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17-12-2022 | Esophageal Cancer | Thoracic Oncology

Development and Validation of a Predictive Model of Therapeutic Effect in Patients with Esophageal Squamous Cell Carcinoma Who Received Neoadjuvant Treatment: A Nationwide Retrospective Study in Japan

Authors: Akihiko Okamura, MD, PhD, Masayuki Watanabe, MD, PhD, Jun Okui, MD, MPH, Satoru Matsuda, MD, PhD, Ryo Takemura, PhD, Hirofumi Kawakubo, MD, PhD, Hiroya Takeuchi, MD, PhD, Manabu Muto, MD, PhD, Yoshihiro Kakeji, MD, PhD, Yuko Kitagawa, MD, PhD, Yuichiro Doki, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2023

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Abstract

Background

Neoadjuvant treatment has become the standard of care for patients with advanced esophageal cancer. However, few studies have elucidated the clinical factors that predict response to neoadjuvant therapy in a large multicenter cohort. We aimed to develop a predictive model of therapeutic effect in patients with esophageal squamous cell carcinoma (SCC) who received neoadjuvant treatment.

Methods

This nationwide study included 4078 patients from 85 institutions. Patients who received neoadjuvant treatment followed by surgery for esophageal SCC were eligible. We developed a logistic regression model to predict good pathological therapeutic effects, and a predictive nomogram was generated by applying the logistic regression formula.

Results

Among neoadjuvant regimens, cisplatin plus 5-fluorouracil (CF) was the most frequently used (60.2%), followed by docetaxel plus CF (DCF, 27.4%), CF with radiotherapy (CF-RT, 4.5%), adriamycin plus CF (3.6%), nedaplatin plus 5-fluorouracil (0.9%), and DCF-RT (0.5%). Multivariable analysis revealed that male sex, advanced cT category, and increased pretherapeutic SCC antigen level were independently associated with not achieving a good therapeutic effect. Moreover, intensified neoadjuvant regimens were independently associated with favorable therapeutic effects; DCF-RT elicited the best therapeutic effect, followed by CF-RT and DCF. A predictive model including nine commonly measured preoperative variables was generated, and the area under the curve was 0.679 (95% confidence interval: 0.658–0.700). This nomogram was also adequately validated internally.

Conclusions

The model developed in this study was validated and predicts the therapeutic effect in patients with esophageal SCC who received neoadjuvant treatment. This model might contribute to individualized treatment strategies.
Appendix
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Metadata
Title
Development and Validation of a Predictive Model of Therapeutic Effect in Patients with Esophageal Squamous Cell Carcinoma Who Received Neoadjuvant Treatment: A Nationwide Retrospective Study in Japan
Authors
Akihiko Okamura, MD, PhD
Masayuki Watanabe, MD, PhD
Jun Okui, MD, MPH
Satoru Matsuda, MD, PhD
Ryo Takemura, PhD
Hirofumi Kawakubo, MD, PhD
Hiroya Takeuchi, MD, PhD
Manabu Muto, MD, PhD
Yoshihiro Kakeji, MD, PhD
Yuko Kitagawa, MD, PhD
Yuichiro Doki, MD, PhD
Publication date
17-12-2022
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 4/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-022-12960-9

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