AbstractObjective To evaluate the recurrence pattern and identify the risk factors of esophageal squamous cell carcinoma after neoadjuvant therapy combined with surgery.Methods Clinical data of 275 patients with thoracic esophageal squamous cell carcinoma treated with neoadjuvant therapy combined with surgery from December 2011 to December 2015 were retrospectively analyzed. The follow-up data of the enrolled patients were complete and analyzable. The recurrence pattern, recurrence time, recurrence location and influencing factors after neoadjuvant therapy in combination with surgery were analyzed. The recurrence rate was calculated by Kaplan-Meier method. The multivariate analysis was performed by Cox regression model. Results The median follow-up time was 32(3-84) months, and the median time of the first recurrence was 10.6(2.0-69.1) months. The 1-,2-and 3-year recurrence rates were 32.0%,45.1% and 52.3%, respectively. A total of 152 cases (55.3%) had recurrence. Among them,77 cases (50.6%) had local-regional recurrence (LRR),34 cases (23.4%) had distant metastasis (DM),33 cases (21.7%) had LRR+DM and 8 cases (6.0%) had recurrence in unknown site. Among the patients with LRR, lymph node recurrence was the most common (n=98,89.1%). For DM patients, lung metastasis (n=33,49.3%),liver metastasis (n=16,23.9%),bone metastasis (n=14,20.9%) and non-regional lymph node metastasis (n=14,20.9%) were commonly observed.The multivariate analysis showed that postoperative T stage (P=0.008), N stage (P<0.001) and the number of lymph node dissection (P<0.001) were the independent risk factors for recurrence after treatment.Conclusions The recurrence rate after neoadjuvant therapy remains relatively high for esophageal squamous cell carcinoma, and the regional lymph node is the most common site of recurrence. Postoperative pathological T staging, N staging and the number of lymph node dissection are the independent risk factors for recurrence after treatment.
Fund:National Natural Science Foundation of China (81372436);Special Funds for Science and Technology Research and Development of Henan Province (182106000062);Project of Tackling Key Problems in Medical Science and Technology of Henan Province (2018020502)
Corresponding Authors:
Ge Hong, Email:gehong666@126.com
Cite this article:
Fan Chengcheng,Feng Zhuo,Ge Hong et al. Analysis of recurrence pattern of neoadjuvant therapy combined with surgical treatment for esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(3): 179-183.
Fan Chengcheng,Feng Zhuo,Ge Hong et al. Analysis of recurrence pattern of neoadjuvant therapy combined with surgical treatment for esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(3): 179-183.
[1] Meredith KL,Weber JM,Turaga KK,et al. Pathologic response after neoadjuvant therapy is the major determinant of survival in patients with esophageal cancer[J]. Ann Surg Oncol,2010,17(4):1159-1167. DOI:10.1245/s10434-009-0862-1.
[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] 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.
[4] Yamashita K,Watanabe M,Mine S,et al. Patterns and outcomes of recurrent esophageal cancer after curative esophagectomy[J]. World J Surg,2017,41(9):2337-2344. DOI:10.1007/s00268-017-4024-5.
[5] Wu SG,Dai MM,He ZY,et al. Patterns of regional lymph node recurrence after radical surgery for thoracic esophageal squamous cell carcinoma[J]. Ann Thorac Surg,2016,101(2):551-557. DOI:10.1016/j.athoracsur.2015.08.057.
[6] Ninomiya I,Okamoto K,Tsukada T,et al. Recurrence patterns and risk factors following thoracoscopic esophagectomy with radical lymph node dissection for thoracic esophageal squamous cell carcinoma[J]. Mol Clin Oncol,2016,4(2):278-284. DOI:10.3892/mco.2015.688.
[7] Shaikh T,Zaki MA,Dominello MM,et al. Patterns and predictors of failure following tri-modality therapy for locally advanced esophageal cancer[J]. Acta Oncol, 2015,55(3):303-308. DOI:10.3109/0284186X.2015.1110252.
[8] Blackham AU,Sm HN,Schell MJ,et al. Recurrence patterns and associated factors of locoregional failure following neoadjuvant chemoradiation and surgery for esophageal cancer[J]. J Surg Oncol,2017,117(2):150-159. DOI:10.1002/jso.24808.
[9] 陈龙奇,胡春燕,张合林,等. 淋巴结清扫数目对进展期食管癌TNM分期和预后的影响[J]. 中华肿瘤杂志,2007,29(8):604-608.
Chen LQ,Hu CY,Zhang HL,et al. Impact of the number of dissected lymph node on TNM stage and prognosis in advanced esophagus carcinoma[J]. J Chin Oncol,2007,29(8):604-608.
[10] Peyre CG,Hagen JA,DeMeester SR,et al. Predicting systemic disease in patients with esophageal cancer after esophagectomy:a multinational study on the significance of the number of involved lymph nodes[J]. Ann Surg,2008,248(6):979-985. DOI:10.1097/SLA.0b013e3181904f3c.
[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. DOI:10.6004/jnccn.2014.0111.
[12] Zhou S,Liu S,Zhang L,et al. Recurrence risk based on pathologic stage after neoadjuvant chemoradiotherapy in esophageal squamous cell carcinoma:Implications for Risk-Based Postoperative surveillance strategies[J]. Ann Surg Oncol,2018,25(12):3639-3646. DOI:10.1245/s10434-018-6736-7.
[13] Burmeister BH,Thomas JM,Burmeister EA,et al. Is concurrent radiation therapy required in patients receiving preoperative chemotherapy for adenocarcinoma of the oesophagus? A randomised phase Ⅱ trial[J]. Eur J Cancer,2011,47(3):354-360. DOI:10.1016/j.ejca.2010.09.009.
[14] Klevebro F,Alexandersson DG,Wang N,et al. A randomized clinical trial of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy for cancer of the oesophagus or gastro-oesophageal junction[J]. Ann Oncol,2016,27(4):660. DOI:10.1093/annonc/mdw010.
[15] Hsu HY,Chao YK,Hsieh CH,et al. Postoperative adjuvant therapy improves survival in pathologic nonresponders after neoadjuvant chemoradiation for esophageal squamous cell carcinoma:a propensity-matched analysis[J]. Ann Thorac Surg,2016,102(5):1687-1693. DOI:10.1016/j.athoracsur.2016.05.026.
[16] Meguid RA,Hooker CM,Taylor JT,et al. Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer:does the pattern of recurrence differ for patients with complete response and those with partial or no response?[J]. J Thorac Cardiovas Surg,2009,138(6):1309-1317. DOI:10.1016/j.jtcvs.2009.07.069.
[17] 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,2017,269(1):83-87. DOI:10.1097/SLA.0000000000002435.
2020, Vol. 29 
