Yokota Tomoya, Ando Nobutoshi, Igaki Hiroyasu, Shinoda Masayuki, Kato Ken, Mizusawa Junki, Katayama Hiroshi, Nakamura Kenichi, Fukuda Haruhiko, Kitagawa Yuko
Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
Oncology. 2015;89(3):143-51. doi: 10.1159/000381065. Epub 2015 Apr 16.
Neoadjuvant chemotherapy with 5-fluorouracil plus cisplatin and subsequent esophagectomy with two- to three-field lymphadenectomy is a standard treatment for patients with clinical stage II/III squamous cell carcinoma (SCC) of the esophagus. This study investigates the prognostic factors for patients who received neoadjuvant chemotherapy.
Of 164 patients assigned to receive neoadjuvant chemotherapy in the JCOG9907 trial, multivariate analyses were performed for 159 and 149 patients to evaluate the preoperative and the combined preoperative and postoperative prognostic factors, respectively.
The multivariate analyses using preoperative factors showed that clinical stage T3 [vs. cT1-2; hazard ratio (HR) 3.60, p = 0.0007] and serum albumin (Alb) <4.0 g/dl (vs. ≥ 4.0 g/dl; HR 2.29, p = 0.0005) were associated with a poor prognosis. Four independent prognostic factors were identified by multivariate analysis of both preoperative and postoperative factors: pathological curability B (pB; R0 with stage IV or pD < pN) or pC [microscopic or macroscopic residual tumor (R1/R2)] [vs. pA (R0); HR 1.93, p = 0.015], pathological stage N1 (vs. pN0; HR 3.86, p = 0.0012), cT3 (vs. cT1-2; HR 2.80, p = 0.0073), and serum Alb <4.0 g/dl (vs. ≥ 4.0 g/dl; HR 2.03, p = 0.0069).
Preoperative cT stage, Alb, and postoperative pathological findings are independent prognostic factors for patients undergoing neoadjuvant chemotherapy for advanced thoracic esophageal SCC. This analysis may aid in stratification according to individual patient risk.
5-氟尿嘧啶联合顺铂新辅助化疗及随后的两野或三野淋巴结清扫食管切除术是临床II/III期食管鳞状细胞癌（SCC）患者的标准治疗方法。本研究调查接受新辅助化疗患者的预后因素。
在JCOG9907试验中，164例被分配接受新辅助化疗的患者中，分别对159例和149例患者进行多因素分析，以评估术前及术前与术后联合的预后因素。
术前因素的多因素分析显示，临床分期T3[对比cT1-2；风险比（HR）3.60，p = 0.0007]和血清白蛋白（Alb）<4.0 g/dl（对比≥4.0 g/dl；HR 2.29，p = 0.0005）与预后不良相关。通过对术前和术后因素的多因素分析确定了四个独立的预后因素：病理可治愈性B（pB；R0伴IV期或pD < pN）或pC[镜下或肉眼可见残留肿瘤（R1/R2）][对比pA（R0）；HR 1.93，p = 0.015]、病理分期N1（对比pN0；HR 3.86，p = 0.0012）、cT3（对比cT1-2；HR 2.80，p = 0.0073）和血清Alb <4.0 g/dl（对比≥4.0 g/dl；HR 2.03，p = 0.0069）。
术前cT分期、Alb及术后病理结果是晚期胸段食管SCC接受新辅助化疗患者的独立预后因素。该分析可能有助于根据个体患者风险进行分层。
