Abstract
BackgroundDespite the established oncological benefits of neoadjuvant chemotherapy for esophageal squamous cell cancer, not all cases demonstrate benefit. Hence, predicting the response to chemotherapy before treatment is desirable. Some reports have shown that immune factors are related to the chemotherapy response. This study aimed to investigate the utility of serum IgG levels for predicting chemotherapy response.MethodsAmong the patients who underwent esophagectomy after neoadjuvant chemotherapy at Nagoya City University Hospital between December 2012 and June 2019, 130 cases were included in this study. Response to chemotherapy and pretreatment serum IgG levels were examined in 77 cases. FP (5-fluorouracil and cisplatin) therapy or DCF (docetaxel, cisplatin, and 5-FU) therapy was performed as neoadjuvant chemotherapy. DCF therapy was selected for patients aged <75 years, who could be safely administered chemotherapy based on their medical history.ResultsThis study divided cases into two groups: the effective response group (PR) and ineffective response group (SD and PD). We classified 1, 37, and 39 cases as PD, PR, and SD, respectively. None of the cases were classified as CR. The effective response group had significantly lower serum IgG levels than the ineffective response group (p < 0.001). The cutoff serum IgG value was determined to be 1087 mg/dL. The low IgG group had significantly more cases who had effective response to chemotherapy compared with the high IgG group (odds ratio [OR] = 9.009; 95% confidence interval [CI] = 2.974–30.157; p < 0.001). Univariate and multivariate analyses revealed serum IgG level to be an independent predictor for response to chemotherapy (p = 0.001). Furthermore, cases with effective pathological response had significantly lower pretreatment serum IgG levels than those who did not (p = 0.006).ConclusionsOur finding showed that serum IgG levels can be an independent predictor of the response to neoadjuvant chemotherapy for esophageal squamous cell carcinoma.Trial registrationThis retrospective study was approved by the review board of Nagoya City University Graduate School of Medical Sciences (reception number: 60-18-0008).
Highlights
Esophageal cancer, which ranks seventh in terms of incidence and sixth in terms of overall mortality worldwide, has remained one of the most common malignancies, with esophageal squamous cell cancer (ESCC) being the dominant histological type in East Asia [1].The oncological benefits of neoadjuvant chemotherapy and chemoradiotherapy for ESCC have had a major impact on clinical practices [2,3,4]
Response to neoadjuvant chemotherapy Among the 77 patients included 58 had swollen lymph nodes larger than 10 mm, with the response to chemotherapy being determined using the rate of change of the target lesions
While studies have shown that neoadjuvant chemotherapy is beneficial for improving the prognosis of stage II/ III esophageal cancer [5], not all cases exhibit an effective response to chemotherapy
Summary
Esophageal cancer, which ranks seventh in terms of incidence and sixth in terms of overall mortality worldwide, has remained one of the most common malignancies, with esophageal squamous cell cancer (ESCC) being the dominant histological type in East Asia [1].The oncological benefits of neoadjuvant chemotherapy and chemoradiotherapy for ESCC have had a major impact on clinical practices [2,3,4]. Japanese guidelines for the treatment of ESCC have shown that neoadjuvant chemotherapy comprising 5-fluorouracil and cisplatin (FP), established by the JCOG9907 trial, was beneficial for patients with clinical stage II/III ESCC [5]. A randomized controlled phase III trial comparing FP; docetaxel, cisplatin, and 5-fluorouracil (DCF); and FP–radiotherapy as neoadjuvant treatment for clinical stage II or III esophageal cancer (JCOG1109 trial) is currently being conducted, with our department conducting DCF therapy [6]. Despite the established oncological benefits of neoadjuvant chemotherapy for esophageal squamous cell cancer, not all cases demonstrate benefit. Predicting the response to chemotherapy before treatment is desirable. This study aimed to investigate the utility of serum IgG levels for predicting chemotherapy response
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