Yoko Hiraki1, Yutaka Kimura2, Motohiro Imano1, Hiroaki Kato1, Mitsuru Iwama1, Osamu Shiraishi1, Atsushi Yasuda1, Masayuki Shinkai1, Tomoki Makino3, Masaaki Motoori4, Makoto Yamasaki3, Hiroshi Miyata5, Takao Satou6, Taroh Satoh7, Hiroshi Furukawa1, Masahiko Yano5, Yuichiro Doki3, Takushi Yasuda1. 1. Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. 2. Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. you_kimura@aol.com. 3. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan. 4. Department of Surgery, Osaka General Medical Center, Osaka, Japan. 5. Department of Surgery, Osaka International Cancer Institute, Osaka, Japan. 6. Department of Diagnostic Pathology, Kindai University Hospital, Osaka-Sayama, Japan. 7. Department of Frontier Science for Cancer and Chemotherapy, Graduate School of Medicine, Osaka University, Suita, Japan.
Abstract
PURPOSE: The purpose of this study is to determine the clinical significance of micrometastases after neoadjuvant chemotherapy (NAC) and the difference in controlling micrometastases using different NAC regimens in resectable advanced esophageal squamous cell carcinoma (ESCC). METHODS: We analyzed patients with ESCC who underwent esophagectomy with lymph node dissection after NAC with Adriamycin + cisplatin + 5-fluorouracil (ACF) or docetaxel + cisplatin + 5-fluorouracil (DCF). Micrometastasis was defined as a single isolated cancer cell or cluster of cancer cells on the cervical, recurrent nerve, or abdominal LNs as shown by immunohistochemical staining with anti-cytokeratin antibody (AE1/AE3). The associations between micrometastases, recurrence, prognosis, and regimen differences were investigated. RESULTS: One hundred and one cases (ACF group: 51 cases; DCF group: 50 cases) were analyzed. Micrometastases occurred in 24 patients (23.8%): 17/51 (33.3%) in the ACF group and 7/50 (13.5%) in the DCF group (p = 0.0403). The 5-year recurrence-free survival (RFS) rates for patients without (n = 77) and with (n = 24) micrometastases were 62 and 32%, respectively, (hazard ratio, 2.158; 95% confidence interval, 1.170-3.980; stratified log-rank test, p = 0.0115). A multivariate analysis showed that stage pN1 or higher and micrometastases were significant risk factors affecting RFS. CONCLUSION: In resectable advanced ESCC, controlling micrometastases in the LNs after NAC varied by regimen and may be associated with preventing ESCC recurrence.
PURPOSE: The purpose of this study is to determine the clinical significance of micrometastases after neoadjuvant chemotherapy (NAC) and the difference in controlling micrometastases using different NAC regimens in resectable advanced esophageal squamous cell carcinoma (ESCC). METHODS: We analyzed patients with ESCC who underwent esophagectomy with lymph node dissection after NAC with Adriamycin + cisplatin + 5-fluorouracil (ACF) or docetaxel + cisplatin + 5-fluorouracil (DCF). Micrometastasis was defined as a single isolated cancer cell or cluster of cancer cells on the cervical, recurrent nerve, or abdominal LNs as shown by immunohistochemical staining with anti-cytokeratin antibody (AE1/AE3). The associations between micrometastases, recurrence, prognosis, and regimen differences were investigated. RESULTS: One hundred and one cases (ACF group: 51 cases; DCF group: 50 cases) were analyzed. Micrometastases occurred in 24 patients (23.8%): 17/51 (33.3%) in the ACF group and 7/50 (13.5%) in the DCF group (p = 0.0403). The 5-year recurrence-free survival (RFS) rates for patients without (n = 77) and with (n = 24) micrometastases were 62 and 32%, respectively, (hazard ratio, 2.158; 95% confidence interval, 1.170-3.980; stratified log-rank test, p = 0.0115). A multivariate analysis showed that stage pN1 or higher and micrometastases were significant risk factors affecting RFS. CONCLUSION: In resectable advanced ESCC, controlling micrometastases in the LNs after NAC varied by regimen and may be associated with preventing ESCC recurrence.
Authors: P van Hagen; M C C M Hulshof; J J B van Lanschot; E W Steyerberg; M I van Berge Henegouwen; B P L Wijnhoven; D J Richel; G A P Nieuwenhuijzen; G A P Hospers; J J Bonenkamp; M A Cuesta; R J B Blaisse; O R C Busch; F J W ten Kate; G-J Creemers; C J A Punt; J T M Plukker; H M W Verheul; E J Spillenaar Bilgen; H van Dekken; M J C van der Sangen; T Rozema; K Biermann; J C Beukema; A H M Piet; C M van Rij; J G Reinders; H W Tilanus; A van der Gaast Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245
Authors: D P Kelsen; R Ginsberg; T F Pajak; D G Sheahan; L Gunderson; J Mortimer; N Estes; D G Haller; J Ajani; W Kocha; B D Minsky; J A Roth Journal: N Engl J Med Date: 1998-12-31 Impact factor: 91.245
Authors: Katrin M Sjoquist; Bryan H Burmeister; B Mark Smithers; John R Zalcberg; R John Simes; Andrew Barbour; Val Gebski Journal: Lancet Oncol Date: 2011-06-16 Impact factor: 41.316