Risk Factors for Residual Tumors in Surgery Following Neoadjuvant Chemotherapy for Esophageal Cancer

Abstract

Neoadjuvant chemotherapy (NAC) followed by esophagectomy is considered the standard treatment for resectable advanced esophageal squamous cell carcinoma in Japan. The purpose of this study was to identify the risk factors for residual tumors in surgery following NAC. We herein described risk factors for residual tumors in surgery following neoadjuvant chemotherapy for thoracic esophageal cancer. We reviewed the medical records of patients in our institution selected by using the following criteria: (1) pathologically confirmed squamous cell carcinoma or adenosquamous carcinoma before treatment; (2) cT1 to cT3; and (3) receipt of thoracotomy performed between 2007 and 2010 with the intention of curative resection after NAC composed of 5-fluorouracil plus cisplatin. The patients were divided into the complete resection group (R0 group), and the macroscopic or microscopic residual tumor group [R(+) group]. A total of 88 patients were eligible (R0, 70 patients; R1, 9 patients; R2, 7 patients; and not resected, 2 patients). There were more cT3 cancers and clinical node-positive diseases in the R(+) group than in the R0 group. Multivariate analysis identified tumor depth (cT3) and tumor location (above the carina) as risk factors for residual tumor. Patients with cT3 esophageal cancer above the carina have a high risk of residual tumor in esophagectomy following NAC. In these patients, more intensive preoperative therapy will be required.