Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan.
Oncology. 2023;101(3):203-212. doi: 10.1159/000528937. Epub 2023 Jan 4.
This study aimed to clarify the impact of the average relative dose intensity (RDI) of neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-NAC) for resectable locally advanced esophageal squamous cell carcinoma (ESCC).
To identify the optimal RDI, recurrence-free survival (RFS) and cumulative incidence function (CIF) for recurrence were calculated in low and high RDI groups with any cut-off points. The optimal RDI was defined as the highest RDI administered with a significant increase in either RFS or CIF. The clinicopathological characteristics of the two groups divided by optimal RDI were investigated. The preoperative prognostic factors associated with RFS were confirmed by multivariable Cox proportional hazards model.
Among the 150 eligible patients treated with DCF-NAC from 2010 to 2020, 3-year RFS and CIF were 56.3% and 37.8% in 90 patients in the less than 80% RDI group (<80% RDI) and 73.3% and 26.7% in 60 patients in the more than or equal to 80% RDI group (≥80% RDI), respectively. The optimal cut-off RDI was identified as 80%. The <80% RDI group included older individuals, a lower value of creatinine clearance, a higher Charlson Comorbidity Index, reduced RDI at first course, and grade 1-0 in the histopathological tumor response than the ≥80% RDI group. R0 resection and postoperative complication rates were equal in both groups. Cox proportional hazards model identified the response rate and RDI as predictors of RFS.
An average RDI of more than or equal to 80% improved prognosis in patients receiving DCF-NAC for ESCC.
本研究旨在阐明多西他赛、顺铂和 5-氟尿嘧啶（DCF-NAC）新辅助化疗在可切除局部晚期食管鳞癌（ESCC）中的平均相对剂量强度（RDI）对预后的影响。
为了确定最佳 RDI，对于任何截断值，在低 RDI 组和高 RDI 组中计算无复发生存（RFS）和复发累积发生率（CIF）。最佳 RDI 定义为与 RFS 或 CIF 显著增加相关的最高 RDI 给药。通过最优 RDI 分组，研究两组的临床病理特征。采用多变量 Cox 比例风险模型确定与 RFS 相关的术前预后因素。
在 2010 年至 2020 年期间，150 例接受 DCF-NAC 治疗的患者中，90 例 RDI 低于 80%（<80% RDI）的患者 3 年 RFS 和 CIF 分别为 56.3%和 37.8%，60 例 RDI 大于或等于 80%（≥80% RDI）的患者 3 年 RFS 和 CIF 分别为 73.3%和 26.7%。最佳截断 RDI 为 80%。<80% RDI 组患者年龄较大，肌酐清除率较低，Charlson 合并症指数较高，第一疗程 RDI 降低，组织病理学肿瘤反应程度为 1-0 级。两组患者 R0 切除率和术后并发症发生率相等。Cox 比例风险模型确定反应率和 RDI 是 RFS 的预测因子。
对于接受 DCF-NAC 治疗的 ESCC 患者，RDI 大于或等于 80% 可改善预后。
