Postchemoradiotherapy Pathologic Stage Classified by the American Joint Committee on the Cancer Staging System Predicts Prognosis of Patients with Locally Advanced Esophageal Squamous Cell Carcinoma
Jhe-Cyuan Guo, Ta-Chen Huang, Chia-Chi Lin, Min-Shu Hsieh, Chin-Hao Chang, Pei-Ming Huang, Jang-Ming Lee, Feng-Ming Hsu, Jason Chia-Hsien Cheng, Hsiu-Po Wang, Kun-Huei Yeh, Ann-Lii Cheng, Chih-Hung Hsu, Jhe-Cyuan Guo, Ta-Chen Huang, Chia-Chi Lin, Min-Shu Hsieh, Chin-Hao Chang, Pei-Ming Huang, Jang-Ming Lee, Feng-Ming Hsu, Jason Chia-Hsien Cheng, Hsiu-Po Wang, Kun-Huei Yeh, Ann-Lii Cheng, Chih-Hung Hsu
Abstract
Introduction: To determine whether the postchemoradiotherapy (post-CRT) pathologic stage predicts the outcomes of patients with locally advanced esophageal squamous cell carcinoma (ESCC) undergoing preoperative CRT followed by surgery.
Methods: From three phase II trials of preoperative CRT for locally advanced ESCC, 140 patients were included. Preoperative CRT comprised twice weekly paclitaxel and cisplatin-based regimens and 40-Gy radiotherapy in 20 fractions. The post-CRT pathologic stage was classified according to the American Joint Committee on Cancer, 7th edition staging system. The prognostic effects of clinicopathologic factors were analyzed using Cox regression.
Results: With a median follow-up of 61.9 months, the median progression-free survival (PFS) and overall survival (OS) of the entire cohort were 24.5 and 30.9 months, respectively. The post-CRT pathologic stage was 0 in 34.5%, I in 12.9%, II in 29.3%, III in 13.6%, and ypT0N1-2 in 6.4% of the patients. The median PFS was 47.2, 25.9, 16.0, 9.4, and 15.1 months, and the median OS was 57.4, 34.1, 26.2, 14.1, and 17.6 months for patients with post-CRT pathologic stage 0, I, II, III, and ypT0N1-2, respectively. In multivariate analysis, performance status (p < 0.001), tumor location (p = 0.016), and extranodal extension (p = 0.024) were independent prognostic factors for PFS, whereas performance status (p < 0.001) and post-CRT pathologic stage (p = 0.027) were independent prognostic factors for OS.
Conclusions: The post-CRT pathologic stage classified by American Joint Committee on Cancer, 7th edition staging system predicted the survival of locally advanced ESCC patients who underwent preoperative paclitaxel and cisplatin-based CRT followed by esophagectomy.
Trial registration: ClinicalTrials.gov NCT00154804 NCT01034189 NCT01034332.
Source: PubMed