| Background:Esophageal squamous cell carcinoma(ESCC)ranks high in incidence rate and mortality rate.Most patients are diagnosed with advanced stage and have poor prognosis.Neoadjuvant therapy combined with surgery has become the standard treatments for locally advanced ESCC.However,the optimal mode of neoadjuvant treatment for esophageal squamous cell carcinoma(ESCC)has not been well characterized.Purpose:Our study was aimed to compare neoadjuvant chemotherapy(NCT)with neoadjuvant chemoradiotherapy(NCRT)for patients with ESCC in terms of perioperative outcomes,pathological response and long-term survival.Methods:Data from ESCC patients receiving NCRT or NCT combined with esophagectomy between 2001 and 2018 from the National Cancer Center in China were retrospectively collected.Long-term survival,pathological response,and perioperative mortality and morbidity were compared between the NCRT and NCT groups.A Cox proportional hazards model,and subgroup analysis and propensity score matching(PSM)were used to minimize bias due to potential confounding.Results:Out of 344 eligible patients with ESCC in our study,93 patients were identified in each group by PSM.The complete pathologic response(pCR)rate in the NCRT group was markedly higher than that in the NCT group(before PSM:33.3%vs.5.8%;after PSM:37.6%vs.5.4%;both P<0.001).The rates of 30-day or 90-day mortality were comparable between the two groups,but the NCRT group had an increased postoperative hospital stay(P<0.001 before PSM and P=0.012 after PSM)and more postoperative complications(P<0.001 before PSM and P=0.026 after PSM),especially,anastomotic leaks(P=0.001 before PSM and P=0.013 after PSM).No significant differences in 5-year overall survival(OS)(P=0.369)or 5-year relapse-free survival(RFS)(P=0.527)was noted between unmatched groups,but the trend favored NCRT in the PSM groups(76.9%vs.59.3%;hazard ratio[HR]1.59;95%confidence interval[CI]0.90-2.82;P=0.110 for OS,and 58.6%vs.50.4%;HR 1.72;95%CI 0.98-3.02;P=0.059 for RFS).Multivariate analysis showed that only ypT and ypN stage were independent predictors of OS before and after PSM(both P<0.05).Conclusions:Compared to NCT,NCRT led to higher pathological response rates and more postoperative complications,without improving survival.Prospective head-to-head clinical trials to compare these two types of neoadjuvant therapies in ESCC are warranted.Background:Current strategies are insufficient to predict complete pathologic response(pCR)for esophageal squamous cell carcinomas(ESCCs)before treatment.Here,we aim to develop a novel long non-coding RNA(lncRNA)signature for pCR and outcome prediction of ESCCs through a multicenter analysis for a Chinese population.Methods:Differentially expressed lncRNAs(DELs)between pCRs and less than pCR(<pCR)in the pretreated cancer biopsies were identified from 28 cases in Guangzhou cohort and verified from 30 cases in Beijing discovery cohort.Then a prediction model was built through Fisher’s linear discriminant analysis(FLDA)of 67 cases in Beijing training cohort.Then an internal cohort and an integrated external cohort(Zhengzhou and Anyang cohorts)were used to validate the predictive accuracy.The prognostic value of this signature was also evaluated.Results:Twelve DELs were identified from Guangzhou cohort and six lncRNAs were verified.Then,a classifier of three lncRNAs(SCAT1,PRKAG2-AS1,and FLG-AS1)was established and achieved a high accuracy with an area under the receiver operating characteristic curve(AUC)of 0.952 in the training cohort,which was well validated in the internal validation cohort and external cohort with the AUCs of 0.856 and 0.817,respectively.Furthermore,the predictive score was identified as the only independent predictor for pCR.Patients with high discriminant score showed a significantly longer overall and relapse-free survival(P<0.05).Conclusions:We developed the first and applicable three-lncRNA signature of pCR and outcome prediction,which is robust and reproducible in multicenter cohorts for ESCCs with nCRT. |
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