Patients achieving pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC) have a favorable prognosis. However, about 20–30% of the patients still suffer recurrences, and there are few studies evaluating prognostic factors in these patients. This retrospective analysis was performed to identify the prognostic factors in ESCC patients with pCR after NCRT followed by surgery.
Among 234 patients with ESCC who were treated with NCRT followed by surgery between 2007 and 2014 at Asan Medical Center in South Korea, 108 patients who achieved pCR (n = 108, 46.2%) were included in this analysis. Clinical, pathologic, treatment, and laboratory factors including inflammation-based scores such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and modified Glasgow prognostic score (mGPS) were included in univariate and multivariate analysis using the Cox-proportional hazards model.
With the median follow-up duration of 84.5 months (range, 1.3–139.9), 10 patients (9.2%) had recurrent disease. The 5-year overall survival (OS) and relapse-free survival (RFS) rates were 71.9% and 71.5%, respectively. In multivariate analysis, advanced clinical T stage (T3/4 vs.1/2: HR = 2.7; 95% CI, 1.37–5.16; p = 0.004), higher post-NCRT PLR (≥167.4: HR = 2.0; 95% CI, 1.01–3.78; p = 0.048), and age ≥65 years (HR = 2.4; 95% CI, 1.25–4.71; p = 0.009) were independent poor prognostic factors for OS. Advanced clinical T stage (T3/4 vs.1/2: HR = 2.7; 95% CI, 1.31–5.65; p = 0.007), higher post-NCRT PLR (≥167.4: HR = 2.1; 95% CI, 1.00–4.20; p = 0.049), and age ≥65 years (HR = 2.1; 95% CI, 1.02–4.21; p = 0.044) were also significant adverse prognostic factors for RFS. The 5-year OS rates according to number of risk factors (0/1 vs. 2 vs. 3) were 84.9%, 59.1%, and 43.6%, respectively.
Post-NCRT PLR together with age and pretreatment clinical T stage might be useful in identifying patients with a poor prognosis even after achieving pCR with NCRT plus surgery.
Clinical trial identification
Legal entity responsible for the study
Asan Medical Center.
Has not received any funding.
All authors have declared no conflicts of interest.