Okunaka Mashiro, Kotani Daisuke, Fujiwara Hisashi, Sato Kazuma, Fujiwara Naoto, Mishima Saori, Sakashita Shingo, Yoshino Takayuki, Fujita Takeo, Kojima Takashi
Department of Pharmacy, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
Ther Adv Med Oncol. 2024 Feb 22;16:17588359241229432. doi: 10.1177/17588359241229432. eCollection 2024.
Docetaxel, cisplatin, and 5-fluorouracil (DCF) combination chemotherapy has been established as one of the standard neoadjuvant therapies for locally advanced esophageal squamous cell carcinoma (ESCC). However, little is known about prognostic factors in patients with residual pathological disease after neoadjuvant DCF followed by surgery for locally advanced ESCC who are candidates for adjuvant nivolumab.
This study aimed to investigate prognostic factors in patients with residual pathological disease after neoadjuvant DCF chemotherapy followed by surgery for locally advanced ESCC.
This was a retrospective cohort study.
This retrospective cohort study included patients who received neoadjuvant DCF followed by surgery for locally advanced ESCC between June 2014 and January 2020 at the National Cancer Center Hospital East.
Among a total of 210 patients, 45 patients (21.4%) achieved a pathological complete response. The 3-year disease-free survival (DFS) rate was significantly lower in patients with residual pathological disease than in those with a pathological complete response [53.5% 74.5%; hazard ratio (HR): 2.09, 95% confidence interval (CI): 1.16-3.77, = 0.01]. In patients with residual pathological disease ( = 165), multivariate analysis revealed that pathological node positivity (HR: 3.59, 95% CI: 1.92-6.71, < 0.01), supraclavicular lymph node metastasis (HR: 2.15, 95% CI: 1.19-3.90, = 0.01), and lymphovascular invasion (HR: 1.90, 95% CI: 1.14-3.17, = 0.02) were significantly associated with poor DFS.
In this largest-to-date cohort study, patients with residual pathological disease after neoadjuvant DCF followed by surgery for locally advanced ESCC had a poor prognosis. In these patients, pathological node positivity, including supraclavicular lymph node metastasis, and lymphovascular invasion were considered significant prognostic factors.
多西他赛、顺铂和5-氟尿嘧啶（DCF）联合化疗已被确立为局部晚期食管鳞状细胞癌（ESCC）的标准新辅助治疗方法之一。然而，对于接受新辅助DCF治疗后手术切除的局部晚期ESCC患者，若存在残留病理疾病，其预后因素鲜为人知，而这些患者是辅助使用纳武单抗的候选对象。
本研究旨在调查接受新辅助DCF化疗后手术切除的局部晚期ESCC患者，若存在残留病理疾病，其预后因素。
这是一项回顾性队列研究。
这项回顾性队列研究纳入了2014年6月至2020年1月在国立癌症中心东医院接受新辅助DCF治疗后手术切除的局部晚期ESCC患者。
在总共210例患者中，45例（21.4%）达到病理完全缓解。残留病理疾病患者的3年无病生存率（DFS）显著低于病理完全缓解患者[53.5%对74.5%；风险比（HR）：2.09，95%置信区间（CI）：1.16 - 3.77，P = 0.01]。在残留病理疾病患者（n = 165）中，多因素分析显示，病理淋巴结阳性（HR：3.59，95%CI：1.92 - 6.71，P < 0.01）、锁骨上淋巴结转移（HR：2.15，95%CI：1.19 - 3.90，P = 0.01）和淋巴管浸润（HR：1.90，95%CI：1.14 - 3.17，P = 0.02）与DFS不良显著相关。
在这项迄今为止规模最大的队列研究中，接受新辅助DCF治疗后手术切除的局部晚期ESCC患者，若存在残留病理疾病，预后较差。在这些患者中，包括锁骨上淋巴结转移在内的病理淋巴结阳性和淋巴管浸润被认为是重要的预后因素。
