Abstract
BackgroundsIn this study, we evaluated the factors associated with a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for esophageal squamous cell carcinoma (ESCC).MethodsPre-nCRT parameters in ESCC patients treated between 1999 and 2006 were analyzed to identify predictors of pCR. All patients received 5-fluorouracil/cisplatin-based chemotherapy and external beam radiation followed by scheduled esophagectomy. Variables were analyzed using univariate and multivariate analyses with pCR as the dependent variable. Estimated pCR rate was calculated with a regression model.ResultsFifty-nine (20.9%) of 282 patients achieved pCR. Univariate analysis identified four patient factors (age, smoking status, drinking history and hypertension), one pre-nCRT parameter (tumor length) as significant predictors of pCR (all P <0.05). On multivariate analysis, tumor length ≤3 cm (favorable, odds ratio (OR): 4.85, P = 0.001), patient age >55 years (favorable, OR: 1.95, P = 0.035), and being a non-smoker (favorable, OR: 3.6, P = 0.003) were independent predictors of pCR. The estimated pCR rates based on a logistic regression including those three predictors were 71%, 35 to approximately 58%, 19 to approximately 38%, and 12% for patients with 3, 2, 1 and 0 predictors, respectively.ConclusionAge, smoking habit and tumor length were important pCR predictors. These factors may be used to predict outcomes for ESCC patients receiving nCRT, to develop risk-adapted treatment strategies, and to select patients who could participate in trials on new therapies.
Highlights
Carcinoma of the esophagus is a highly malignant cancer and is generally associated with a poor prognosis [1]
Previous studies have evaluated the use of clinical parameters as potential markers of tumor response to neoadjuvant chemoradiotherapy (nCRT) in esophageal cancer, and in these studies, a lower clinical stage was associated with a higher pathologic complete response (pCR) rate in the esophageal adenocarcinoma group [8]
General characteristics of the study participants Over the study period, 313 stage II to IV esophageal cancer patients received nCRT followed by surgery in the Chang Gung Memorial Hospital (CGMH)
Summary
Carcinoma of the esophagus is a highly malignant cancer and is generally associated with a poor prognosis [1]. Previous studies have evaluated the use of clinical parameters as potential markers of tumor response to nCRT in esophageal cancer, and in these studies, a lower clinical stage was associated with a higher pCR rate in the esophageal adenocarcinoma group [8]. Other studies have explored the use of molecular and genetic predictors of pCR. Other studies that have attempted to identify specific molecular markers have generally focused on the squamous subtype [13,14]. The prognostic impact of these markers was determined indirectly through interactions with other unfavorable pathological descriptors, such as advanced T stage or lymph node metastases, resulting in their exclusion from multivariate analysis
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