Only pathologic complete response to neoadjuvant chemotherapy improves significantly the long term survival of patients with resectable esophageal squamous cell carcinoma

Abstract

BACKGROUND Surgery is the standard treatment for patients with resectable esophageal carcinoma, but the long term prognosis of these patients is unsatisfactory. Some randomized trials of preoperative chemotherapy suggest that the prognosis of patients who respond may be improved. METHODS This randomized, controlled trial compared patients with clinically resectable esophageal epidermoid carcinoma who underwent surgery alone (Arm A) with those who received preoperative chemotherapy (Arm B). Overall survival and the prognostic impact of major response to chemotherapy were analyzed. Forty‐eight patients were enrolled in each arm. Chemotherapy consisted of two or three cycles of cisplatin (100 mg/m2 on Day 1) and 5‐ fluorouracil (1000 mg/m2 per day continuous infusion on Days 1–5). In both study arms, transthoracic esophagectomy plus two‐field lymphadenectomy was performed. The two groups were comparable in terms of patient characteristics. RESULTS Forty‐seven patients were evaluable in each arm. The curative resection rate was 74.4% (35 of 47 patients) in Arm A and 78.7% (37 of 47 patients) in Arm B. Treatment‐related mortality was 4.2% in both arms. The response rate to preoperative chemotherapy was 40% (19 of 47 patients), including 6 patients (12.8%) who achieved a pathologic complete responses. Overall survival was not improved significantly. The 19 patients in Arm B who responded to chemotherapy and underwent curative resection had significantly better 3‐year and 5‐year survival rates (74% and 60%, respectively) compared with both nonresponders (24% and 12%, respectively; P = 0.0002) and patients in Arm A who underwent complete resection (46% and 26%, respectively; P = 0.01): Patients who achieved a pathologic complete response (P = 0.01), but not those who achieved a partial response (P = 0.2), had significantly improved survival. CONCLUSIONS Patients with resectable esophageal carcinoma who underwent preoperative chemotherapy and obtained a pathologic complete response had a significantly improved long term survival. Major efforts should be undertaken to identify patients before neoadjuvant treatments who are likely to respond. Cancer 2001;91:2165–74. © 2001 American Cancer Society.

Phase II study of neoadjuvant therapy with nab-paclitaxel and cisplatin followed by surgery in patients with locally advanced esophageal squamous cell carcinoma

“…The correlation between down-staging and histological response to any preoperative therapy and prognosis has been reported previously in ESCC [7, 25]. This finding was in according with other studies indicating that down-staging with preoperative therapy could result in achieving a high tumor response and improving the complete resection rate and prolonging survival.…”

Neoadjuvant or adjuvant therapy for resectable esophageal cancer: a systematic review and meta-analysis

“…Of these, 30 were fully published reports [5,21-25,27-34,36,37,39,40,42-48,52,56-60], and four were available in abstract form only [35,41,51,53]. The four-arm trials by Fok et al [5] and Nygaard et al [24] contributed to multiple comparisons.…”

“…Seven randomized trials of preoperative chemotherapy and surgery versus surgery alone are presented in Table 4[24,32-35,37,48]. Of these seven RCTs, six were available as fully published reports, and one was available as an abstract only [35].…”

“…The Gastrointestinal Cancer DSG pooled the available data on preoperative chemotherapy with surgery versus surgery alone [24,32-34,37,48] (Figure 3). No significant difference in the risk of mortality at one year was detected (RR, 1.00; 95% CI, 0.83 to 1.19; p = 0.98).…”

Remnant lymph node metastases after neoadjuvant therapy and surgery in patients with pathologic T0 esophageal carcinoma impact on prognosis

“…[5] Patients obtained a pathologic complete response (pCR) had a significantly improved long-term survival compared with pathologic partial response patients. [6] Recently, Gabriel et al [7] reported that patients with clinically node-negative esophageal carcinoma benefited from neoadjuvant CRT, however, patients with clinically node-positive did not get overall survival (OS) benefit compared with surgery alone.…”