2005;242:684–92.CrossRefGoogle Scholar
  6. 6.
    Tong DK, Law S, Kwong DL, et al. Histological regression of squamous esophageal carcinoma assessed by percentage of residual viable cells after neoadjuvant chemoradiation is an important prognostic factor. Ann Surg Oncol. 2010;17:2184–92.CrossRefGoogle Scholar
  7. 7.
    Yokota T, Ando N, Igaki H, et al. Prognostic factors in patients receiving neoadjuvant 5-fluorouracil plus cisplatin for advanced esophageal cancer (JCOG9907). Oncology. 2015;89:143–51.CrossRefGoogle Scholar
  8. 8.
    Hatogai K, Fujii S, Kojima T, et al. Prognostic significance of tumor regression grade for patients with esophageal squamous cell carcinoma after neoadjuvant chemotherapy followed by surgery. J Surg Oncol. 2016;113:390–6.CrossRefGoogle Scholar
  9. 9.
    Kodama T, Hatogai K, Yano T, et al. Pathological tumor regression grade of metastatic tumors in lymph node predicts prognosis in esophageal cancer patients. Cancer Sci. 2018;109:2046–55.CrossRefGoogle Scholar
  10. 10.
    Akutsu Y, Shuto K, Kono T, et al. The number of pathologic lymph nodes involved is still a significant prognostic factor even after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma. J Surg Oncol. 2012;105:756–60.CrossRefGoogle Scholar
  11. 11.
    Okumura H, Uchikado Y, Matsumoto M, et al. Prognostic factors in esophageal squamous cell carcinoma patients treated with neoadjuvant chemoradiation therapy. Int J Clin Oncol. 2013;18:329–34.CrossRefGoogle Scholar
  12. 12.
    Tanaka K, Miyata H, Yamasaki M, et al. Circulating miR-200c levels significantly predict response to chemotherapy and prognosis of patients undergoing neoadjuvant chemotherapy for esophageal cancer. Ann Surg Oncol. 2013;10:607–15.CrossRefGoogle Scholar
  13. 13.
    Smyth EC, Fassan M, Cunningham D, et al. Effect of pathologic tumor response and nodal status on survival in the medical research council adjuvant gastric infusional chemotherapy trial. J Clin Oncol. 2016;34:2721–7.CrossRefGoogle Scholar
  14. 14.
    Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Cancer. 1994;73:2680–6.CrossRefGoogle Scholar
  15. 15.
    Chirieac LR, Swisher SG, Ajani JA, et al. Posttherapy pathologic stage predicts survival in patients with esophageal carcinoma receiving preoperative chemoradiation. Cancer. 2005;103:1347–55.CrossRefGoogle Scholar

Copyright information

© The Japan Esophageal Society 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological SurgeryTokai University School of MedicineIseharaJapan

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