Fluoropyrimidine/platinum-based first-line chemotherapy in metastatic esophageal squamous cell carcinoma: Prognostic factor analysis in 239 patients.

Abstract

4088 Background: Esophageal squamous cell carcinoma (SCC) is considerably more prevalent in East Asia. Despite of relatively high prevalence of esophageal SCC, prognosis is very poor with limited options of effective chemotherapy regimens. We attempted to identify favorable subgroups of patient who are likely to benefit from 5-fluorouracil/cisplatin (FP) or capecitabine/cisplatin (XP) chemotherapy as first-line treatment. Methods: Between January 2000 to December 2010, 239 patients were diagnosed of recurrent, metastatic esophageal SCC and received either FP or XP as first-line chemotherapy. Clinicopathologic variables and treatment outcome were retrospectively collected. Results: Among 239 patients, 104 (43.5%) patients had recurrent esophageal SCC after previous curative resection (n=93) or definitive concurrent chemoradiotherapy (n=11), and 135 (56.5%) patients had metastatic disease at initial diagnosis. 143 (59.8%) patients received FP and 96 (40.2%) patients received XP. There was no difference in response rate (RR) between FP group (RR=44.8%) and XP group (RR=54.2%; p=0.154). Median progression-free survival (PFS) and median overall survival following FP/XP chemotherapy for 239 patients were 4.4 months (95% CI, 3.954-4.786) and 11.3 months (95% CI, 9.837-12.763), respectively. There was no difference in OS and PFS between the two regimen groups. At multivariate analysis, poor performance status (ECOG≥2), low albumin level (≤3.5g/dL), and weight loss (10% of the weight loss for 3 months) at the time of chemotherapy were significantly associated with both worse PFS (P<0.05) and OS (P<0.05). When patients were categorized into risk groups according to risk score (1=one factor), median OS for each subgroup (0, 1, 2-3) was 14.7 months (95% CI, 10.507-18.953, n=104), 10.3 months (95% CI, 8.680-11.860, n=90), and 5.9 months (95% CI, 3.047-8.753, n=39) respectively (P<0.001). Conclusions: The present study represents the largest series to analyze the treatment outcome of FP/XP chemotherapy in metastatic SCC. Risk-adapted stratification of treatment for subgroup of metastatic SCC patients should be actively pursued.