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Abstract
Esophageal squamous cell carcinoma (ESCC) is a gastrointestinal carcinoma with a poor prognosis. To improve the survival of patients with this disease, neoadjuvant chemotherapy (NAC) has been introduced. However, the survival benefits of NAC or the correlation between NAC and postoperative complications have not been well considered. In the present study, we retrospectively investigated the clinicopathological effectiveness of NAC in patients with clinical stage II and III thoracic ESCC. This retrospective study enrolled 63 patients with clinical stage II and III thoracic ESCC, who underwent resection of the thoracic esophagus and three-field lymph node dissection between January 2007 and December 2013. NAC with cisplatin plus 5-fluorouracil (5-FU) was introduced in 38 patients. NAC did not correlate with the occurrence of postoperative complications. The 5-year disease-free survival (DFS) rate of the 38 patients with NAC (41.6%) was similar to that for the 25 patients who did not receive NAC (38.1%; P = 0.784). However, we found that the DFS of 17 patients with histopathological Grade 2 and 3 tumors who received NAC (5-year DFS rate: 58.1%) was significantly higher than that of 21 patients with low histopathological grade tumors who received NAC (5-year DFS rate: 28.6%), or than that of the 25 patients who did not receive NAC (38.1%). Moreover, we found that the effectiveness of NAC assessed macroscopically did not correlate with the effectiveness of NAC assessed microscopically. These findings may indicate that preoperative estimation of NAC effectiveness is important in avoiding unnecessary adverse drug effects caused by NAC, and in prolonging the survival of patients with thoracic ESCC. * Corresponding author.
Highlights
Studies on the distribution of lymph-node metastases in patients with resected thoracic esophageal squamous cell carcinoma (ESCC) have revealed extensive metastases to lymph nodes located in the neck, chest and abdomen [1]
A total of 63 patients diagnosed as having clinical stage II and III thoracic ESCC who were considered fit for a surgical treatment strategy underwent esophagectomy, and R0 operations were performed
We found that neoadjuvant chemotherapy (NAC) did not correlate with the development of postoperative complications such as anastomotic leakage, respiratory complications, cardiovascular complications, chylothorax, wound infections and other infectious complications
Summary
Studies on the distribution of lymph-node metastases in patients with resected thoracic esophageal squamous cell carcinoma (ESCC) have revealed extensive metastases to lymph nodes located in the neck, chest and abdomen [1]. The JCOG 9204 study assessed the benefit of postoperative adjuvant chemotherapy with cisplatin plus 5-fluorouracil (5-FU) as compared with surgery alone in patients with resectable stage I or II esophageal cancer. Disease-free survival was improved significantly in the patients who received postoperative chemotherapy, and especially in patients with lymph node metastasis. In the JCOG 9907 study, neoadjuvant chemotherapy (NAC) with cisplatin plus 5-FU was compared with postoperative chemotherapy with cisplatin plus 5-FU in patients with clinical stage II or III esophageal cancer. On the basis of these results, NAC followed by radical surgery is recommended in cases of locally advanced squamous cell carcinoma
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