Systemic control and evaluation of the response to neoadjuvant chemotherapy in resectable thoracic esophageal squamous cell carcinoma with ¹⁸F-fluorodeoxyglucose positron emission tomography-positive lymph nodes.

PURPOSE

(18)F-fluorodeoxyglucose positron emission tomography-positive lymph nodes (PET-N positive) in patients with resectable thoracic esophageal squamous cell carcinoma (TESCC) are associated with a high rate of postoperative distant recurrence. The purpose of this study was to evaluate the systemic control and survival benefit of neoadjuvant chemotherapy (NAC, cisplatin + doxorubicin + 5-fluorouracil) in these patients.

METHODS

Of 77 patients with resectable TESCC who were PET-N positive, we evaluated 51 treated with NAC + surgery in this study and 26 who had undergone surgery alone (SA) in a previous study. Historical comparisons of the groups were made, and the response to treatment was evaluated in the NAC group.

RESULTS

The NAC group had a higher rate of pN0-1 and a lower rate of postoperative recurrence (p < 0.0001 and p < 0.024, respectively) than the SA group; however, their relapse-free survival (RFS) rates were not significantly different. The NAC group had a significantly higher RFS in cT1/T2 cases, but showed similar survival in cT3 cases. On the other hand, post-treatment PET-N-negative patients had a higher RFS (p = 0.008) and a lower rate of distant recurrence (p = 0.021), even with cT3 disease. A multivariate analysis identified the post-treatment PET-N evaluation to be the only significant predictor of the RFS in cT3 cases.

CONCLUSIONS

NAC significantly suppressed postoperative recurrence in TESCC PET-N-positive patients, but the survival benefit was unclear. However, post-treatment PET-N-negative patients were likely responders to NAC.