Clinical Predictors of Neoadjuvant Chemotherapy Efficacy in Esophageal Squamous Cell Carcinoma

Esophageal squamous cell carcinoma (ESCC) is resistant to multidisciplinary treatments. Neoadjuvant chemotherapy (NAC) enhances outcomes but varies in effectiveness, highlighting the need for predictive markers. This study aimed to identify factors influencing the efficacy of NAC in treating ESCC and predict its efficacy.

We included 66 ESCC patients who underwent esophageal surgery at the Chiba University Hospital after receiving NAC with 5-fluorouracil and cisplatin between 2008 and 2021. We pathologically evaluated the chemotherapy response and classified it into low (Grades 0, 1a) and high (Grades 1b, 2, 3) sensitivity groups. We statistically analyzed clinical factors, blood tests, and predictors such as BMI, neutrophil percentage, and total protein.

Sixty-six ESCC patients, classified into low (54.5%) and high (45.5%) sensitivity groups based on their response to chemotherapy, were included. Higher BMI was linked to reduced sensitivity (p=0.033). Blood tests showed correlation between NAC sensitivity and eosinophils, total protein (TP), and prothrombin time international normalized ratio (PT-INR). Multivariate analysis identified BMI, neutrophil percentage, and TP as significant predictors. A scoring system (0-3) using BMI, TP, and neutrophil fraction correlated significantly with treatment response (p=0.002). Kaplan-Meier analysis indicated improved disease-specific survival (DSS) in responders, though not significantly (p=0.061).

Three factors -BMI, neutrophil fraction, and TP- were identified that significantly affect the efficacy of NAC in ESCC. These factors were used to develop a scoring system that correlates with treatment efficacy, offering potential utility in predicting the success of NAC in ESCC patients.