Resectable Thoracic Esophageal Squamous Cell Research Articles

Predictive potential of preoperative Naples prognostic score-based nomogram model for the prognosis in surgical resected thoracic esophageal squamous cell carcinoma patients: A retrospective cohort study.

The present study aimed to establish an effective prognostic nomogram model based on the Naples prognostic score (NPS) for resectable thoracic esophageal squamous cell carcinoma (ESCC). A total of 277 patients with ESCC, who underwent standard curative esophagectomy and designated as study cohort, were retrospectively analyzed. The patients were divided into different groups, including NPS 0, NPS 1, NPS 2, and NPS 3 or 4 groups, for further analysis, and the results were validated in an external cohort of 122 ESCC patients, who underwent surgery at another cancer center. In our multivariate analysis of the study cohort showed that the tumor-node-metastasis (TNM) stage, systemic inflammation score, and NPS were the independent prognostic factors for the overall survival (OS) and progression-free survival (PFS) durations. In addition, the differential grade was also an independent prognostic factor for the OS in the patients with ESCC after surgery (all P < .05). The area under the curve of receiver operator characteristics for the PFS and OS prediction with systemic inflammation score and NPS were 0.735 (95% confidence interval [CI] 0.676-0.795, P < .001) and 0.835 (95% CI 0.786-0.884, P < .001), and 0.734 (95% CI 0.675-0.793, P < .001) and 0.851 (95% CI 0.805-0.896, P < .001), respectively. The above independent predictors for OS or PFS were all selected in the nomogram model. The concordance indices (C-indices) of the nomogram models for predicting OS and PFS were 0.718 (95% CI 0.681-0.755) and 0.669 (95% CI 0.633-0.705), respectively, which were higher than that of the 7th edition of American Joint Committee on Cancer TNM staging system [C-index 0.598 (95% CI 0.558-0.638) for OS and 0.586 (95% CI 0.546-0.626) for PFS]. The calibration curves for predicting the 5-year OS or PFS showed a good agreement between the prediction by nomogram and actual observation. In the external validation cohort, the nomogram discrimination for OS was better than that of the 7th edition of TNM staging systems [C-index: 0.697 (95% CI 0.639-0.755) vs 0.644 (95% CI 0.589-0.699)]. The calibration curves showed good consistency in predicting the 5-year survival between the actual observation and nomogram predictions. The decision curve also showed a higher potential of the clinical application of predicting the 5-years OS of the proposed nomogram model as compared to that of the 7th edition of TNM staging systems. The preoperative NPS-based nomogram model had a certain potential role for predicting the prognosis of ESCC patients.

Perioperative tislelizumab plus chemotherapy for locally advanced resectable thoracic esophageal squamous cell carcinoma trial: a prospective single-arm, phase II study (PILOT trial)

BackgroundThe promising therapeutic outcomes of neoadjuvant immunotherapy combined with chemotherapy in the treatment of locally advanced esophageal squamous cell carcinoma (ESCC) have been confirmed by several phase II clinical trials and have been widely demonstrated in clinical work. Theoretically, postoperative adjuvant immunotherapy may further improve the therapeutic effect, but there is still lack of evidence. The aim of this study was to analyse the safety and efficacy of perioperative immunotherapy (tislelizumab) in locally advanced resectable thoracic ESCC (PILOT trial).MethodsSeventy-three eligible patients with pathologically confirmed thoracic ESCC of clinical T1b-3N1-3M0 or T3N0M0 stage were allocated to receive neoadjuvant immunotherapy (tislelizumab 200 mg d1, q3w × 2 cycles) plus chemotherapy (nad-paclitaxel 260 mg/m2 d1 + carboplatin AUC = 5 d1, q3w × 2 cycles) treatment. Patients with pathologic complete response (pCR) after esophagectomy received adjuvant tislelizumab (200 mg every 3 weeks for up to one year), and patients with non-pCR were assigned adjuvant tislelizumab plus chemotherapy for two cycles and then maintenance tislelizumab (200 mg every 3 weeks for up to 15 cycles). The primary endpoint of this study is 2-year disease-free survival (DFS) in non-pCR patients. The secondary endpoints include pCR rate, major pathological response rate, 2-year DFS in pCR patients, R0 resection rate, adverse events, and overall survival.DiscussionThis protocol was reviewed and approved by the Ethics Committee of Shanghai Chest Hospital (IS23059). This is the first prospective clinical trial to investigate the safety and efficacy of perioperative immunotherapy for locally advanced resectable thoracic ESCC. We hypothesize that perioperative immunotherapy could be a promising therapeutic strategy that can provide better 2-year DFS in non-pCR patients.Trial registrationClinicalTrial.gov: NCT0605633.

Preoperative neoadjuvant chemoradiotherapy provides borderline resectable thoracic esophageal cancer with equivalent treatment results as clinically T3 thoracic esophageal cancer.

Because the optimal treatment strategy for borderline resectable (cT3br) thoracic esophageal cancer patients remains unclear, it is of great interest whether preoperative neoadjuvant therapy for cT3br could achieve results comparable to those seen with resectable T3 cancer (cT3r). We speculated that preoperative neoadjuvant chemoradiotherapy (NACRT) would be particularly effective in cT3br thoracic esophageal cancer patients and compared to cT3br and cT3r. Of 186 cT3 thoracic esophageal cancer patients treated with intended NACRT, 162 received radical esophagectomy. More than 97% were squamous cell carcinomas. Patients were partitioned into two groups according to whether invasion of adjacent organs was suspected (cT3br and cT3r). Treatment outcomes and survival were analyzed. Sixty-eight patients (36.6%) were classified as cT3br and 118 (63.4%) as cT3r. The cT3br group had significantly more tumors in the upper and middle mediastinum (p < 0.0001) and more cases with cM1 (lymph node) (p = 0.0104) than the cT3r group. In addition, the cT3br patients receiving esophagectomy exhibited a significantly lower pathological complete response rate than the cT3r patients (p = 0.0374). However, the R0 resection rate did not differ between the cT3br and cT3r patients (p = 0.0978), and the two groups treated with intended NACRT had similar 5-year overall (OS) and disease-specific survival (DSS) (p = 0.3831 and p = 0.9020). In addition, the incidence and patterns of recurrence did not differ between the cT3br and cT3r patients receiving esophagectomy (p = 0.8109 and p = 0.3128). Preoperative neoadjuvant chemoradiotherapy appears to be a promising treatment for patients with borderline resectable thoracic esophageal squamous cell carcinoma.

163P Neoadjuvant chemoradiotherapy plus tislelizumab followed by surgery for esophageal carcinoma: An interim analysis of the prospective, single-arm, phase II trial

This study aimed to evaluate the safety and efficacy of neoadjuvant chemoradiotherapy (nCRT) combined with sequential tislelizumab followed by surgery for resectable thoracic esophageal squamous cell carcinoma (TESCC).

Does synchronous early head and neck cancer with esophageal cancer need treatment after preoperative chemotherapy?

Treatment options for patients with resectable thoracic esophageal squamous cell cancer (ESCC) and synchronous head and neck cancer (HNC) are unclear. Little has been reported about the effects of chemotherapy on early HNC. The aim of this study was to investigate the treatment outcomes of resectable thoracic ESCC with synchronous early HNC. We retrospectively reviewed 37 patients undergoing esophagectomy for thoracic ESCC with synchronous early HNC from January 2008 to December 2018. Among 37 patients who had synchronous early HNC, 27 patients received preoperative therapy for ESCC before HNC treatment, and 16 of 27 patients achieved a complete response for HNC by preoperative chemotherapy. Fifteen of 16 patients did not receive additional treatment, and regional recurrence of HNC was not observed. In one other case, an oral excision was performed, but no cancer cell remnants were found pathologically. No significant difference in overall survival and disease-free survival was observed between 15 patients with follow-up and 22 patients with surgery or radiation. Our results indicate that early HNC with comorbid ESCC could be followed up without additional treatment if preoperative chemotherapy is successful.

A phase II study of neoadjuvant immunotherapy combined with chemotherapy (camrelizumab plus albumin paclitaxel and carboplatin) in resectable thoracic esophageal squamous cell cancer (NICE study): Interim results.

4060 Background: We conducted a phase II trial of preoperative chemotherapy with albumin paclitaxel and carboplatin combined with camrelizumab (NICE regimen), in patients with locally advanced esophageal squamous cell carcinoma (ESCC) with multiple lymph nodes metastasis. Initial results were analyzed to assess the efficacy and safety of this strategy. Methods: This was a prospective, multicenter, open, single arm, phase II trial. Eligible patients were histologically confirmed thoracic ESCC, staged as T1b-4a, N2-3 (≥ 3 stations), and M0 or M1 lymph node metastasis (confined to the supraclavicular lymph nodes) according to the 8th edition of American Joint Committee on Cancer. Patients received neoadjuvant treatment (NICE regimen) with intravenous camrelizumab (200 mg, day 1) plus albumin paclitaxel (100 mg/m2, day 1, 8, 15) and carboplatin (area under curve 5, day 1) of each 21-day cycle, for two cycles before surgery. The primary endpoint is pathological complete response (pCR) rate in the per-protocol population, which included all patients who had tumor resection and received at least one cycle of neoadjuvant treatment. Secondary endpoints include R0 resection rate, adverse events and disease-free survival. Safety was assessed in the modified intention-to-treat population. Results: Of the planned 60 patients enrolled, 55 (91.7%) patients have received the full two-cycles NICE regimen successfully, 4 patients didn’t receive the complete neoadjuvant therapy due to intolerance (3 patients) and drop out (1 patient), 1 patient died due to pneumonia on the second cycle of neoadjuvant therapy. Grade 3-5 treatment-related adverse events (TRAEs) rate was 53.3% and TRAEs resulting in discontinuation rate was 6.7%. The common grade 3-5 TRAEs included lymphopenia (50%), thrombocytopenia (10%), pneumonia (5%) and thyroid dysfunction (3.3%). At the time of writing, 47 patients underwent surgery within 27-85 days (median 36 days) after NICE treatment, in which 7 patients had delays to surgery due to TRAEs. All patients achieved radical (R0) resection. There was no in-hospital and postoperative 30-day mortality. pCR (ypT0N0) was identified in 20 (42.5%) of 47 patients and 5 (10.6%) patients had complete pathological response of the primary tumor but residual disease in lymph nodes alone (ypT0N+). Conclusions: Preoperative NICE regimen has achieved satisfatory initial results of disease response in locally advanced thoracic ESCC. A phase III randomized controlled trial is required to demonstarate the possible survival improvement. Trial registration: ChiCTR1900026240 Clinical trial information: ChiCTR1900026240.

Neoadjuvant chemoradiotherapy plus surgery in the treatment of potentially resectable thoracic esophageal squamous cell carcinoma

BACKGROUNDIn recent years, neoadjuvant chemoradiotherapy (NCRT) combined with surgery has been gradually applied in patients with locally advanced thoracic esophageal cancer, but its effectiveness and safety remains unclear. In this clinical trial, we prospectively investigated the efficacy and safety of NCRT plus surgery in the treatment of thoracic esophageal squamous cell carcinoma (TESCC).AIMTo investigate the efficacy and safety of NCRT combined with surgery in the treatment of potentially resectable TESCC. METHODSThirty patients with advanced TESCC hospitalized in our hospital from July 2016 to June 2019 were prospectively studied. All patients received NCRT, which included intensity modulated conformal radiotherapy (40-44 Gy/20-22f, 2 Gy/f) and chemotherapy (paclitaxel 150-175 mg/m2d1, 22 + lobaplatin 25-30 mg/m2d2, 23 for two cycles). Surgery was performed after radiotherapy and chemotherapy. The effectiveness and safety of these treatments were observed. RESULTSAmong these 30 patients, complete response was achieved in two cases (6.7%) and partial response in 26 cases (86.7%), yielding an objective response rate of 100%. All patients underwent radical surgery successfully. The R0 resection rate was 100%, and the pathologic complete response rate was 33.3%. The incidence of grade III- IV granulocytopenia was 10% during the NCRT, and anastomotic leakage occurred in one patient after surgery. CONCLUSIONFor patients with potentially resectable TESCC, NCRT can effectively reduce the tumor size, increase R0 resection rate, and achieve obvious pathological degradation, with mild adverse reactions. Thus, it is worthy of wider clinical application.

127P A prospective phase II clinical trial exploring neoadjuvant immunotherapy combined with chemotherapy in resectable thoracic esophageal squamous cell cancer (TESCC) with multi-station lymph node metastases (NICE study): Preliminary results

127P A prospective phase II clinical trial exploring neoadjuvant immunotherapy combined with chemotherapy in resectable thoracic esophageal squamous cell cancer (TESCC) with multi-station lymph node metastases (NICE study): Preliminary results

Comparisons of short-term outcomes between robot-assisted and thoraco-laparoscopic esophagectomy with extended two-field lymph node dissection for resectable thoracic esophageal squamous cell carcinoma.

Video-assisted thoracoscopic surgery has been identified as priori choice compared with open approaches in esophageal cancer surgery. With the developments in the Da Vinci robotic system, the robot-assisted minimally invasive esophagectomy (RAMIE) has been increasingly popular. However, whether RAMIE could be a better choice over thoraco-laparoscopic minimally invasive esophagectomy (TLMIE) is unclear. The clinicopathological characteristics of patients who received RAMIE or TLMIE with modern two-field lymph node dissection in Sun Yat-sen University Cancer Center between Jan 2016 to Jan 2018 were retrospectively retrieved. The 1:1 propensity score match analysis was performed to compare the short-term effectiveness and safety between the two groups. Two hundred and fifteen esophageal squamous cell carcinoma (ESCC) patients received RAMIE (101 patients) or TLMIE (114 patients) were included in the analysis. After a 1:1 propensity score matching, 108 patients (54 pairs) who received RAMIE or TLMIE displayed no significant variance in baseline clinicopathological characteristics. No significant difference in operative time, intraoperative blood loss, number of resected lymph nodes, and R0 resection rates were observed between the matched groups. However, the recurrent laryngeal nerve protection was better in RAMIE group (P=0.021). Nevertheless, both the incidences of common postoperative complications and length of ICU (hospital) stay were similar in two groups. The average total (P=0.009) and daily (P=0.028) expenses of RAMIE were higher. In general, RAMIE could benefit patients by providing better recurrent laryngeal nerve protection. In order to promote the applications of RAMIE, more efforts should be made to reduce the costs by the social and medical insurance agencies.

Lymphovascular invasion as an independent prognostic indicator in radically resected thoracic esophageal squamous cell carcinoma.

BackgroundThe prognostic value of lymphovascular invasion (LVI) in esophageal cancer remains controversial. This study investigated the impact of LVI on prognosis in thoracic esophageal squamous cell carcinoma (ESCC).MethodsA total of 1586 patients who underwent radical esophagectomy were selected for the study. Correlations between LVI and clinicopathological features were evaluated by χ2 test. Univariate analysis of the survival curve was conducted using the Kaplan–Meier method. Multivariate analysis was carried out by Cox regression. The Akaike information criterion (AIC) and the concordance index (c‐index) were employed to assess model prognostic accuracy of different pN staging systems.ResultsThe presence of LVI was detected in 406 of 1586 (25.6%) patients. LVI frequency was significantly higher in patients with higher pN classifications (P < 0.001). LVI had independent significant prognostic value in ESCC (P < 0.001). In subgroup analyses, the presence of LVI significantly decreased overall survival in pN0, pN2, and pN3 stage patients. The AIC value of the pN staging system modified by LVI was lower than that of the current pN staging system, while the c‐index of the modified pN staging system was higher than that of the current pN staging system.ConclusionOur results suggest that LVI is an independent prognostic indicator in radically resected thoracic ESCC. LVI could potentially supplement the pN ESCC staging system. ESCC patients with LVI could be staged at more advanced pN classifications.

PS02.233: PRETREATMENT PROGNOSTIC FACTORS IN PATIENTS WITH RESECTABLE CSTAGE II-IV THORACIC ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Background Background Advanced esophageal cancer patients often develop tumor recurrence even after curative resection. Inexpensive and easily available prognostic factors are expected in daily clinical practice. The aim of this study was to identify the prognostic factors in patients with resectable cStage II-IV thoracic esophageal squamous cell carcinoma. Methods Patients and Methods The study included 118 patients who underwent esophagectomy with curative intent for resectable cStage II-IV thoracic ESCC between January 2000 and December 2014. Time-dependent receiver operating characteristic curve analyses for 3-year overall survival (OS) as the endpoint were calculated, and the maximal Youden index was estimated to set the cut-off value for continuous variables. Survival rates were calculated by Kaplan-Meier method, and survival curves were compared using log-rank test. Univariate analysis and multivariate analysis for OS were conducted with Cox proportional hazards models. Results Results The median follow-up period was 33 months (1–160 months). The 5-year OS rate for the entire study population was 52.2%. In univariate analysis, age (70 &lt; ), sex, performance statue, American Society of Anesthesiologists Physical Status (ASA), serum squamous cell carcinoma antigen level (1.2 ng/ml &lt; ), lymphocyte count (≤ 1172/μl), serum albumin level (≤ 3.7 g/dl), total cholesterol level (≤ 193 mg/dl), and C-reactive protein level (0.28 &lt; mg/dl) were significantly associated with OS. In multivariate analysis, ASA (HR for ASA 2: 1.457, 95%CI 0.594–3.579; HR for ASA 3: 7.427, 95%CI 2.189–25.199; P = 0.001) and total cholesterol level (HR 0.506, 95% CI 0.261–0.983; P = 0.044) were independent prognostic factors for OS. The 5-year relapse free survival (RFS), cancer specific survival (CSS) and OS were 58.4%, 74.5% and 67.5% in high- total cholesterol group, and 38.7%, 51.3% and 39.1% in low- total cholesterol group, respectively (P = 0.031 in RFS, P = 0.004 in CSS, and P = 0.002 in OS). Conclusion Our findings showed that pretreatment total cholesterol level and ASA are independent prognostic factors of overall survival in patients with resectable cStage II-IV thoracic esophageal squamous cell carcinoma. Disclosure All authors have declared no conflicts of interest.

RA07.07: THE ROLE OF 18F-FLUORODEOXYGLUCOSE POSITRON-EMISSION TOMOGRAPHY ON SURVIVAL OF PATIENTS FOLLOWING NEOADJUVANT CHEMOTHERAPY AND SURGERY FOR ESOPHAGEAL CANCER

Abstract Background The occurrence of lymph node metastases (LNMs) is a critical factor for postoperative survival in patients with esophageal cancer. Generally F-fluorodeoxyglucose positron-emission tomography (FDG-PET) has a low sensitivity and a relatively high rate of false-negative for detecting LNMs. However, the role of FDG-PET in predicting the outcome is still unclear. The aim of this study is to assess the role of FDG-PET in predicting survival in patients with resectable thoracic esophageal squamous cell carcinoma (TESCC) treated with neoadjuvant chemotherapy (NAC). Methods Seventy-three patients with TESCC received NAC followed by surgery, and underwent FDG-PET before NAC in our hospital between January 2012 and November 2016. The number of PET-positive lymph nodes (LNs) and the maximum standardized uptake value (SUVmax) of the LNs were prospectively evaluated. The results of FDG-PET were compared with the pathological results and the prognosis. Results 15 patients had no PET-positive LNs, 23 had one, 15 had two and 20 patients had three or more positive LNs. A significantly high proportion of the PET-positive LNs ≧3 group had ≧3 pathological LNMs than the PET-positive LNs ≦2 group (70.0 vs. 22.6%, P &lt; 0.001). The PET-positive LNs ≧3 group also had a significantly lower 3-year overall survival rate (47.9 vs. 71.9%, P = 0.018). Univariate Cox's proportional hazard regression analyses revealed the PET-positive LNs ≧3 status (Hazard ratio = 2.68 [1.14–6.28], P = 0.024) and the SUVmax of the LNs ≧8 status (Hazard ratio = 2.45 [1.06–5.65], P = 0.036) were significant prognostic factors. On the other hand, the SUVmax of the primary tumor was not a significant prognostic factor. Conclusion We identified the PET-positive LNs ≧3 status and the SUVmax of the LNs ≧8 status in patients with resectable TESCC before NAC as potential adverse prognostic factors for survival. Disclosure All authors have declared no conflicts of interest.

Pretreatment NRS-2002 scores combined with hematologic inflammation markers are independent prognostic factors in patients with resectable thoracic esophageal squamous cell carcinoma.

BackgroundThe purpose of this study was to investigate the prognostic values of Nutritional Risk Screening 2002 (NRS-2002) and hematologic inflammation markers in patients with esophageal squamous cell carcinoma (ESCC) receiving curative esophagectomy.Materials and methodsA total of 277 patients with ESCC treated with standard curative esophagectomy were retrospectively analyzed. These patients were grouped for further analysis according to the systemic inflammation score (SIS), the combination of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio (CNP) score and NRS-2002 score. The Kaplan–Meier method and log-rank test were adopted to calculate and compare the progression-free survival (PFS) and overall survival (OS) rates with these parameters. The Cox proportional hazards model was used to carry out univariate and multivariate analyses. Receiver operating characteristic (ROC) curves were applied to verify the accuracy of SIS, CNP and NRS-2002 for survival prediction.ResultsIn univariate analysis, the following factors were significantly associated with poor PFS and OS: sex, T stage, N stage, TNM stage, SIS, CNP and NRS-2002 (all P<0.05). Furthermore, multivariate Cox regression analysis showed that CNP (hazard ratio [HR]=1.602; 95% confidence interval [CI] 1.341–1.913; P=0.000), NRS-2002 (HR=2.062; 95% CI 1.523–2.792; P=0.000) and TNM stage (HR=1.194; 95% CI 1.058–1.565; P=0.048) were independent prognostic factors for PFS. Correspondingly, CNP (HR=1.707; 95% CI 1.405–2.074; P=0.000), NRS-2002 (HR=2.716; 95% CI 1.972–3.740; P=0.000) and TNM stage (HR=1.363; 95% CI 1.086–1.691; P=0.036) were also independent prognostic factors for OS. Finally, the results of ROC curves indicated that CNP and NRS-2002 were superior to SIS as a predictive factor for PFS or OS in patients with ESCC receiving surgery.ConclusionThis study demonstrated that CNP combined with NRS-2002 is promising as a predictive marker for predicting clinical outcomes in patients with ESCC receiving surgery.

Evaluation of prognostic markers for patients with curatively resected thoracic esophageal squamous cell carcinomas.

The Glasgow Prognostic Score (GPS), neutrophil/lymphocyte ratio (NLR) and prognostic nutritional index (PNI) are prognostic parameters for malignancies. Additionally, serum squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragments (CYFRA 21-1) are tumor markers for squamous cell carcinoma. In the present study, the prognostic importance of these markers in patients with resectable thoracic esophageal cancer was investigated. In this retrospective study, 84 enrolled patients diagnosed with resectable clinical stage I-III thoracic esophageal squamous cell carcinomas (ESCCs) underwent thoracic esophageal resection and three-field lymph node dissection at Tottori University Hospital between January 2007 and December 2013. The correlations among preoperative patient markers (GPS, NLR, PNI, SCC-Ag and CYFRA 21-1) and the occurrence of postoperative complications and patient survival were analyzed. The operative mortality was 2.4%, and morbidity was 42.9%. Strong correlations between occurrence of postoperative complications and open thoracotomy (P=0.083) and high-serum CYFRA 21-1 (P=0.007) were observed. In 15 patients with high-serum CYFRA 21-1, postoperative complications were detected in 11 of them (73.3%); on the other hand, complications occurred in 25 of 69 (36.2%) with low-serum CYFRA 21-1. The 5-year disease-free survival rate and 5-year overall survival rate of all the patients were 52.2 and 50.8%, respectively. Among the prognostic parameters, preoperative high NLR was determined to be a poor prognostic factor, independent of the tumor stage in the multivariate analysis. These results may indicate that, in patients with preoperative high-serum CYFRA 21-1, more attention should be paid to the occurrence of postoperative complications. Therefore, in such cases, anastomosis between blood vessels of the substitute esophagus and cervical vessels would be recommended. Furthermore, in patients with high preoperative NLR, effective adjuvant chemoradiotherapy should be considered to prolong the patients' survival, even of stage I or II patients.

The pretreatment Controlling Nutritional Status (CONUT) score is an independent prognostic factor in patients with resectable thoracic esophageal squamous cell carcinoma: results from a retrospective study.

BackgroundThe purpose of this study was to investigate the impact of the Controlling Nutritional Status (CONUT) score on survival compared with the platelet to lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), and the Glasgow Prognostic Score (GPS) in patients with resectable thoracic esophageal squamous cell carcinoma (ESCC).MethodsOne hundred eighty-five consecutive patients who underwent subtotal esophagectomy with curative intent for resectable thoracic ESCC were retrospectively reviewed. Time-dependent receiver operating characteristic curve analyses for 3-year overall survival (OS) as the endpoint were performed, and the maximal Youden indices were calculated to assess discrimination ability and to determine the appropriate cut-off values of CONUT, PLR, and NLR. The patients were then classified into high and low groups based on these cut-off values. Correlations between CONUT and other clinicopathological characteristics were analyzed. Prognostic factors predicting overall survival (OS) and relapse-free survival (RFS) were analyzed using Cox proportional hazards models.ResultsThe areas under the curve predicting 3-year OS were 0.603 for CONUT, 0.561 for PLR, 0.564 for NLR, and 0.563 for GPS. The optimal cut-off values were two for the CONUT score, 193 for PLR, and 3.612 for NLR. The high-CONUT group was significantly associated with lower BMI, high-PLR, high-NLR, and GPS1/2 groups. On univariate analysis, high-CONUT, high-PLR, high-NLR, and GPS 1/2 groups were significantly associated with poorer OS and RFS. Of these factors, multivariate analysis revealed that only the CONUT score was an independent prognostic factor for OS (HR 2.303, 95 % CI 1.191–4.455; p = 0.013) and RFS (HR 2.163, 95 % CI 1.139–4.109; p = 0.018).ConclusionsThe CONUT score was an independent predictor of OS and RFS before treatment and was superior to PLR, NLR, and GPS in terms of predictive ability for prognosis in patients with resectable thoracic ESCC.

Optimal Adjuvant Treatment for Curatively Resected Thoracic Esophageal Squamous Cell Carcinoma: A Radiotherapy Perspective.

PurposeThe purpose of this study was to evaluate the benefits of adjuvant treatment for curatively resected thoracic esophageal squamous cell carcinoma (ESCC) and determine the optimal adjuvant treatments.Materials and MethodsOne hundred ninety-five patients who underwent a curative resection for thoracic ESCC between 1994 and 2014 were reviewed retrospectively. Postoperatively, the patients received no adjuvant treatment (no-adjuvant group, n=68), adjuvant chemotherapy (AC group, n=62), radiotherapy (RT group, n=41), or chemoradiotherapy (CRT group, n=24). Chemotherapy comprised cisplatin and 5-fluorouracil administration every 3 weeks. The median RT dose was 45.0 Gy (range, 34.8 to 59.4 Gy). The overall survival (OS), disease-free survival (DFS), locoregional recurrence (LRR), and distant metastasis (DM) rates were estimated.ResultsAt a median follow-up duration of 42.2 months (range, 6.3 to 215.2 months), the 5-year OS and DFS were 37.6% and 31.4%, respectively. After adjusting for other clinicopathologic variables, the AC and CRT groups had a significantly better OS and DFS compared to the no-adjuvant group (p < 0.05). The LRR rate was significantly lower in the RT and CRT groups than in the no-adjuvant group (p < 0.05), whereas no significant difference was observed in the AC group. In the no-adjuvant and AC groups, 25% of patients received high-dose salvage RT due to LRR. The DM rates were similar. The anastomotic stenosis and leakage were similar in the treatment groups.ConclusionAdjuvant treatment might prolong survival after an ESCC resection, and RT contributes to a reduction of the LRR. Overall, the risks and benefits should be weighed properly when selecting the optimal adjuvant treatment.

Efficacy of intensity-modulated radiotherapy for resected thoracic esophageal squamous cell carcinoma.

BackgroundLittle is known about the clinical use of intensity-modulated radiotherapy (IMRT) in postoperative radiotherapy (PORT) of esophageal cancer; therefore, we retrospectively investigated the clinical value of postoperative IMRT among resected thoracic esophageal squamous cell carcinoma (TESCC) patients.MethodsWe enrolled a total of 228 patients with resected TESCC who underwent IMRT between January 2004 and June 2009 in the study. PORT was applied via IMRT with a median total dose of 60 Gy. The Kaplan–Meier method was used to calculate survival rates, and a log-rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis.ResultsThe one, three, and five-year overall survival rates of all patients were 89.9%, 56.7%, and 45.1%, respectively. Univariate analysis showed that significant prognostic factors included Union for International Cancer Control 2002 stage, lymphatic metastasis, number of metastatic lymph nodes, the degree of metastatic lymph nodes, the degree of differentiation, and vascular tumor thrombus (P < 0.05). Treatment failure occurred in 98 (45.2%) patients because of recurrence or metastases. Early reactions were observed at rates of 18.0% for radiation esophagitis and 5.7% for radiation pneumonitis more than grade 2. Late side effects included anastomotic stenosis (1.3%) and gastrointestinal bleeding (3.1%).ConclusionsThe postoperative prophylactic IMRT of TESCC provided a favorable local control rate and acceptable toxicity.

Postoperative adjuvant therapy for resectable thoracic esophageal squamous cell carcinoma: a retrospective analysis of 426 cases.

The aim of this study was to evaluate the value of postoperative adjuvant therapy for resectable thoracic esophageal squamous cell carcinoma (ESCC) in China. We retrospectively analyzed 426 eligible patients seen between October 2007 and November 2011. Specifically, we assessed clinicopathological characteristics and the disease-free and overall survival rates. Of the 426 patients, 272 cases underwent surgery alone, and 154 cases received postoperative adjuvant therapy (67 cases with radiotherapy, 57 cases with chemotherapy, and 30 cases with simultaneous chemoradiotherapy). The median follow-up time was 48.0months (23.0-72.0months), and the median survival time was 48.4months (1.0-72.0months). We found a significant difference between the surgery-alone and adjuvant therapy groups in the status of lymph node (LN) metastasis (N stage; P<0.01), but there were no differences between the two groups with regard to other clinicopathological characteristics, including age, sex, lesion location, T stage, differentiation grades, surgery approach, or average number of LN dissections. The 5-year disease-free survival (DFS) rates of the surgery-alone and adjuvant therapy groups were 48.9 and 37.1%, respectively (P<0.001); no significant difference was found in 5-year overall survival (OS) rate between the two groups (P>0.05). A stratification analysis based on N stage suggested that the 5-year DFS and OS rates were similar in N0-N3 subgroups (P>0.05), except that patients with surgery alone had a higher 5-year DFS than those with postoperative adjuvant therapy in N0 subgroup (P=0.013). Our data suggest that patients with resectable thoracic ESCC may not benefit from postoperative adjuvant therapy. Further prospective studies are required to elucidate the utility of postoperative adjuvant therapy and to standardize individualized treatments for resectable ESCC.

Adjuvant chemotherapy versus surgery alone for esophageal squamous cell carcinoma: a meta-analysis of randomized controlled trials and nonrandomized studies

The effect of adjuvant chemotherapy on survival of patients with thoracic esophageal squamous cell carcinomas is still controversial, and the subgroup of patients who will most likely benefit from the adjuvant chemotherapy on long-term survival has not yet been identified clearly. Studies published from 1995 to May 2012 were searched in Medline, Embase, PubMed, Cancerlit, the Cochrane Library, CNKI and major scientific meetings. Randomized controlled trials and nonrandomized studies comparing surgery plus adjuvant chemotherapy with surgery alone in patients with resectable thoracic esophageal squamous cell carcinomas were included. Eleven studies with a total of 2047 patients were identified, consisting of the adjuvant chemotherapy arm (n = 887) and surgery-alone arm (n = 1160). There was not statistically significant benefit on 3-year overall survival for adjuvant chemotherapy (risk ratio [RR] = 0.89, 95% confidence interval [CI], 0.72 to 1.09; P = 0.25). Adjuvant chemotherapy could significantly prolong the 1-year disease-free survival (DFS) (RR = 0.68, 95%CI, 0.51 to 0.89; P = 0.006), but not 3-year DFS (RR = 0.97, 95%CI, 0.73 to 1.29; P = 0.84). Further analysis showed that patients with stage III-IV diseases could benefit from adjuvant chemotherapy on 3-year overall survival (RR = 0.43, 95%CI, 0.31 to 0.61; P = 0.00001), but not in the case of patients with stageI-IIdiseases (RR = 1.12, 95%CI, 0.65 to 1.93; P = 0.68). Additionally, patients with positive lymph node could benefit on 5-year DFS from adjuvant chemotherapy (RR = 0.79, 95%CI, 0.64 to 0.99; P = 0.04). The modality treatment with adjuvant chemotherapy for patients with squamous cell carcinoma of thoracic esophagus might be determined according to pathological stage or the status of lymph node metastasis.

A efficacy analysis of intensity-modulated radiotherapy or three-dimensional conformal radiotherapy for resected thoracic esophageal squamous cell carcinoma

Objective To analyze retrospectively the clinical therapeutic effect and toxicities of three-dimensional conformal radiotherapy ( 3DCRT) or intensity modulated radiotherapy ( IMRT) for resected stage Ⅱ/Ⅲ thoracic esophageal squamous cell carcinoma ( TESCC). Methods A total of 251patients with resected TESCC underwent 3DCRT or IMRT at the Cancer Hospital ( Institute) , Chinese Academy of Medical Sciences between 2004. 1 t0 2009. 7 enrolled. Postoperative radiotherapy applied via 3DCRT ( 20 patients) or IMRT (231 patients) with a median total dose of 60 Gy. The Kaplan-Meier methodwas used to calculate the survival rates, and the log-rank test was used for univariate analysis. The Cox proportional model was used for multivariate analysis. Results The follow-up rate was 98. 8％ . 159 and 57 patients were followed t0 3 and 5 years, respectively. The 1-, 3-and 5-year overall survival ( OS) rates for all the patients were 90. 8％ , 56. 1％ and 45. 8％ , respectively. For the stage Ⅱa, Ⅱb, and Ⅲ stage patients , the 5-year OS rates were 65. 0％ , 53. 8％ and 38. 4％ , respectively ( X2 = 7. 30 , P = 0. 026) . The 5-year OS rates were 64. 9％ and 40. 4％ for the patients with negative and positive lymph node metastasis ( X2 =7. 04 , P = 0. 008 ) . Univariate analysis showed that the significant prognostic factors include UICC 2002 stage, the degree of differentiation, lymphatic metastasis and vascular carcinomatous thrombus ( X2 =7. 30 ,7. 04 , 8. 34 ,9. 40 , P = 0. 026 , 0. 008 , 0. 004 ,0.002 ) . Multivariate analysis revealed that the grade of differentiation, lymphatic metastasis and vascular carcinomatous thrombus were independent prognostic factors ( X2 = 6. 86, 5. 27, 4. 24, P= 0. 009, 0. 022, 0. 040 ). Treatment failure occurred in 58 patients because of systemic metastases , 14 cervical lymph node recurrence , 17 abdominal lymph node metastases, and 31 0f intrathoracic recurrence. Five patients had grade 2 0r worse late treatment-related anastomotic stenosis , and 8 patients died from late treatment-related gastrointestinal bleeding. Conclusions Postoperative prophylactic 3DCRT or IMRT of TESCC can provide a favorable local control rate and acceptable toxicity. Postoperative radiotherapy should be included into the standard treatment of Stage ⅢTESCC or TESCC with lymph node metastasis. Key words: Esophageal neoplasms/surgery; Intensity-modulated radiotherapy,postoperative; Three-dimensional conformal radiotherapy,postoperative; Prognosis