Factors Predicting Effectiveness of Neoadjuvant Therapy for Esophageal Squamous Cell Carcinoma

Abstract

The aim of the study was to elucidate pretreatment factors that can predict the outcome of neoadjuvant chemoradiotherapy or chemotherapy (NAC(R)T) and help us choose treatment strategies appropriate for individual patients.Few studies have investigated whether clinical data obtainable before the treatment can predict the efficacy of NAC(R)T.Of 1540 patients treated for esophageal squamous cell carcinoma (ESCC) at our department between January 2000 and June 2014, those who underwent surgical resection of cStage II or more advanced ESCC after NAC(R)T (113 NACRT and 146 NACT patients) were enrolled in this study. Information all available before the treatment was analyzed to extract factors that can predict the effectiveness of NAC(R)T. NAC(R)T was considered effective when Grade 2 or greater treatment efficacy was achieved based on the histological grading system.NACRT was effective in 51 (45%) of 113 patients. The analysis of 35 pretreatment factors showed that female sex (hazard ratio [HR] = 3.650; 1.181–11.236), absence of dyslipidemia (HR = 3.284; 1.341–8.041), and histologically poorly differentiated tumor (HR = 2.431; 1.052–5.619) were factors predicting NACRT effectiveness. On the other hand, NACT was effective in 21 (14%) of 146 patients. The analysis of pretreatment factors showed that absence of dyslipidemia (HR = 10.204; 1.302–83.33) and therapy with docetaxel, cisplatin, and 5-fluorouracil (HR = 2.097; 1.027–4.280) were factors predicting NACT effectiveness.The findings of this study investigating factors that could predict the outcome of NAC(R)T suggest that the prevalence of dyslipidemia influences the outcome of NAC(R)T for ESCC.

RAD51 Expression as a Biomarker to Predict Efficacy of Preoperative Therapy and Survival for Esophageal Squamous Cell Carcinoma

“…Consistent results were observed in the CF, DCF, and CRT subgroups. Similar results have been reported in previous studies investigating the relationship between response to preoperative therapy and survival in patients with esophageal cancer 6,23,24 . Our results, obtained from a large cohort, indicated that a heterogenous response to preoperative therapy definitively affected the prognostic outcome, and emphasized the need for molecular markers that predict the effect of preoperative therapy.…”

“…preoperative therapy and survival in patients with esophageal cancer. 6,23,24 Our results, obtained from a large cohort, indicated that a heterogenous response to preoperative therapy definitively affected the prognostic outcome, and emphasized the need for molecular markers that predict the effect of preoperative therapy. We collected data from patients who received CF, DCF, or CRT as preoperative therapy for ESCC.…”

Histological Differentiation Grade and Surgery Affects Short-Term Mortality in Esophageal Squamous Cell Carcinoma Patients

“…Further, poorly differentiated ESCC may have a differential response to CCRT. Since radiation sensitivity is high among undifferentiated cells that exhibit high mitotic activity and stay in the active developmental stage [33], poorly differentiated ESCC are more susceptible to radiation [12]. In contrast, tumor cells tend to be poorly differentiated under hypoxic conditions, which makes cells less vulnerable to radiation and chemotherapy via HIF activation [28,30,34,35].…”

“…In locally advanced ESCC patients undergoing concurrent chemoradiotherapy (CCRT), those with a poorly differentiated histology appeared to have higher local failure rates [11]. Conversely, some reports showed that poorly differentiated ESCC patients had a better response to neoadjuvant CCRT [12] and bene ted from postoperative CCRT with regard to controlling local recurrence and distant metastases [13]. Hence, it is worthwhile to examine the possible differential effects of histological grade on short-term survival outcome when considering therapeutic strategies for ESCC.…”

Metabolic Rather than Pathological Response to Preoperative Chemoradiotherapy Is a Stronger Predictor of Survival in cStage IIB-IV Esophageal Cancer

“…Moreover, according to Schneider et al (11) and Okumura et al (12) prognosis was significantly better among patients with shrunken tumors or with tumors classified as pN0. Furthermore, Ohkura et al recently reported that survival rates were increased when there was down-staging due to tumor shrinkage and grade 2 or greater treatment efficacy based on the histological grading system (13). These studies reported that pathological response was a useful predictor for survival outcome, but these were for postoperative factors and therefore not prescriptive.…”