Effect of complications on prognosis during neoadjuvant chemotherapy for esophageal cancer

Abstract

Objective Previous researchers have focused upon the influence of postoperative complications on prognosis of esophagectomy, with very little attention paid to the potential negative effects of complications during neoadjuvant therapy. The hypothesis under investigation in this study was that the prognosis after esophageal cancer surgery is negatively influenced by complications causing hospital admission during neoadjuvant therapy. Methods Patients receiving neoadjuvant therapy and surgery for esophageal cancer between 2003 and 2011 were identified and followed up until 2017. The association between hematological and non-hematological complications during neoadjuvant therapy and risks of short-term and long-term mortality after surgery were analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs). The HRs were adjusted for appropriate confounding variables. Results Among 738 patients, complications during neoadjuvant therapy requiring emergency hospitalization affected 73 (9.9%) patients. Hematological complications were associated with an increased 90-day overall mortality (HR=5.63, 95% CI: 1.26-24.81), especially in patients with stage 0-Ⅱ regardless of whether there were residuals in incisal margins; and the disease-related mortality rate of esophageal adenocarcinoma was significantly increased after 5 years (HR=3.21, 95% CI: 1.05-10.33). In the prognosis group of poor expectances (tumor stage Ⅲ-Ⅳ) with non-hematologic complications, there was a high mortality rate at 5 years after surgery (HR=2.34, 95% CI: 1.17-4.89). Hematological or non-hematologic complications in other subgroups did not affect the 5-year mortality rate. Conclusions Adjuvant chemotherapy after esophagectomy for patients with esophageal cancer may cause complications which will adversely affect the short-term and long-term mortality. Key words: Esophageal neoplasm; Adjuvant chemotherapy; Complication