Effect analysis of neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy in the treatment of locally advanced esophageal squamous cell carcinoma

Abstract

Objective To compare the clinical effect of neoadjuvant chemoradiotherapy (nCRT) and neoadjuvant chemotherapy (nCT) in the treatment of locally advanced esophageal squamous cell carcinoma. Methods The retrospective cohort study was conducted. The clinicopathological data of 156 patients with local advanced esophageal squamous cell carcinoma who were admitted to the Zhongshan Hospital of Fudan University from January 1, 2010 to December 31, 2015 were collected. Among 156 patients, 59 undergoing nCRT were allocated into the nCRT group and 97 undergoing nCT were allocated into the nCT group. Patients in the nCRT group and nCT group respectively received 2 cycles chemotherapy by the TP regimen+ 40 Gy radiotherapy (2 Gy/d) and 2 cycles chemotherapy by the TP regimen. Patients were evaluated by imaging examinations after 6 weeks neoadjuvant therapy completion, and then underwent abdominal and right chest-left cervico three-incision thoracoscopic surgery. Observation indicators: (1) treatment situations; (2) postoperative pathological examination; (3) follow-up and survival situations. Follow-up using outpatient examination and telephone interview was performed once every 3 months within 2 years and once every 6 months after 3 years up to January 2017. Follow-up included levels of tumor markers [carcinoembryonic antigen (CEA) and SCC-Ag], thoracic or abdominal computed tomography (CT), neck and abdominal ultrasonography and gastroscopy or PET/CT examination if necessary. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M (range) and comparison between groups was analyzed using the nonparametric test. Count data were analyzed using the chi-square test or Fisher exact probability. Comparison of ordinal data was done by the nonparametric test. The survival rate was calculated using the life table method and survival was analyzed by the Log-rank test. Results (1) Treatment situations: all the patients in the 2 groups were able to burden neoadjuvant therapy and thoracic esophagectomy. Six patients in the nCRT group and 15 in the nCT group had conversion to open surgery. Operation time, volume of intraoperative blood loss, cases with postoperative readmission of ICU, cases with complications, cases with perioperative death and duration of hospital stay were (201±25)minutes, (137±66)mL, 5, 24 (10 with pulmonary complications, 8 with anastomotic leakage, 3 with hoarseness, 2 with cardiovascular complications and 1 with chylopleura), 0, 12 days (range, 9-93 days) in the nCRT group and (195±20)minutes, (133±58)mL, 8, 30 (11 with anastomotic leakage, 10 with pulmonary complications, 4 with hoarseness, 2 with cardiovascular complications, 1 with postoperative hemorrhage, 1 with delayed gastric emptying and 1 with chylopleura), 1, 11 days (range, 9-78 days) in the nCT group, respectively, with no statistically significant difference between the 2 groups (χ2=0.883, t=0.102, 0.692, χ2=0.048, 1.541, Z=0.225, P>0.05). (2) Postoperative pathological examination: R0 resection rate was 96.6% in the nCRT group and 93.8% in the nCT group, with no statistically significant difference between the 2 groups (χ2=0.589, P>0.05). Results of postoperative pathological examination showed that G0, G1, G2 and G3 of tumor regression grade were respectively detected in 18, 16, 7, 18 patients in the nCRT group and 4, 5, 4, 84 patients in the nCT group, with a statistically significant difference between the 2 groups (Z=-7.151, P<0.05). Stage 0, Ⅰ, Ⅱ, ⅢA, ⅢB and ⅣA of postoperative ypTNM stage were respectively detected in 16, 9, 23, 4, 6, 1 patients in the nCRT group and 4, 9, 37, 6, 34, 7 in the nCT group, with a statistically significant difference between the 2 groups (Z=-4.890, P<0.05). The down-staging was detected in 48 patients of the nCRT group and 50 patients of the nCT group, with a statistically significant difference between the 2 groups (χ2=13.957, P<0.05). (3) Follow-up and survival situations: of 156 patients, 153 were followed up for 12-82 months, with a median time of 36 months. The 1-, 3-, 5-year overall survival rates were 88.1%, 61.4%, 34.9% in the nCRT group and 81.4%, 43.8%, 23.1% in the nCT group, with a statistically significant difference between the 2 groups (χ2=4.336, P<0.05). Conclusion The nCRT in the treatment of locally advanced esophageal squamous cell carcinoma can enhance postoperative pathological response rate, down-staging rate and overall survival rate compared with nCT, without increasing incidence of perioperative complications. Key words: Esophageal neoplasms; Surgical procedures, operative; Neoadjuvant chemoradiotherapy; Neoadjuvant chemotherapy