Prognostic Factors for Patients With Esophageal Squamous Cell Carcinoma After Neoadjuvant Chemotherapy Followed by Surgery

Abstract

Background/aim: Neoadjuvant chemotherapy (NAC) followed by surgery is a standard treatment for patients with locally advanced esophageal cancer. This study aimed to identify patients who might be eligible for postoperative adjuvant therapy.

Patients and methods: We reviewed the surgical outcomes of 84 patients who received NAC followed by esophagectomy to treat esophageal squamous cell carcinoma (ESCC) and revealed prognostic factors associated with locally advanced ESCC.

Results: Univariate and multivariate analyses revealed the pretreatment level of squamous cell carcinoma-related antigen [SCC-A; hazard ratio (HR)=1.50, p=0.01], ypT ≥3 (HR=2.51; p=0.04), ypN ≥1 (HR=5.87; p=0.01), ypM1 (HR=2.38; p=0.049), and lymphovascular invasion (HR=3.12, p=0.049) as significant independent covariates for recurrence-free survival (RFS). The 5-year RFS rates for patients with 0-1, 2-3, or 4-5 of these indicators of poor prognosis were 97.1%, 51.2%, and 6.7% (p≤0.001 for all). Recurrence rates among these groups also significantly differed at 2.9%, 50.0%, and 93.3% (p<0.0001).

Conclusion: Pretreatment SCC-A, ypT, ypN, ypM, and lymphovascular invasion were significantly associated with RFS in patients with ESCC who received NAC followed by surgery. The status of these prognostic factors in ESCC might indicate a need for postoperative adjuvant therapy after NAC followed by surgery.

Keywords: Cancer; esophagus; metastasis; recurrence; surgery; survival.