Some authors have suggested that the immunological response to postoperative infectious complications (ICs) enhances the viability of undetectable residual tumor cells after surgery, thereby inducing disease recurrence. We hypothesize that recurrence might not occur if neoadjuvant chemotherapy (NAC) treatment of micrometastases can prevent residual cancer cell growth. We evaluated whether or not NAC exerted prophylactic effects against the negative prognostic impact induced by postoperative ICs and assessed its interaction among subgroups of histological response.
We retrospectively examined 111 patients who received NAC followed by radical esophagectomy between January 2011 and September 2015. Risk factors for the recurrence-free survival (RFS) were examined by Cox proportional hazard analyses. Pathological responders to NAC were defined as those with a tumor disappearance of more than one-third of the initial tumor. Postoperative ICs were defined using the Clavien–Dindo classification.
A pathological response to NAC was observed in 54 (48.6 %) patients. Forty-five patients (40.5%) developed postoperative ICs. The 3-year RFS were 68.8% in the patients who developed ICs and 38.6% in the patients who did not developed ICs (p = 0.001). The multivariate analysis demonstrated that postoperative ICs were a significant independent risk factor for the RFS (hazard ratio [HR], 2.368; 95% confidence interval [CI], 1.256-4.465, p = 0.008). In the subset analysis, in responders, the 3-year RFS were 63.2% in the patients who developed ICs and 71.5% in the patients who did not developed ICs (p = 0.524). In non-responders, the 3-year RFS were 29.3% in the patients who developed ICs and 65.4% in the patients who did not developed ICs (p = 0.006). The multivariate analysis demonstrated that postoperative ICs were a significant independent risk factor for RFS in the non-responders (HR, 2.632; 95% CI, 1.072-6.467, p = 0.035) but not in the responders (HR, 1.480; 95% CI, 0.469-4.667, p = 0.503).
These results suggested that response to NAC can eliminate the poor prognosis induced by postoperative ICs in esophageal cancer patients.
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