Yin-Kai Chao1, Hui-Shan Chen2, Bing-Yen Wang3, Po-Kuei Hsu4, Chia-Chuan Liu5, Shiao-Chi Wu6. 1. Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan. 2. Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan. 3. Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital and Institute of Medicine, Chung Shan Medical University, Chung, Taichung, Taiwan. 4. Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan. 5. Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan. 6. Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan scwu@ym.edu.tw chaoyk@gmail.com.
Abstract
OBJECTIVES: Few data are currently available on the factors associated with survival in oesophageal cancer patients who achieve pathological complete response (pCR) after chemoradiotherapy (CRT). Using a nationwide database, we investigated the predictors of survival in this patient group. METHODS: Data were retrieved from the Taiwan Cancer Registry to identify patients with oesophageal squamous cell carcinoma (OSCC) who achieved pCR after CRT followed by oesophagectomy between 2008 and 2013. The median number of dissected nodes (20) was used as the cut-off to classify the extent of lymph node dissection (LND). Tumour location was defined according to the seventh edition of the American Joint Committee on Cancer staging system. Cox proportional hazard regression analyses were used to identify factors associated with survival. RESULTS: Of the 1103 patients who underwent CRT followed by surgery, 319 (28.9%) achieved pCR. Thirty- and 90-day mortality rates were 3.5 and 4.7%, respectively. The 3-year overall survival rate was 55.9%. Multivariate Cox survival analysis identified age ≥55 years [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.07 to 2.78, P = 0.025], an LND number of <20 (HR: 1.62, 95% CI: 1.01 to 2.61, P = 0.047) and lesions located in the upper third (HR: 2.35, 95% CI: 1.18 to 4.65, P = 0.015) as adverse prognostic factors for survival in pCR patients. CONCLUSIONS: Patient age ≥55 years, upper third lesions and an LND number of <20 are adverse prognostic factors in OSCC patients who achieve pCR following CRT. High-risk patients should be strictly followed.
OBJECTIVES: Few data are currently available on the factors associated with survival in oesophageal cancerpatients who achieve pathological complete response (pCR) after chemoradiotherapy (CRT). Using a nationwide database, we investigated the predictors of survival in this patient group. METHODS: Data were retrieved from the Taiwan Cancer Registry to identify patients with oesophageal squamous cell carcinoma (OSCC) who achieved pCR after CRT followed by oesophagectomy between 2008 and 2013. The median number of dissected nodes (20) was used as the cut-off to classify the extent of lymph node dissection (LND). Tumour location was defined according to the seventh edition of the American Joint Committee on Cancer staging system. Cox proportional hazard regression analyses were used to identify factors associated with survival. RESULTS: Of the 1103 patients who underwent CRT followed by surgery, 319 (28.9%) achieved pCR. Thirty- and 90-day mortality rates were 3.5 and 4.7%, respectively. The 3-year overall survival rate was 55.9%. Multivariate Cox survival analysis identified age ≥55 years [hazard ratio (HR): 1.72, 95% confidence interval (CI): 1.07 to 2.78, P = 0.025], an LND number of <20 (HR: 1.62, 95% CI: 1.01 to 2.61, P = 0.047) and lesions located in the upper third (HR: 2.35, 95% CI: 1.18 to 4.65, P = 0.015) as adverse prognostic factors for survival in pCR patients. CONCLUSIONS:Patient age ≥55 years, upper third lesions and an LND number of <20 are adverse prognostic factors in OSCC patients who achieve pCR following CRT. High-risk patients should be strictly followed.