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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)
AbstractObjective 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.
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.
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2018, Vol. 27 
