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Utility of Initial Tumor Reduction as a Prognostic Factor in Esophageal Squamous Cell Cancer Patients Undergoing Neoadjuvant Chemotherapy Followed by Surgery

A Retrospective Cohort Study

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

While a neoadjuvant chemotherapy regimen using docetaxel, cisplatin, and 5-fluorouracil (NAC-DCF) is considered the standard treatment for locally advanced esophageal cancer (EC) in Japan, a reliable marker for early prediction of treatment efficacy remains unclear. We investigated the utility of the tumor response after a first course of NAC-DCF as a post-surgery survival predictor in patients with EC.

Methods

We enrolled 150 consecutive patients who underwent NAC-DCF followed by surgery for EC between September 2009 and January 2019. The initial tumor reduction (ITR), defined as the percentage decrease in the shorter diameter of the tumor after the first course of NAC-DCF, was evaluated using computed tomography. We analyzed the relationship between ITR, clinicopathological parameters, and survival.

Results

The median ITR was 21.07% (range −11.45 to 50.13%). The optimal cut-off value for ITR for predicting prognosis was 10% (hazard ratio [HR] 3.30, 95% confidence interval [CI] 1.98–5.51), based on univariate logistic regression analyses for recurrence-free survival (RFS). Compared with patients with ITR <10%, patients with ITR ≥10% showed a significantly higher proportion of ypM0 (80.0% vs. 92.5%) and responders in terms of overall clinical response (50.0% vs. 80.8%). Multivariate analysis for RFS revealed that ypN2-3 (HR 2.78, 95% CI 1.67–4.62), non-response in terms of overall clinical response (HR 1.87, 95% CI 1.10–3.18), and ITR <10% (HR 2.48, 95% CI 1.42–4.32) were independent prognostic factors.

Conclusions

Tumor response after the first course of NAC-DCF may be a good predictor of survival in patients with EC who underwent NAC-DCF plus surgery.

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Acknowledgment

This study was supported by the YOKOYAMA Foundation for Clinical Pharmacology (Grant Number: YRY-2304). The authors would like to thank Editage (www.editage.jp) for English-language editing.

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Authors and Affiliations

  1. Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan

    Takaomi Hagi MD, PhD, Osamu Shiraishi MD, PhD, Tomoya Nakanishi MD, Masashi Kohda MD, Yoko Hiraki MD, PhD, Hiroaki Kato MD, PhD, Atsushi Yasuda MD, PhD, Masayuki Shinkai MD, PhD, Motohiro Imano MD, PhD & Takushi Yasuda MD, PhD

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Correspondence to Osamu Shiraishi MD, PhD.

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Takaomi Hagi, Osamu Shiraishi, Tomoya Nakanishi, Masashi Kohda, Yoko Hiraki, Hiroaki Kato, Atsushi Yasuda, Masayuki Shinkai, Motohiro Imano, and Takushi Yasuda have no conflicts of interest to declare in relation to this work.

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Hagi, T., Shiraishi, O., Nakanishi, T. et al. Utility of Initial Tumor Reduction as a Prognostic Factor in Esophageal Squamous Cell Cancer Patients Undergoing Neoadjuvant Chemotherapy Followed by Surgery. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15314-9

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