Outcomes of Preoperative Chemotherapy with Docetaxel, Cisplatin, and 5-Fluorouracil Followed by Esophagectomy in Patients with Resectable Node-Positive Esophageal Cancer

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• 作者：Masayuki Watanabe MD ; PhD ; FACS (1)
  Yoshifumi Baba MD ; PhD (1)
  Naoya Yoshida MD ; PhD ; FACS (1)
  Takatsugu Ishimoto MD ; PhD (1)
  Yohei Nagai MD ; PhD (1)
  Masaaki Iwatsuki MD ; PhD (1)
  Shiro Iwagami MD ; PhD (1)
  Hideo Baba MD ; PhD ; FACS (1)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2014
• 出版时间：September 2014
• 年：2014
• 卷：21
• 期：9
• 页码：2838-2844
• 全文大小：276 KB
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• 作者单位：Masayuki Watanabe MD, PhD, FACS (1)
  Yoshifumi Baba MD, PhD (1)
  Naoya Yoshida MD, PhD, FACS (1)
  Takatsugu Ishimoto MD, PhD (1)
  Yohei Nagai MD, PhD (1)
  Masaaki Iwatsuki MD, PhD (1)
  Shiro Iwagami MD, PhD (1)
  Hideo Baba MD, PhD, FACS (1)
  
  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
  
• ISSN：1534-4681

文摘

Background There is a consensus that neoadjuvant therapy is an essential component of treatment for resectable advanced esophageal cancer. The aim of this study was to evaluate the efficacy of preoperative docetaxel/cisplatin/5-fluorouracil (DCF) followed by esophagectomy for patients with node-positive esophageal cancer using a prospective database. Methods Fifty-five consecutive patients with resectable node-positive esophageal cancer were treated with preoperative DCF between August 2008 and December 2010. Of these patients, 54 completed 2 courses of DCF, and 50 underwent esophagectomy after the planned chemotherapy. Clinical and pathologic responses to DCF were investigated, as was patient prognosis. Cox proportional hazard regression was used to determine factors that independently affected recurrence. Results Complete response, partial response, stable disease, and progressive disease were observed in 5, 24, 24, and 2 patients, respectively. Overall, the clinical response rate was 53?%. Pathologic complete response was achieved in 6 cases (12?%), and the overall pathologic response rate was 36?%. Downstaging was observed in 23 cases (46?%). Two-year overall and disease-free survival rates were 78 and 56?%, respectively. Multivariate analysis revealed that residual tumor [R1/2; hazard ratio (HR) 5.21, 95?% confidence interval (CI) 1.64-7.2], pathologic poor response (grade 1a; HR 3.08, 95?% CI 1.08-1.1), and ypN (M1Lym; HR 13.3, 95?% CI 2.06-16) were independent predictors of recurrence. Conclusions DCF has strong antitumor activity for esophageal cancer and may confer survival benefits when used as preoperative chemotherapy.