Improved prognosis with induction chemotherapy in pathological complete responders after trimodality treatment for esophageal squamous cell carcinoma: Hypothesis generating for adjuvant treatment
Journal
European Journal of Surgical Oncology
Journal Volume
45
Journal Issue
8
Pages
1498-1504
Date Issued
2019
Abstract
Purpose: To compare the locations of recurrences and survival outcomes in esophageal squamous cell carcinoma (ESCC) patients with pathological complete response (pCR) after neoadjuvant concurrent chemoradiotherapy (CCRT) with or without preceding induction chemotherapy (IC) followed by esophagectomy. Methods: Among 276 patients with locally advanced ESCC undergoing trimodality treatment during 2004–2014, 94 (34.1%) with pCR were eligible. The cohort included 26 patients undergoing IC before CCRT (IC group), and 68 patients who did not receive IC (non-IC group). Results: At a median follow-up of 51.4 months (95% confidence interval; 42.9–62.1), 19 patients experienced recurrences. There was a trend toward fewer distant failures in the IC group (0% vs.14.7%, p = 0.057), while locoregional recurrence was similar (7.7% vs. 7.4%). IC was associated with significantly improved survivals with the 5-year RFS and OS rates for the IC group of 85.1% and 90.5%, respectively, compared to of 46.2% and 48.1% for the non-IC group (p = 0.008 for RFS, and p = 0.015 for OS). By multivariable analyses, IC remained the only significant factor associated with survivals (HR:0.18 for RFS, p = 0.020 and HR:0.18 for OS, p = 0.025). The effect of IC in the whole cohort, irrespective of pathological response, was also assessed. Patients with non-pCR in the IC group had a trend toward worse survivals compared to the non-IC group Conclusions: In ESCC patients with pCR after trimodality treatment, IC was associated with favorable survivals. The benefits of IC might be a hypothesis generation for adjuvant treatment for patients with pCR. ? 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
SDGs
Other Subjects
cisplatin; fluorouracil; folinic acid; paclitaxel; adjuvant chemoradiotherapy; adult; aged; Article; cancer prognosis; cancer recurrence; cancer staging; cancer surgery; continuous infusion; controlled study; distant metastasis; esophageal squamous cell carcinoma; esophagus resection; female; follow up; human; induction chemotherapy; intensity modulated radiation therapy; lung metastasis; lymph node dissection; major clinical study; male; mediastinum metastasis; multimodality cancer therapy; overall survival; pneumonia; postoperative complication; priority journal; recurrence free survival; retrospective study; second cancer; surgical mortality; treatment response; chemoradiotherapy; cohort analysis; comparative study; disease free survival; esophagus resection; esophagus tumor; induction chemotherapy; Kaplan Meier method; middle aged; mortality; multimodality cancer therapy; neoadjuvant therapy; pathology; procedures; prognosis; proportional hazards model; risk assessment; squamous cell carcinoma; survival analysis; treatment outcome; tumor invasion; tumor recurrence; Adult; Aged; Carcinoma, Squamous Cell; Chemoradiotherapy; Cohort Studies; Combined Modality Therapy; Disease-Free Survival; Esophageal Neoplasms; Esophagectomy; Female; Humans; Induction Chemotherapy; Kaplan-Meier Estimate; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Survival Analysis; Treatment Outcome
Publisher
W.B. Saunders Ltd
Type
journal article