Kurahashi Yasunori, Tomita Toshihiko, Okugawa Takuya, Kitajima Kazuhiro, Murakami Motoki, Kohno Shugo, Hojo Yudai, Nakao Eiichiro, Nakamura Tatsuro, Ishida Yoshinori, Shinzaki Shinichiro, Shinohara Hisashi
Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan.
Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Hyogo, Japan.
PLoS One. 2025 Aug 8;20(8):e0328835. doi: 10.1371/journal.pone.0328835. eCollection 2025.
Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin, and 5-fluorouracil (DCF) is highly effective for advanced esophageal squamous cell carcinoma, and patients with a good response sometimes desire to avoid surgery. The aim of this single-center, retrospective study was to predict the probability of residual tumors using a newly devised scoring system and identify conditions that may obviate the need for surgery. Between January 2017 and March 2024, 106 patients received NAC with DCF, followed by radical resection at our institution. After NAC, patients underwent multimodal assessments to correlate the evaluation parameters with residual tumors. A scoring system was developed by incorporating the parameters that exhibited significant differences. After calculating the scores for all patients, a receiver operating characteristic (ROC) curve was generated to determine the optimal cutoff value for predicting residual tumors. Eighteen patients achieved a pathological complete response, of whom 12 showed complete tumor disappearance, including lymph node metastases. The scoring system included the following seven parameters: endoscopic irregularity, elevation, and pink-color sign after iodine staining; identification of the main tumor, regional lymph nodes ≥5 mm in long diameter, presence of positive lymph node findings on computed tomography; and positive 18F-fluorodeoxyglucose uptake on positron emission tomography. The area under the ROC curve was 0.957, with a cutoff value of 3 for residual tumors. All patients with a score of 0 showed complete tumor disappearance. Our scoring system suggests that surgery might be safely omitted in patients with a score of 0. Comprehensive and flexible clinical decision-making is essential.
多西他赛、顺铂和5-氟尿嘧啶（DCF）新辅助化疗对晚期食管鳞状细胞癌疗效显著，部分反应良好的患者希望避免手术。本单中心回顾性研究旨在通过一种新设计的评分系统预测残留肿瘤的可能性，并确定可能无需手术的情况。2017年1月至2024年3月，106例患者在本院接受DCF新辅助化疗，随后行根治性切除术。新辅助化疗后，患者接受多模式评估，以将评估参数与残留肿瘤相关联。通过纳入显示出显著差异的参数开发了一种评分系统。计算所有患者的评分后，生成受试者操作特征（ROC）曲线以确定预测残留肿瘤的最佳临界值。18例患者达到病理完全缓解，其中12例肿瘤完全消失，包括淋巴结转移。评分系统包括以下七个参数：内镜下不规则、隆起及碘染色后粉红色征；确定主要肿瘤、长径≥5mm的区域淋巴结、计算机断层扫描显示阳性淋巴结表现；以及正电子发射断层扫描显示18F-氟脱氧葡萄糖摄取阳性。ROC曲线下面积为0.957，残留肿瘤的临界值为3分。所有评分为0分的患者肿瘤均完全消失。我们的评分系统表明，评分为0分的患者可能可以安全地省略手术。全面且灵活的临床决策至关重要。
