Predictors of pathological complete response to neoadjuvant chemoradiotherapy for esophageal squamous cell carcinoma

Abstract

BackgroundsIn this study, we evaluated the factors associated with a pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for esophageal squamous cell carcinoma (ESCC).MethodsPre-nCRT parameters in ESCC patients treated between 1999 and 2006 were analyzed to identify predictors of pCR. All patients received 5-fluorouracil/cisplatin-based chemotherapy and external beam radiation followed by scheduled esophagectomy. Variables were analyzed using univariate and multivariate analyses with pCR as the dependent variable. Estimated pCR rate was calculated with a regression model.ResultsFifty-nine (20.9%) of 282 patients achieved pCR. Univariate analysis identified four patient factors (age, smoking status, drinking history and hypertension), one pre-nCRT parameter (tumor length) as significant predictors of pCR (all P <0.05). On multivariate analysis, tumor length ≤3 cm (favorable, odds ratio (OR): 4.85, P = 0.001), patient age >55 years (favorable, OR: 1.95, P = 0.035), and being a non-smoker (favorable, OR: 3.6, P = 0.003) were independent predictors of pCR. The estimated pCR rates based on a logistic regression including those three predictors were 71%, 35 to approximately 58%, 19 to approximately 38%, and 12% for patients with 3, 2, 1 and 0 predictors, respectively.ConclusionAge, smoking habit and tumor length were important pCR predictors. These factors may be used to predict outcomes for ESCC patients receiving nCRT, to develop risk-adapted treatment strategies, and to select patients who could participate in trials on new therapies.

Pathological complete response in patients with esophageal cancer after the trimodality approach: The association with baseline variables and survival—The University of Texas MD Anderson Cancer Center experience

“…The pathCR rate was 24% (23% and 32% for patients with AC and SCC, respectively). These results are in accordance with published reports on this subject, in which the pathCR rate has ranged from 19% to 30%, with AC patients achieving a lower pathCR rate than SCC patients, for whom the pathCR rates are slightly higher (Table ). A recently published report by Chao et al from the Taiwan Cancer Registry showed a 28.9% pathCR rate among 1103 patients with esophageal SCC.…”

The Incremental Value of Subjective and Quantitative Assessment of 18F-FDG PET for the Prediction of Pathologic Complete Response to Preoperative Chemoradiotherapy in Esophageal Cancer

“…The reported influences of clinical parameters-including pretreatment EUS-based tumor length and T stage and posttreatment endoscopic biopsy-on the probability of pathCR in our study were in accordance with existing literature (5,40,41). The finding that induction chemotherapy before chemoradiotherapy was associated with a significantly higher rate of pathCR in the current series was in line with a recent phase II randomized trial at MDACC that did report a difference in pathCR rate in favor of induction chemotherapy (26% vs. 13%), but this difference was not statistically significant in that trial (P 5 0.094) (42).…”

A 17-molecule set as a predictor of complete response to neoadjuvant chemotherapy with docetaxel, cisplatin, and 5-fluorouracil in esophageal cancer

“…Several reports revealed the survival benefit in pCR cases after neoadjuvant therapy for esophageal cancer and suggested the necessity of a useful predictor of pCR [ 10 , 11 ]. Furthermore, studies have reported some examination methods and biomarkers to predict pCR after neoadjuvant therapy for esophageal cancer, although no predictors of pCR have been developed for clinical application in esophageal cancer [ 43 – 45 ]. A previous study found no significant differences in the oncological outcomes of clinical complete response (cCR) cases between a no treatment group and a radical surgery group after neoadjuvant chemoradiotherapy or radiotherapy for advanced esophageal cancer [ 46 ], and the data suggested a “watch and wait” policy for cases with cCR in order to avoid the morbidity associated with radical surgery.…”