The Role of Adjuvant Chemotherapy after Neoadjuvant Chemoradiotherapy Followed by Surgery in Patients with Esophageal Squamous Cell Carcinoma
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Purpose This study aimed to investigate the efficacy of adjuvant chemotherapy after neoadjuvant chemoradiotherapy (CCRTx) followed by surgery in patients with esophageal squamous cell carcinoma (ESCC). Materials and Methods We retrospectively analyzed the data from 382 patients who received neoadjuvant CCRTx and esophagectomy for ESCC between 2003 and 2018. Results This study included 357 (93.4%) men, and the years median patient age was 63 (range, 40 to 84 years). Overall, 69 patients (18.1%) received adjuvant chemotherapy, whereas 313 patients (81.9%) did not. The median follow-up period was 28.07 months (interquartile range, 15.50 to 62.59). The 5-year overall survival (OS) and disease-free survival were 47.1% and 42.6%, respectively. Adjuvant chemotherapy did not improve OS in all patients, but subgroup analysis revealed that adjuvant chemotherapy improved the 5-year OS in patients with ypT+N+ (24.8% vs. 29.9%, p=0.048), whereas the survival benefit of adjuvant chemotherapy was not observed in patients with ypT0N0, ypT+N0, or ypT0N+. Multivariable analysis revealed that ypStage and adjuvant chemotherapy (hazard ratio, 0.601; p=0.046) were associated with OS in patients with ypT+N+. Freedom from distant metastasis was marginally different according to the adjuvant chemotherapy (48.3% vs. 41.3%, p=0.141). Conclusion Adjuvant chemotherapy after neoadjuvant therapy followed by surgery reduces the distant metastasis in ypT+N+ ESCC patients, thereby improving the OS. The consideration could be given to administration of adjuvant chemotherapy to ypT+N+ ESCC patients with tolerable conditions.
Abstract
Purpose This study aimed to investigate the efficacy of adjuvant chemotherapy after neoadjuvant chemoradiotherapy (CCRTx) followed by surgery in patients with esophageal squamous cell carcinoma (ESCC). Materials and Methods We retrospectively analyzed the data from 382 patients who received neoadjuvant CCRTx and esophagectomy for ESCC between 2003 and 2018. Results This study included 357 (93.4%) men, and the years median patient age was 63 (range, 40 to 84 years). Overall, 69 patients (18.1%) received adjuvant chemotherapy, whereas 313 patients (81.9%) did not. The median follow-up period was 28.07 months (interquartile range, 15.50 to 62.59). The 5-year overall survival (OS) and disease-free survival were 47.1% and 42.6%, respectively. Adjuvant chemotherapy did not improve OS in all patients, but subgroup analysis revealed that adjuvant chemotherapy improved the 5-year OS in patients with ypT+N+ (24.8% vs. 29.9%, p=0.048), whereas the survival benefit of adjuvant chemotherapy was not observed in patients with ypT0N0, ypT+N0, or ypT0N+. Multivariable analysis revealed that ypStage and adjuvant chemotherapy (hazard ratio, 0.601; p=0.046) were associated with OS in patients with ypT+N+. Freedom from distant metastasis was marginally different according to the adjuvant chemotherapy (48.3% vs. 41.3%, p=0.141). Conclusion Adjuvant chemotherapy after neoadjuvant therapy followed by surgery reduces the distant metastasis in ypT+N+ ESCC patients, thereby improving the OS. The consideration could be given to administration of adjuvant chemotherapy to ypT+N+ ESCC patients with tolerable conditions.
참고문헌 (14)
- Sung H, "Global cancer statistics 2020 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 71, pp.209~249 (2021)
- 박성용, "Esophageal Cancer in Korea: Epidemiology and Treatment Patterns", Journal of Chest Surgery, 54(6), pp.454~459 (2021), 대한심장혈관흉부외과학회[DOI]
- Mariette C, "Therapeutic strategies in oesophageal carcinoma : role of surgery and other modalities", Lancet Oncol, 8, pp.545~553 (2007)
- Rice TW, "Recommendations for neoadjuvant pathologic staging(ypTNM)of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC", UICC staging manuals, 2016, pp.29, 906~912
- Lordick F, "Oesophageal cancer : ESMO clinical practice guidelines for diagnosis, treatment and follow-up", Ann Oncol, 27, pp.v50~v57 (2016)
- Kitagawa Y, "Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society : part 2", Esophagus, 16, pp.25~43 (2019)
- Semenkovich TR, "Adjuvant therapy for node-positive esophageal cancer after induction and surgery : a multisite study", Ann Thorac Surg, 108, pp.828~836 (2019)
- Zhao Y, "Perioperative versus preoperative chemotherapy with surgery in patients with resectable squamous cell carcinoma of esophagus : a phase III randomized trial", J Thorac Oncol, 10, pp.1349~1356 (2015)
- Brescia AA, "Adjuvant therapy for positive nodes after induction therapy and resection of esophageal cancer", Ann Thorac Surg, 101, pp.200~208 (2016)
- Clavien PA, "The Clavien-Dindo classification of surgical complications : five-year experience", Ann Surg, 250, pp.187~196 (2009)
- Shah MA, "Treatment of locally advanced esophageal carcinoma : ASCO guideline", J Clin Oncol, 38, pp.2677~2694 (2020)
- Kelly RJ, "Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer", N Engl J Med, 384, pp.1191~1203 (2021)
- Little AG, "The Society of Thoracic Surgeons practice guidelines on the role of multimodality treatment for cancer of the esophagus and gastroesophageal junction", Ann Thorac Surg, 98, pp.1880~1885 (2014)
- Samson P, "Adjuvant chemotherapy for patients with pathologic node-positive esophageal cancer after induction chemotherapy is associated with improved survival", J Thorac Cardiovasc Surg, 156, pp.1725~1735 (2018)