Abstract
BackgroundA pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) ensures long-term survival in esophageal squamous cell carcinoma (ESCC) patients following esophagectomy, but pCR patients are a minority. The aim here was to identify prognostic factors in patients with non-pCR ESCC after NACRT.MethodsThis is a retrospective study. Investigated were 5-year overall survival (OS), disease-specific survival (DSS), and relapse-free survival (RFS) among non-pCR ESCC patients divided into pT0N0, primary site pCR (pT0N+), lymph node pCR (pT+N0), and non-pCR in both the tumor and lymph node (pT+N+) subgroups after NACRT and esophagectomy. Focusing on the SUVmax reduction rate in the primary tumor in 88 patients who underwent FDG-PET before and after NACRT, we used univariate and multivariate Cox proportional hazard models to identify prognostic factors.ResultsAlthough there were no significant survival differences among non-pCR ESCC patients with pT0N+, pT+N0, or pT+N+, survival rate among pT+N+patients was the poorest. After setting a 60% cutoff for the SUVmax reduction rate in the tumor, RFS curves for non-pCR patients significantly differed between patients above the cutoff and those below it. For pT+N+ patients, the SUVmax reduction rate (<60% vs ≥ 60%) was an independent prognostic factor of OS, DSS, and RFS.ConclusionBecause ESCC patients with SUVmax reduction rates of <60% in the tumor after NACRT and categorized as pT+N+ after NACRT had significantly poorer prognoses, even after esophagectomy, a change in treatment strategy may be an option to improve survival.
Highlights
A pathological complete response after neoadjuvant chemoradiotherapy (NACRT) ensures longterm survival in esophageal squamous cell carcinoma (ESCC) patients following esophagectomy, but pCR patients are a minority
Little has been reported about the prognosis of non-pCR patients, who account for the majority ESCC patients treated with NACRT
Patients and tumor characteristics Of 115 ESCC patients enrolled in this retrospective study, chemotherapy consisting of FP was used for 43 (37%) patients, while FGP was used for 73 (63%) patients
Summary
A pathological complete response (pCR) after neoadjuvant chemoradiotherapy (NACRT) ensures longterm survival in esophageal squamous cell carcinoma (ESCC) patients following esophagectomy, but pCR patients are a minority. Because many ESCC patients are diagnosed with locally advanced tumors with lymph node metastasis, multimodal treatment combining surgery with chemotherapy and/or radiotherapy has been introduced to improve patient prognosis [1]. In this effort, several clinical trials have shown the efficacy of neoadjuvant chemotherapy (NACT) and neoadjuvant chemoradiotherapy (NACRT) [2,3,4,5,6,7,8,9]. NACRT leads to marked down-staging of ESCC tumors, and a pathological complete response (pCR) to NACRT is a key factor contributing to survival in patients with esophageal cancer [10]. Few studies have focused on the difference in prognosis between primary tumor pCR (pT0N+), lymph node pCR (pT+N0), and non-pCR of both primary tumor and lymph node (pT+N+) in patients with ESCC
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