RT Journal Article
SR Electronic
T1 Early Recurrence and Cancer Death After Trimodal Therapy for Esophageal Squamous Cell Carcinoma
JF Anticancer Research
JO Anticancer Res
FD International Institute of Anticancer Research
SP 1433
OP 1440
DO 10.21873/anticanres.13259
VO 39
IS 3
A1 HAMAI, YOICHI
A1 EMI, MANABU
A1 IBUKI, YUTA
A1 MURAKAMI, YUJI
A1 NISHIBUCHI, IKUNO
A1 NAGATA, YASUSHI
A1 FURUKAWA, TAKAOKI
A1 KUROKAWA, TOMOAKI
A1 OHSAWA, MANATO
A1 OKADA, MORIHITO
YR 2019
UL http://ar.iiarjournals.org/content/39/3/1433.abstract
AB Background/Aim: Although locally advanced esophageal squamous cell carcinoma (ESCC) can be controlled and survival can be prolonged by neoadjuvant chemoradiotherapy (NCRT) followed by surgery (trimodal therapy), some patients still develop early recurrence and die of cancer even after such intensive therapy. The present study aimed to determine the factors associated with early recurrence and cancer death for patients with ESCC treated by trimodal therapy. Patients and Methods: We evaluated risk factors for recurrence within 6 months, as well as cancer death within 1 year based on data from 141 patients with ESCC who underwent NCRT followed by curative esophagectomy. Results: The carcinoembryonic antigen level before treatment, postoperative complications, pathology after neo-adjuvant therapy (ypT, ypN), lymphatic invasion, venous invasion and pathological response of the primary tumor were significant factors in a comparison of patients with and without early recurrence. Multivariate analysis subsequently selected ypN [ypN, 0/1 vs. 2/3; hazard ratio (HR)=4.13, 95% confidence interval (CI)=1.25-13.66; p=0.02] as an independent covariate for early recurrence. Postoperative complications, ypT, ypN, poorer tumor differentiation, lymphatic invasion and venous invasion were significant factors in a comparison of patients with and without early cancer death. Multivariate analysis subsequently selected postoperative complications of grade ≥3b (vs. <3b) defined according to the Clavien–Dindo classification (HR=5.9, 95% CI=1.53-23.47; p=0.01) and venous invasion (vs. without: HR=4.80, 95% CI=1.21-19.14; p=0.03) as independent covariates for early cancer death. Conclusion: Further reduction of postoperative complications are needed after NCRT for patients with ESCC. Meticulous surveillance and postoperative adjuvant therapy should be considered for patients with risk factors for early recurrence and cancer death.