Risk factors of early recurrence within 6months after esophagectomy following neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma.

Abstract

Esophagectomy following neoadjuvant chemotherapy (NAC) is a standard treatment for resectable advanced esophageal cancer in Japan. However, approximately 10% of patients with resectable advanced esophageal cancer experience recurrence within 6months. One hundred twenty-eight patients with resectable advanced esophageal cancer underwent NAC between October 2008 and July 2015 in Kumamoto University Hospital. Among them, 82 patients with esophageal squamous cell carcinoma (SCC), who underwent curative esophagectomy without adjuvant treatment, were eligible. Clinicopathological factors correlated with early recurrence were retrospectively analyzed. Of 82 patients, 14 (17%) recurred within 6months after surgery. The logistic regression analysis suggested that CRP before NAC≥0.5mg/dl [hazard ratio (HR) 33.8, 95% confidence interval (CI) 2.767-413.9; p=0.006), presence of poorly differentiated SCC component (HR 138, 95% CI 5.339-3576; p=0.003), and pathological vessel invasion (HR 16.3, 95% CI 1.960-136.1; p=0.010) were candidates for independent risk factors of early recurrence. Patients with at least two factors frequently recurred (82%). Of 14 patients with early recurrence, 13 (93%) had a distant metastasis. Patients with resectable advanced esophageal cancer with at least two factors of CRP before NAC≥0.5mg/dl, presence of poorly differentiated SCC component, and pathological vessel invasion might be at high risk for early recurrence after esophagectomy following NAC. These patients might be considered for additional treatment and should be meticulously followed up after treatment.