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Published on: February 12, 2017
Clinical outcomes of esophageal squamous cell carcinoma with pathological complete response after neoadjuvant
Xiaofeng Duan1, Zhengjun Li2, Ruizhen Wang2
1Department of Minimally Invasive Esophageal Surgery, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tiyuanbei, Huanhuxi Rd., Hexi District, Tianjin, 300060, China. xduan@tmu.edu.cn.
Background:
Neoadjuvant chemoradiotherapy (NCRT) followed by surgery is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Pathological complete response (pCR) is a key prognostic indicator, yet clinical outcomes and recurrence patterns in ESCC patients achieving pCR warrant further investigation.
Methods:
We retrospectively analyzed patients with cT2-4aN0-3 ESCC who underwent NCRT followed by esophagectomy between 2014 and 2022. Patients were stratified into pCR (ypT0N0) and non-pCR groups. Survival and recurrence outcomes were assessed using Kaplan-Meier and Cox regression analyses.
Results:
Among 136 patients (mean age 59.1 ± 7.2 years, 90.4% male), 39 (28.7%) achieved pCR. With a median follow-up of 30 months, the 5-year overall survival (OS) rate was 81.6% in the pCR group versus 39.2% in the non-pCR group (p < 0.001), and the 5-year disease-free survival (DFS) rate was 70.1 vs. 31.0%, respectively (p < 0.001). Recurrence occurred in 26.3% of pCR patients, significantly lower than the 65.9% in non-pCR patients (p < 0.001). Multivariate analysis identified pCR as an independent favorable prognostic factor for OS (HR 0.351, 95% CI 0.121-0.980, p = 0.040) and ypTNM stage for both OS (HR 1.516, 95% CI 1.114-2.063, p = 0.006) and DFS (HR 1.733, 95% CI 1.381-2.174, p = 0.001).
Conclusion:
Achieving pCR after NCRT is associated with significantly improved survival in ESCC patients. However, recurrence still occurs in a notable proportion of pCR patients, underscoring the need for further risk stratification and exploration of adjuvant strategies even in this favorable response group.
