Comparison of therapeutic outcomes in esophageal squamous cell carcinoma following neoadjuvant chemoradiotherapy: A prospective observational cohort study

Yu-Wei Liu; Jui-Ying Lee; Yao-Kuang Wang; Yi-Hsun Chen; Pen-Tzu Fang; Shah-Hwa Chou; Ming-Huang Chen; Li-Yuan Bai; Chia-Jui Yen; Ming-Tsang Wu; I-Chen Wu

doi:10.1016/j.jfma.2023.06.010

Comparison of therapeutic outcomes in esophageal squamous cell carcinoma following neoadjuvant chemoradiotherapy: A prospective observational cohort study

J Formos Med Assoc. 2024 Jan;123(1):106-115. doi: 10.1016/j.jfma.2023.06.010. Epub 2023 Jun 27.

Authors

Yu-Wei Liu¹, Jui-Ying Lee², Yao-Kuang Wang³, Yi-Hsun Chen⁴, Pen-Tzu Fang⁵, Shah-Hwa Chou⁶, Ming-Huang Chen⁷, Li-Yuan Bai⁸, Chia-Jui Yen⁹, Ming-Tsang Wu¹⁰, I-Chen Wu¹¹

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, 807, Taiwan.
² Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
³ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
⁴ Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.
⁵ Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.
⁶ Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
⁷ Center of Immuno-Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁸ Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital and China Medical University, Taichung, Taiwan.
⁹ Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁰ PhD Program in Environmental and Occupational Medicine, College of Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, 807, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
¹¹ Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: minica@kmu.edu.tw.

PMID: 37385933
DOI: 10.1016/j.jfma.2023.06.010

Abstract

Background: Patients with locally advanced esophageal squamous cell carcinoma (ESCC) following neoadjuvant chemoradiotherapy (nCRT) may not always receive resection despite the possible achievement of a pathologic complete response (pCR) being associated with superior survival benefit. We aimed to compare outcomes among ESCC patients with or without pCR and those refusing surgery.

Methods: In total, 111 medically operable, non-cervical ESCC patients after the same protocol of nCRT (platinum/5-fluorouracil plus radiation 50Gy) were prospectively enrolled between 2011 and 2021. Eighty-three of them underwent esophagectomy comprising pCR (n = 32) and non-pCR (n = 51), while 28 operable patients declined surgery (refusal-of-surgery group). Predictors and survival data were analyzed.

Results: In terms of esophagectomy, 38.5% (32/83) patients achieved pCR. The pCR group exhibited better pretreatment performance status than the non-pCR group (adjusted odds ratio: 0.11, 95% confidence interval: 0.03-0.58; p = 0.01). Among pCR, non-pCR, and refusal-of-surgery groups, the 5-year overall survival (OS) rates were 56%, 29% and 50% (p = 0.08) and progression-free survival (PFS) rates were 52%, 28% and 36% (p = 0.07) respectively. The pCR group had significantly better OS and PFS than the non-PCR group (adjusted hazard ratio: 2.33 and 1.93, p = 0.02 and 0.049 respectively) but not the refusal-of-surgery group.

Conclusion: Better pretreatment performance status is associated with higher chance of pCR. Consistent with previous studies, we found attainment of pCR confers the best OS and PFS. Suboptimal OS in the refusal-of-surgery group reflects some of them would have residual disease in addition to complete remission. Further studies are needed to identify prognostic factors of pCR to select candidates who could validly decline esophagectomy.

Keywords: Esophageal squamous cell carcinoma; Esophagectomy; Neoadjuvant chemoradiotherapy; Pathologic complete response; Refusal of surgery.

Publication types

Observational Study

MeSH terms

Chemoradiotherapy
Esophageal Neoplasms* / drug therapy
Esophageal Squamous Cell Carcinoma* / drug therapy
Esophagectomy / methods
Humans
Neoadjuvant Therapy / methods
Neoplasm Staging
Prospective Studies
Retrospective Studies
Treatment Outcome