Recurrence risk stratification of esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy
Wang Xiushen, Zhang Xiqian, Xi Mian, Bu Shanshan
Department of Radiation Oncology,Zhengzhou University Affiliated Cancer Hospital,Zhengzhou 450008,China (Wang XS,Bu SS); Department of Radiation Oncology,Cancer Center of Sun Yat-Sen University,Guangzhou 510060,China (Xi M); Department of Radiation Oncology,First Afiliated Hospital of Zhengzhou University,Zhengzhou 450052,China (Zhang XQ)
Abstract：Objective To analyze the pattern of recurrence risk and investigate the association between pathological staging and recurrence risk in patients with esophageal squamous cell carcinoma (ESCC) treated with neoadjuvant chemoradiotherapy (CRT). Methods Clinical data of 174 patients with advanced thoracic ESCC treated with neoadjuvant CRT between 2002 and 2015 were retrospectively analyzed. All patients received preoperative concurrent platinum-based chemotherapy with conformal radiotherapy (40-50.4 Gy,conventional fractionation) combined with surgery. Kaplan-Meier method was utilized to analyze the survival,the log-rank test was conducted to compare the differences between groups,and the Cox regression model was used for multivariate analysis. Results The median follow-up time was 53.9 months. A total of 44.8% of patients achieved pathological complete response,and 59 patients (33.9%) recurred after neoadjuvent CRT.The postoperative recurrence rate was 22.2% for patients with pathological stage 0/I,38.7% for stage Ⅱ and 68.2% for stage Ⅲ(P=0.000).The 5-year recurrence-free survival (RFS) rates were 74.7%,61.4% and 20.9% for patients with pathological stage 0/Ⅰ,Ⅱ and Ⅲ,respectively (P=0.000).In total,20.5% of patients with pathological stage 0/I or Ⅱ recurred after postoperative 3 years,whereas all patients with pathological stage Ⅲ recurred within postoperative 2 years. Multivariate analysis demonstrated that age,clinical TNM staging,chemotherapy regimen,and pathological response after CRT were independent prognostic factors affecting the RFS (P=0.027,0.047,0.010,0.005). Conclusions Pathological stage is significantly correlated with the recurrence risk in ESCC patients after neoadjuvant CRT.Risk-based surveillance strategies can be defined according to different pathologial staging.
Wang Xiushen,Zhang Xiqian,Xi Mian et al. Recurrence risk stratification of esophageal squamous cell carcinoma after neoadjuvant chemoradiotherapy[J]. Chinese Journal of Radiation Oncology, 2018, 27(12): 1051-1055.
[1] Sjoquist KM,Burmeister BH,Smithers BM,et al. Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma:an updated meta-analysis[J].Lancet Oncol,2011,12(7):681-692.DOI:10.1016/S1470-2045(11)70142-5. [2] van Hagen P,Hulshof MC,van Lanschot JJ,et al. Preoperative chemoradiotherapy for esophageal or junctional cancer[J].N Engl J Med,2012,366(22):2074-2084.DOI:10.1056/NEJMoa1112088. [3] Shapiro J,van Lanschot JJB,Hulshof MCCM,et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS):long-term results of a randomised controlled trial[J].Lancet Oncol,2015,16(9):1090-1098.DOI:10.1016/S1470-2045(15)00040-6. [4] Oppedijk V,van der Gaast A,van Lanschot JJ,et al. Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials[J].J Clin Oncol,2014,32(5):385-391.DOI:10.1200/JCO.2013.51.2186. [5] van Hagen P,Wijnhoven BP,Nafteux P,et al. Recurrence pattern in patients with a pathologically complete response after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer[J].Br J Surg,2013,100(2):267-273.DOI:10.1002/bjs.8968. [6] Sudo K,Taketa T,Correa AM,et al. Locoregional failure rate after preoperative chemoradiation of esophageal adenocarcinoma and the outcomes of salvage strategies[J].J Clin Oncol,2013,31(34):4306-4310.DOI:10.1200/JCO.2013.51.7250. [7] Robb WB,Messager M,Dahan L,et al. Patterns of recurrence in early-stage oesophageal cancer after chemoradiotherapy and surgery compared with surgery alone[J].Br J Surg,2016,103(1):117-125.DOI:10.1002/bjs.9959. [8] Abate E,DeMeester SR,Zehetner J,et al. Recurrence after esophagectomy for adenocarcinoma:defining optimal follow-up intervals and testing[J].J Am Coll Surg,2010,210(4):428-435.DOI:10.1016/j.jamcollsurg.2010.01.006. [9] Xi M,Hallemeier CL,Merrell KW,et al. Recurrence risk stratification after preoperative chemoradiation of esophageal adenocarcinoma[J].Ann Surg,2018,268(2):289-295.DOI:10.1097/SLA.0000000000002352. [10] National comprehensive cancer network. NCCN clinical practice guidelines in oncology:V.1.2017[DB/OL][2018-01-05].http:www.nccn.org/patients. [11] Taketa T,Sudo K,Correa AM,et al. Post-chemoradiation surgical pathology stage can customize the surveillance strategy in patients with esophageal adenocarcinoma[J].J Natl Compr Canc Netw,2014,12(8):1139-1144. [12] Davies AR,Gossage JA,Zylstra J,et al. Tumor stage after neoadjuvant chemotherapy determines survival after surgery for adenocarcinoma of the esophagus and esophagogastric junction[J].J Clin Oncol,2014,32(27):2983-2990.DOI:10.1200/JCO.2014.55.9070. [13] Siewert JR,Ott K.Are squamous and adenocarcinomas of the esophagus the same disease?[J] Semin Radiat Oncol,2007,17(1):38-44.DOI:10.1016/j.semradonc.2006.09.007. [14] Steffen T,Dietrich D,Schnider A,et al. Recurrence patterns and long-term results after induction chemotherapy,chemoradiotherapy,and curative surgery in patients with locally advanced esophageal cancer[J].Ann Surg,2017,in press. DOI:10.1097/SLA.0000000000002435. [15] Madden NA,Higgins KA,Zaenger D,et al. Optimal neoadjuvant radiotherapy dose for esophageal cancer:an NCDB analysis of 41.4 Gy versus 50.4 Gy[J].Int J Radiat Oncol Biol Phys,2017,99(Suppl):e169-170. [16] Xi M,Lin SH.Recent advances in intensity modulated radiotherapy and proton therapy for esophageal cancer[J].Expert Rev Anticancer Ther,2017,17(7):635-646.DOI:10.1080/14737140.2017.1331130. [17] Lin SH,Wang L,Myles B,et al. Propensity score-based comparison of long-term outcomes with 3-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy for esophageal cancer[J].Int J Radiat Oncol Biol Phys,2012,84(5):1078-1085.DOI:10.1016/j.ijrobp.2012.02.015. [18] Liu SL,Yang H,Zhang P,et al. Neoadjuvant chemoradiotherapy with cisplatin plus vinorelbine versus cisplatin plus fluorouracil for esophageal squamous cell carcinoma:A matched case-control study[J].Radiother Oncol,2015,116(2):262-268.DOI:10.1016/j.radonc.2015.07.020. [19] Xi M,Xu C,Liao Z,et al. The impact of histology on recurrence patterns in esophageal cancer treated with definitive chemoradiotherapy[J].Radiother Oncol,2017,124(2):318-324.DOI:10.1016/j.radonc.2017.06.019. [20] Fu JH,Rong TH,Li XD,et al. Chemoradiotherapy followed by surgery in treatment of locally advanced esophageal carcinoma:a phase Ⅱ trial[J].Ai Zheng,2004,23(11 Suppl):1473-1476.
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