Prognostic Factors for Esophageal Squamous Cell Carcinoma Treated with Neoadjuvant Docetaxel/Cisplatin/5-Fluorouracil Followed by Surgery

Abstract

Background: Preoperative therapy followed by surgery has become the clinical standard for resectable advanced esophageal cancer. Several studies showed that neoadjuvant docetaxel/cisplatin/5-fluorouracil (DCF) resulted in a high response rate and prolonged relapse-free survival, but what constitutes appropriate additional therapy is unknown. Methods: A total of 101 consecutive patients with cStage I B-III esophageal cancer were treated with preoperative DCF between April 2011 and December 2015. After completing 2 cycles of DCF neoadjuvant chemotherapy (NAC), esophagectomy was performed. We investigated prognostic factors and recurrence patterns in patients with resectable esophageal cancer who underwent DCF NAC followed by surgery. Results: Univariate analysis showed that performance status (hazard ratio, HR 2.85; p = 0.033), clinical response (HR 2.16; p = 0.048), pT stage (HR 2.20; p = 0.047), pN stage (HR 5.83; p< 0.001), pathological curability (HR 5.64; p = 0.038), and histological grade (HR 1.92; p = 0.048) were significant factors. Multivariate prognostic analysis revealed that pN stage and pathological curability were significant prognostic factors (HR 11.20; p < 0.001, and HR 27.41; p = 0.007, respectively). In addition, based on the number of metastatic lymph nodes (LNs), the difference in overall survival was the largest between patients with ≤2 and ≥3 metastatic LNs (HR 5.83; p< 0.001). Distant metastatic recurrence increased significantly in patients with 3 or more pathologically confirmed metastatic LNs (p = 0.008). Conclusion: Distant recurrence occurred more frequently and prognosis was poorer in patients with 3 or more pathologically confirmed metastatic LNs; they might need additional systemic therapy.