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25-04-2024 | Esophageal Cancer | Thoracic Oncology

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

Authors: 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

Published in: Annals of Surgical Oncology

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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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Metadata
Title
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
Authors
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
Publication date
25-04-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15314-9
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