Prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy and surgery

Abstract

Objective To analyze the prognostic factors for esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy and surgery. Methods A retrospective analysis was performed among 74 patients with esophageal squamous cell carcinoma who received neoadjuvant chemoradiotherapy and surgery from January 2007 to April 2014. All patients had preoperative stage cT3-4N0-1M0, consisting of 26 patients with stage cⅡ disease and 48 patients with stage cⅢ disease. Overall survival rates were estimated by the Kaplan-Meier method and compared using the Log-rank test for univariate analysis. Cox regression analysis was performed to provide multivariate analysis. Results The 1-, 3-, and 5-year overall survival (OS) rates were 85.7%, 50.0%, and 37.4% in patients with grade 1 tumor regression, 84.8%, 50.1%, and 46.3% in patients with grade 2 tumor regression, and 93.8%, 85.6%, and 85.6% in patients with grade 3 tumor regression, respectively (P=0.049). The 1-, 3-, and 5-year OS rates were 93.8%, 86.5%, and 86.5% in patients with pathologic complete response (pCR) and 85.2%, 52.4%, and 44.5% in patients without pCR, respectively (P=0.015). The 1-, 3-, and 5-year OS rates were 96.5%, 60.9%, and 57.1% in patients without pathologic lymph node metastasis (ypN-) and 57.1%, 35.7%, and 35.7% in patients with pathologic lymph node metastasis (ypN+ ), respectively (P=0.015). The 1-, 3-, and 5-year OS rates were 93.3%, 70.0%, and 62.1% in downstaged patients and 66.7%, 16.7%, and 16.7% in patients not downstaged, respectively (P=0.000). The multivariate analysis revealed that the ypN status and downstaging were independent prognostic factors for survival in patients (P=0.028; P=0.015). Conclusions Postoperative tumor regression grading is closely associated with prognosis. Particularly, patients with pCR have substantially improved survival. The ypN status and downstaging are independent prognostic factors for survival. Key words: Esophageal neoplasms/radiotehrapy; Esophageal neoplasms/chemotherapy; Esophageal neoplasms/surgery; Prognosis